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Home My WebLink AboutRutherford_Well Abandonment_20240119 • WELL ABANDONMENT RECORD For hitemal Use ONLY: ` This form can be used for single or multiple wells 1.Well Contractor Information: WELL ABANDONMENT DETAILS BRAN DO N' DOTY 7a.Number of wells being abandon Id: . 1 Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply wells ONLY with the same A - 4595 construction/abandonment,you cansubmttpnel form. 7b.Approximate volume of water rellmitinin in well(s): 1.0' tl NC Well Contractor Certification Number PP 1 i g (gal.) GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 1 : 2.Well Construction Permit#: List all applicable well construction permits(i.e.County,Slate,Variance,etc.)ifknown 7d.Amount of disinfectant used: 1 3.Well use(check well use): I Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets O Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout ;i 0 Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout r 0 Drill Cuttings ❑irrigation 0 Specialty Grout I 0 Gravel Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g) 0Monitoring ❑Recovery Injection Well: 7E For each material selected above,provide amount of materials used: , ❑Aquifer Recharge ❑Groundwater Remediation 5.25 GALLONS i ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑Stormwater Drainage - ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE HOLEPLUG ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) I F-7-wr 4as.r,Wcr1 ttwly 4.Date well(s)abandoned: 12/07/23 , JAN 1 9 2024 5a.Well location: i' CLIFFSIDE STEAM STATION I. iP;;;,_; ;n p 7:: r ►J:+ 8.Certification: L :;?:' Facility/Owner Name Facility ID#(ifapplicable) � !.l''` 573 DUKE POWER ROAD MOORESBORO 28114 "- 12/11/23 Physical Address,City,and Zip .Signature of Certified Well Contractor or Well Owner Date RUTHERFORD • By signing this form, I hereby certify that the well(s) was(were) abandoned in County Parcel Identification No.(PIN) accordance with ISA NCAC 02C.01B0'or 2C.0200 Well Construction Standards and that a copy of this record has been provided to the well owner. Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: {i (if well field,one le/long is sufficient) 9.Site diagram or additional well details: 35° 12' 59.03" 81°46' 09.22" • You may use the back of this page to provide additional well site details or well N W abandonment details. You may also attach additional pages if necessary. • 1 CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS ' Attach well construction record(s)if available. For multiple injection or non-water supply I wells ONLY with the sane construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well iD#: MW-1 OS abandonment to the following: • Division of Water Quality,Information Processing Unit, 6b.Total well depth: 33.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b. For Infection Wells: In addition to'sending the form to the address in I0a 6c.Borehole diameter: 2.0 (in.) above,also submit one copy of this form within 30 days of completion of well abandonment to the following: I. i Gd.Water level below ground surface 26.0 (ft.) Division of Water Quality,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 IOc. For Water Supply&Injection Wells: in addition to sending the form to 6e.Outer casing length(if known): . (ft.) the addresses) above, also submit'one copy of this form within 30 days of completion of well abandonment to',the county health department of the county where abandoned. I, 6f.inner casing/tubing length(if known): (ft.) . 6g.Screen length(if known): (ft.) Form GW-30 North Carolina Department Of Environment and Natural Resources-Division of Water Quality Revised March 2013 I I I , WELL ABANDONMENT RECORD For internal Use ONLY: 1, This form can be used for single or multiple wells I I 1.Well Contractor Information: WELL ABANDONMENT DETAILS BRANDON DOTY 7a.Number of wells being abandon ld: 1 Well Contractor Name(or well owner personally abandoning well on his/her property) For nudtiple injection or non-water supply wells ONLY with the some construction/abandonment,you can submit trc form. A - 4595 I. 2.0 7b.Approximate volume of water remaining in well(s): (gal.) NC Well Contractor Certification Number GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: I. 2.Well Construction Permit#: List all applicable well construction permits(.e.Comity,State,Variance,etc.)if known 7d.Amount of disinfectant used: 3.Well use(check well use): I' Water Supply Well: 7e.Sealing materials used(check all,Ithat apply): ❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ' ❑ Sand Cement Grout ! 0 Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings 0 Irrigation 0 Specialty Grout 0 Gravel Non-Water Supply Well: El Bentonite Slurry " 0 Other(explain under 7g) El Monitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation 6.5 GALLONS ❑Aquifer Storage and Recovery ❑Salinity Barrier 0 Aquifer Test ❑Stormwater Drainage il ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) OTracer ABANDONED VIA TREMIE PIPE WITH"BENTONITE HOLEPLUG ❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g) 4.Date well(s)abandoned: 12/07/23 Sst.Well location: ..,, b„Y;,L.