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Home My WebLink AboutCabarrus_Well Abandonment_20240205 V V J LL tiiiPtil 1.17 v1 I111L11 J. 1SL i•.kJ..IN For Internal Use ONLY: • 1.Well Co tractor Information: L WELL ABANDONMENT DETAILSI . ' 0Fo/ //za/Y� 7a.For Geoprobe/DPT or Closed Loop Geothermal Wells having the same Well niractorN a(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of ltr • `0 y . wells abandoned 3 f • . cc • NC Well Contractor Certification Number 7b.Approximate volume of water rimaining in well(s): / J 0 (gal.) Morgan Well & P u mp,r I N C FOR WATER SUPPLY WELLS,ONLY: • Company Name ;,_ ranulated chlorine 1 7c.Type of disinfectant used: g 2:Well Construction Permit#: CA � L� ... 2- / J List all applicable well construction permits(7.e.UIC,County,State,Variance,etc.)iflomown c/�"�iajj f� 7d.Amount of disinfectant used: %tt 4- / 0.2 3.Well use(check well use): . Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural oMuunicipal/Public 0 Neat Cement Grout Vffentonite Chips or Pellets 0 Geothermal(Heating/Cooling Supply) lieRegdential Water Supply(single) 0 Sand Cement Grout,_f--c-�--'.a 1 �; fi Clay ❑Industrial/Commercial ❑Residential Water Supply(shared). 0 Concrete Grout° �- `el' T, i- a^fl`�Di`•iill Cuttings ❑Irrigation 0 Specialty Grout .I-C D 0 5 20240 Gravel Non-Water Supply Well: 0 Bentonite Slimy 0 Other(explain under 7g) ❑Monitoring ❑Recovery ln[oriar its n Pr,:cw,9;; l G15 Injection Well: • • 7f.For each material sele ty kabosOaovide amount of materials used: ❑Aquifer Recharge 0 Groundwater Remediation qt5 3S , ✓f^y0 i s- ❑Aquifer Storage and Recovery ❑Salinity Barrier • / ❑Aquifer•Test OStormwater Drainage ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) 0 Tracer -�J ^� ❑Geothermal(Heating/Cooling Return)• ❑Other(explain under 7g) . 2 1 67A9 1 /1'/U l''r G/ %e'er �P/�1 L2 e r.Uf Casing *f/00.) role ,r ✓✓�;�<r%��-eC��c 4.Date welI(s)abandoned: i 9' <2� ✓ uLel1 //�t� �vil�//• ��ii/�� R�fel/el�S� Se.Well location: // 'r1 t4 , 4j 74/r'C. 'f COOPre 472 rine ,6w1,5/ Uit CtQ55 ✓ Facility/Owner Name Facility ID#(if applicable) 8.Certifilcati.1: ./q i ,b i scgyk Dr CCgCerd oZ3o 7 _%.i/ i� �''' i ___ Physical Address,City,add Zip •.,."-ofCertifi-,Well .n.. •r or.' ell Owner D e c'n L ffd s By signing,this orm here,' certify that the well(s) was (were) abandoned in County Parcel Identification No.(PIN) accordance with 15A 02C.0100 or•2C.0200 Well Construction Standards and that a copy of this record has bden 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: 5 ?(,3 N You may use the back of this page to provide additional well site details or well `7 o t�p�p 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 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#: abandonment to the following: i; Division of Water Resources,Information Processing Unit, 6b.Total well dep i// x (It.) 1617 Mail Service Center,Raleigh,NC 27699-1617 • 10b.For Injection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: 6 (in.) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: i, • 6d.Water Ievel below ground surface: G o' (ft.) Division of Water Resources,Underground Injection Control Program, • 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): (ft.) 10c.For Water Supply&Injection'Wells: In addition to sending the form to the address(es)above,also submit one copy of this form within 30 days of completion �J of well abandonment to the county health' department of the county where 6f.Inner casing/tubing length(if known): / (ft) abandoned. 6g.Screen length(if known): ,2 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources i Revised 2-22-2016 VV LLL 1- DAIN.L 1J1V 1VIL'1' 1 It 't.JI%JJ For Internal Use ONLY: I 1 . N . 1. Contractor Information: WELL ABANDONMENT DETAILS "'„ • �� 5 j ��Q"� 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 o,5 82_ .. wells abandoned:, • i NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.) Morgan Well & Pump, I N C • FOR WATER SUPPLY WELLS,ONLY: Company Name ranulated chlorine 1-' `� +7 7c.Type of disinfectant used: g 2.Well Construction Permit#: C_ha- W G.•2oz3-oo1gZ • List all applicable well construction permits(Le.UIC,County,State,Variance,etc).if known 02, • 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 t-,•rrtilit--{ `„ ,'v A jr, Bentonite Chips or Pellets ' ❑Geothermal(Heating/Cooling Supply) Residential Water Supply(single) ❑ Sand Cement Grout " crDry Clay • ❑Industrial/Commercial ❑Residential Water Supply(shared) O.Concrete Grout F t D 0 5 2024 0 Drill Cuttings ❑hrigation 0 Specialty Grout{ 0 Gravel Non-Water Supply Well: ❑Bentonite S un rrr" 1` r,r '''''''g Ytiltther(explain under 7g) ❑Monitoring ❑Recovery y I3t�r 1-"�� Injection Well: • 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge 0 Groundwater Remediation 1 S 19 Ck,5 fS" Q•eXIIIo ❑Aquifer Storage and Recovery ❑Salinity Barrier t• ❑Aquifer Test ❑Stormwater Drainage . ❑Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedduure:,,�Q1 ❑Geothermal(Closed Loop) 0 Tracer C U Ca•% `\1,N ip G LO LA) %- tie_ ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) ', . •1 2 V,^,r��~ � �1�I,O r',rtddiA ,i, -CL .f►i(fie,c� 4.Date well(s) {abandoned: 3 0 7 • w t.tv 'Q 1„�a S - 61- k) lK 5a.Well location: oil/ WY d coet-a• . . . CVA,Sc 4 cT (IC. . . . Facility/Owner Name Facility ID#(if applicable) 8.Certification: 7qu wyomimokrAdw Z cvmoelwc. Ds-so-2-aZy . Physical Address, �City,and Zip S 4 ignature of Certified Well Contractor or Well Owner Date C0Joo4 1 in S 2'7 By signing this form, I hereby cert j that the well(s) was(were) abandoned in County Parcel Identification No.(PIN) accordance with 15ANCAC 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: 3S• 4 Z3 3 / N 0 • 66 513 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)ifavatlable.For multiple injection or non-water supply wells ONLY with the same construction/abandonment,you can submit one form. I0a. For All Wells: Submit this.form within 30 days of completion of well 6a.Well 1D#: abandonment to the following: • • ` Division of Water Resources,Information Processing Unit, 6b.Total well depth `3 (ft) . 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Injection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: 6 (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: 3 d (ft.) Division of Water Resources,Underground Injection Control Program, • 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): /VA- (ft) • 10c.For Water Supply&Iniectiori Wells: In addition to sending the form to the address(es)above,also submit one copy of this form within 30 days of completion 6f.Inner casing/tubing length(if known): (ft) of well abandonment to the county;health department of the county where abandoned. . 6g.Screen length(if known): 1 ' A" (ft) • Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources • Revised 2-22-2016 '1' I. ,