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Home My WebLink AboutBertie_Well Abandonment_20240119 (6) WELL ABANDONMENT RECORD For Internal Use ONLY: I I 1.Well Contractor Information: WELL ABANDONMENT DETAILS Justin Radford 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-3d is needed. Indicate TOTAL NUMBER of 3270-A wells abandoned: NC Well Contractor Certification Number 7b.Approximate'volume of water remaining in well(s): 1'50 —(gal.) Geological Resources, Inc. FOR WATER SUPPLY WELLSbNLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: N/A List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown i 7d.Amount of disinfectant used: 3.Well use(check well use): i Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout i; ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) I,Concrete Grout ❑ Drill Cuttings DIrrigation ❑Specialty Grout ❑ Gravel Non-Water Supply Well: ❑ Bentonite Slurry �! ❑ Other(explain under 7g) MMonitoring ❑Recovery Injection Well: 7E For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation 20 lbs of Bentonite;, ❑Aquifer Storage and Recovery ❑Salinity Barrier 15 Ibs Concrete II ❑Aquifer Test ❑Stormwater Drainage ❑Experimental Technology El Subsidence Control 'I 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) []TracerPour 1, ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) „ --- 4.Date well(s)abandoned: 01/04/2024 JAN 2 9 2024 5a.Well location: lfiiJT;,=d`Pc^il r C. :` Myers Grocery and White's Cross Grocery 00-0-0000032961&00-0-0000025022 ` �,�I;F: • Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: 1901 & 1906 Wakelon Road, Colerain, NC ; 01/05/2024 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Bertie 6837-05-3544 By signing this form, I hereby cert that the wells) tivas (tivere) 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. 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: 36.136889 N76,86625 W You may use the back of this page to provide additional well site details or well abandonment details. You may also attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach well construction record(s)ifm,ailable. For nultiple injection or non-iratersupply wells ONLY with the same construction/abandonmem,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: M W-14 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 1 1.95 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: 2 (in,) above,also submit one copy of this form within 30 days of completion of well abandonment to the following: 6d.Water level below ground surface' 2.73 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 I� n/a lOc.For Water Supply&Infection Wells: In addition to sending the form to the 6e.Outer casing length(if known): (ft.) 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 i 6E Inner casing/tubing length(if known): abandoned. , 6g.Screen length(if known): 10 Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources i Revised 2-22-2016 1, Ili 1. I WELL ABANDONMENT RECORD For Internal Use ONLY: I 1.Well Contractor Information: WELL ABANDONMENT DETAILS Justin Radford 7a.For Geoprobe/DPT or Closed-loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of 3270-A wells abandoned: II I NC Well Contractor Certification Number 7b.Approximate volume of water retaining in well(s): 1 .15 gal.) r Geological Resources, Inc. FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: N/A List all applicable ivell construction permits(i.e.UIC,County,State,Variance,etc.)iftnouw 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout a Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) 19 Concrete Grout ❑ Drill Cuttings ❑Irri anon ❑ Specialty Grout ❑ Gravel Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g) RMonitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation 20 Ibs of Bentonite ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage 15 Ibs Concrete ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer Pour I ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) _ -- 01/04/2024 =�:. 4.Date well(s)abandoned: J A/i N 5a.Well location: Perrytown Service Center 00-0-0000022792 in Facility/Owner Name Facility ID#(if applicable) 8.Certification: G, '''L�Cz 526 Sand Hill Road, Colerain, NCB' 01/05/2024 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Berne 3801-1432-6555 By signing this fonn, I hereby certify that the ivell(s)was (were) abandoned in County Parcel Identification No.(PIN) accordance iOith 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: (ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details: 36.138194 N 76.803389 W You may use the back of this page to provide additional well site details or well abandonment details. You may also attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach ivellconstruclionrecord(s)ifavailable. Por multiple injection ornon-ivater supply wells ONLY with the same constructionlabandonment,you can submit one form. I�A,n, 10a. For All Wells: Submit this fonn within 30 days of completion of well 6a.Well ID#: 'V'V V-2 abandonment to the following: Division of Water Resources,Information Processing Unit, 15.72 1617 Mail Service Center,Raleigh,NC 27699-16.17 6b.Total well depth: (ft.) 10b.For Infection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: i 6d.Water level below ground surface: l 8.68 Division of Water Resources,Underground Injection Control Program, (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): n/a (ft.) 10c.For Water Supply&Infection Wells: In addition to sending the form to 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 6E Inner casing/tubing length(if known): 6 (ft.) abandoned. 