-i+ai 4'L CLIFFSIDE STEAM STATION 8.Certification: �� 1 9 2024 Facility/Owner Name FacilityID#(ifapplicable) _� 573 DUKE POWER ROAD MOORESBORO 28114 '("(n!;7 ti a P,:-;.z., ,ng 1 11/23 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owl ry t .O13 Date I RUTHERFORD By signing this form, I hereby certify that the well(s) was(were) abandoned in County Parcel Identification No.(PIN) accordan'ee s/it/t 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards • and that a copy of this record has been provided to the well owner. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) 9.Site diagram or additional well details: 35° 12' 59.03" 81°46' 09.22" You may use the back of this page to provide additional well site details or well N W abandonment details. You may also attach additional pages if necessary. I, • CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS ;, Attach well construction record(s)if available. For multiple injection or non-water supply wells ONLY with the some construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: ' MW-10D abandonment to the following: iI Division of water Quality,Information Processing Unit, 39.0 1617 Mail Service Center,Raleigh,NC 27699-1617 6b.Total well depth: (ft.) 10b. For Infection Wells: In addition to sending the form to the address in l0a above,also submit one copy of this form within 30 days of completion of well 6c.Borehole diameter: 2'0 (in.) abandonment to the following: • 26.0 Division of Water Quality,Underground Injection Control Program, 6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636 10c. For Water Supply& Injection Wells: In addition to sending the form to 6e.Outer casing length(if known): '(ft.) the address(es) above; also submit one copy of this form within 30 days of completion of well abandonment to the county health department of the county where abandoned. 6f.Inner casing/tubing length(if known): (ft.) 6g.Screen length(if known): (ft.) Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013 . i• WELL ABANDONMENT RECORD For Internal Use ONLY: This form can be used for single or multiple wells 1.Well Contractor Information: WELL ABANDONMENT DETAILS BRANDON DOTY I 1 7a.Number of wells being-abandoned: Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-watyr supply wells ONLY with the sante construction'abandon,nent,you can submit one form. A -4595 4 I NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: . List all applicable well construction permits(t.e.County,State.Variance,etc.)if known td.Amount of disinfectant used: I; • 3.Well use(check well use): I Water Supply Well: - 7e.Sealing materials used(check all,that apply): DAgricultural ❑Municipal/Public 0 Neat Cement Grout ! 0 Bentonite Chips or Pellets 0 Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 1 0 Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings ❑Irrigation 0 Specialty Grout 0 Gravel Non-Water Supply Well: 0 Bentonite Slurry i. 0 Other(explain under 7g) , 0Monitoring ❑Recovery Injection Well: -- - 7E For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation 3.75 GALLONS 1 ❑Aquifer Storage and Recovery ❑Salinity Barrier i; ❑Aquifer Test ❑Stormwater Drainage ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) . ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE HOLEPLUG OGeothermal(Heating/Cooling Return) ❑Other(explain under 7g) _ 12/07/23 4.Date well(s)abandoned: JAN 1 D 2024 5a.Well location: :. CLIFFSIDE STEAM STATION r art:.;. :- 71 r"".==_--z 9 Lin, 8.Certification: D°;b'Ci=='''= Facility/Owner Name Facility ID#(if applicable) �, [✓ 573 DUKE POWER ROAD MOORESBORO 28114 . 12/11/23 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date I' RUTHERFORD By signing this form, I hereby certify that the well(s)was(were) abandoned in ' County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards and that a copy of this'record has been provided to the well owner. Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,()lie lat/long is sufficient) 9.Site diagram or additional well details: 35° 12' 59.24" 81°46' 09.41" You may use the back of this page to provide additional well site details or well N W abandonment details. You may also attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS ' Attach well construction record(s)if available. For multiple injection or non-water supply wells ONLY with the sante construction/abandonntent,you can subndt one fort. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: CLP-3 abandonment to the following: , Division of Water Quality,'Information Processing Unit, 6b.Total well depth: 23.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 I, lOb. For Injection Wells: In addition to sending the form to the address in 10a 2.0 above,also submit one copy of this form within 30 days of completion of well 6c.Borehole diameter: (in.) abandonment to the following: i. Ii 1 6d.Wafer level below ground surface: DRY (ft.) Division of Water Quality,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 I ' 1Oc.For Water Supply&Injection Wells: In addition to sending the form to Ge.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of completion of well abandonment to the county health department of the county where abandoned. Gf.Inner casing/tubing length(if known): (ft.) • 6g.Screen length(if known): (ft.) t ' 1 . Fonn GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 20 t3 .