New Hanover_Well Abandonment_20240119 (8)

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAII S
Frank Beecher 7a.For Gcoprobc1DPT or Closed-I op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. indicate TOTAL NUMBER of
3225 A wells abandoned:- ( I ,t
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 8.4 3 (gal.)
AECOM Technical Services of North Carolina, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: N/A
LAI 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 _ e Bentonite Chips or Pellets
_ �D. r;n-�;..
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement 6roui '1^*`-° i n;- `-6 Ilry Clay
lam$ ;s 9.9
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout pp ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout JPi 1 9 2024 ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑,ether ex lain under 7
]Monitoring BRecovery (ri;3r+ it _- '
Injection Well: 7f.For each material scicc�cihatiove;provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite Chips-108 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑AquiterTest ❑StormwaterDrainage Water-1.0 gallons
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Slowly added bentonite chips and ensured there was no bridging
taking place. Then added water to hydrate bentonite chips.
4.Date well(q)abandoned: 10.1$.2023 The well was abandoned in accordance with 15A NCAC
5a.Well location: 02C .0113.
River Road Terminal/Kinder Morgan NONCD0001697
Facility/Owner Name Facility 1D#(if applicable) 8.Certification:
3340 River Road, Wilmington, 28412 - /- ;�` 12.16.2023
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Dale
New Hanover R06400-001-003-000
By signing this form, I hereby certify that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: '
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.1775479 N -77.9514812 `l You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(.$)ifavatlable.Formultipleinjeclionornon-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.Weil fD#• RW-4 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 17.8 00 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:4.0 pa) 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• 4.89 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center;Raleigh,NC 27699-1636
I, ,
6e.Outer casing length(if known): N/A N/A 10c.For Water Suooly&Iniection 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
611 Inner casing/tubing length(if known): N/A (ft.) abandoned.
6g.Screen length(if known): N/A 00
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016