6g.Screen length(if known): 10 (ft.) " I Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 i i WELL ABANDONMENT RECORD For Internal Use ONLY: r I L Well Contractor Information: WELL ABANDONMENT DETAILS Justin Radford 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW!30 is needed. Indicate TOTAL NUMBER of 3270—A wells abandoned: NC Well Contractor Certification Number 7b.Approximate volume of water ire i aiming in well(s): 1'00 (gal) Geological Resources, Inc. FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: I 1 q 2.Well Construction Permit#: /~ c List all applicable well construction permits rt.e.U/C,County,Stale,variance,etc.)ijknoivn li 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets ❑Geothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout I ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) a Concrete Grout ❑ Drill Cuttings ❑Irri ation ❑ Specialty Grout I! ❑ Gravel Non-Water Supply Well: ❑Bentonite Slurry ❑ Other(explain under 7g) RMonitoring ❑Recovery Injection Well: 7E For each material selected above,provide amount of materials used: r ❑Aquifer Recharge ❑GroundwaterRemediation 20 Ibs of Bentonitee ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage 15 Ibs Concrete ❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer Pour ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) a.Date well(s)abandoned: 01/04/2024 9 �G24 5a.Well location: Perrytown Service Center 00-0-0000022792 Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: 526 Sand Hill Road, Colerain, NC 01/05/2024 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Bertie 3801-1432-6555 By signing this form, I hereby certif�that the ivell(s) was (were) abandoned in County Parcel Identification No.(PIN) accordance ivilh 1 SA NCAC 02C.0100 a•2C.0200 Well Construction Standards t p 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has bee ,rovided to the ivell owner. (ifwell field,one hit/long is sufficient) 9.Site diagram or additional well details: 36.138194 N 76.803389 `,l, You may use the back of this page to provide additional well site details or well abandonment details. You may also attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS 1 Attach well construction record(s)ifavailable.For multiple injection ornon-waler supply wells ONLY with the same construction/abandonmem,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: M W-1 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 16.07 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Iniection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: (in.) 2 above,also submit one copy of this form within 30 days of completion of well abandonment to the following: , I 9.96 Division of Water Resources,Underground Injection Control Program, 6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636 i n/a 10c.For Water Supply&Injection Wells: In addition to sending the form to the 6e.Outer casing length(if known): (ft.) 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 6E Inner casing/tubing length(if known): 6 (ft.) abandoned. � i I 6g.Screen length(if known): 10 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-20.16 i WELL ABANDONMENT RECORD For Internal Use ONLY: 7 1.Well Contractor Information: WELL ABANDONMENT DETAILS Justin Radford 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-k is needed. Indicate TOTAL NUMBER of 3270—A wells abandoned: NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 1 .17 (gal.) GI Geological Resources, Inc. FOR WATER SUPPLY WELLS LY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: N/A I . List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown I 7d.Amount of disinfectant used: , 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Grout �! a Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) a Concrete Grout ❑ Drill Cuttings ❑Irri ation ❑ Specialty Grout ❑Gravel Non-Water Supply Well: ❑ Bentonite Slurry ; ❑ Other(explain under 7g) RMonitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation 20 Ibs of Bentonite ❑Aquifer Storage and Recovery ❑Salinity Barrier II 15 IbS Concrete ❑Aquifer Test ❑StormwaterDrainage ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer I ` ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Pour 01/04/2024 1' ; JAAJ 4.Date well(s)abandoned: 4 5a.Well location: v ,` Perrytown Service Center 00-0-0000022792 Facility/Owner Name Facility ID#(if applicable) 8.Certification: i 526 Sand Hill Road, Colerain, NC ;', 01/05/2024 Physical Address,City,and Zip Signature of Certified Well Contractor or Well!Owner Date Bertie 3801-1432-6555 1 ; By signing this form, I hereby certii#that the ivell(s) ivas (were) abandoned in County Parcel Identification No.(PIN) accordance iv"ith I'A 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: ii ' (ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details: 36.138194 N 76.803389 W You may use the back of this page to provide additional well site details or well abandonment details. You may also attach additional pages if necessary. CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach well construction record(s)ifavailable.For multiple itjectionornon-watersupplywells ONLY with the same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a•Well ID#: M W-3 abandonment to the following: �I Division of Water Resources,'Information Processing Unit, 61b.Total well depth 1.6.04 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition to sending the form to the address in 10a 2 above,also submit one copy of this form within 30 days of completion of well 6c.Borehole diameter: (in.) r abandonment to the following: I' 8.87 Division of Water Resources,Underground Injection Control Program, 6d.Water level below ground surface: (ft-) 1636 Mail Service Center;Raleigh,NC 27699-1636 �f fn/a 10c.For Water Supply&Injection Wells: In addition to sending the form to the 6e.Outer casing length(if known): (t.) address(es)above,also submit one copy of this form within 30 days of completion of well abandonment to the county,1 health department of the county where d d banone . i 6f.Inner casing/tubing length(if known): 6 (ft.) a , 6g.Screen length(if known): 10 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 1