New Hanover_Well Abandonment_20240119 (5)

WELL ABANDONMENT RECORD For Internal Use ONLY: IJ
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Frank Beecher U
7a.For Ceoprobe/DPT or Closed- oop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/dcpth,only 1 GW136 is needed. Indicate TOTAL NUMBER of
3225-A wells abandoned:- I
�NC Well Contractor Certification Number 7b.Approximate volume of water I' I remaining in well(s): 8.60 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS'DNLY:
Company Name
7a Type of disinfectant used: N/A
2.Well Construction Permit#: N/A
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)iflmown
7d.Amount of disinfectant used:'N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout . `^ <*; .,c, q Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout '_���.+ irylsy
❑Industrial/Commercial ❑Residential Water Supply(shared) a Concrete Grout Drill Cuttings
JA�i 1 9 (���
❑lm ation ❑Specialty Grout � t`Gravel
Non-Water Supply Well: ❑ Rentonite Slurry0 r(explain under 7g)
❑Monitoring CRecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Portland-182.74 pounds Bentonite-7.61 pounds
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Water-13.65 gallons
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermat(Closed Loop) ❑Tracer Tremmie routed with a Portland Mix.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) 9
The well was abandoned in accordance with 15A NCAC
4.Date well(s)abandoned: 10.17.2023 02C .0113.
5a.Well location:
River Road Terminall Kinder Morgan NONCD0001697
Facility/Owner Name Facility rDff(if applicable) 8.Certification:
3340 River Road, Wilmington, 28412 a 12.16.2023
Physical Address,City,and Zip Signature orCertified Well Contractor or Well Owner Date
New Hanover R06400-001-003-000
By signing this form, 1 hereby certiyy that the tvell(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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lattlong is sufficient) 9.Site diagram or additional well details:
34.1775032 N -77.9531087 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(v)ifavailable.Formultiple injection ornon-watersupplywelty
ONLY with the same constructioWabandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well TD#• RW-8 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 22.5 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:4.0 (in) above, also submit one copy of this;,form within 30 days of completion of well
abandonment to the following:
1
9.33 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Ce i ter,Raleigh,NC 27699-1636
N/A 10c.For Water Suooly&Injection iWcus: 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
611 Inner casing/tubing length(if known): N/A (ft) abandoned.
6g.Screen length(if known): N/A
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
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