Craven_Well Abandonment_20240212

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
i
Austin Fowler 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
wells abandoned:NA
4366A
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): NA (gal.)
CiATLI N Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name NA'
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknomw
7d.Amount of disinfectant used: �A
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 i ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑ltri ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
CMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets
❑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 Well backfilled with behtonite to ground surface.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1-15-2024
5a.Well location:
Cherry Point EAD NA
Facility/Owner Name Facility ID#(if applicable) 8. 4ti cation: )
North Carolina, 27533 � - .
Cherry Point, 4 2-6-2024
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Craven NA
By signing this form, I hereby certify that the wells)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.
56.Latitude and longitude in degrees/minutes/seconds or decimal degrees: b
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.902059 N -76.890661 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)ifavoilable.For multiple injection ornon-watersupplywells _
ONLY with the same construction abandonment,you can submit one form.
72GW26 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: abandonment to the following:
Division of Water Resources,Information Processing Unit,
66.Total well depth:
14.0 (ft.) 1617 Mail Service Center,i Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
66.Borehole diameter:
4.25 (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: 10.74 (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 Suvoly&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): 14.0 (ft.) abandoned.
6g.Scretin length(if known): 10.0 (ft.) v
i' E>
FEB 1 2 2024
Form GW-30 North Carolina Department ofEnviromnental Quality-Division of Water Resources Revised 2-22-2016
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i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Austin Fowler 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
4366A wells abandoned:NA I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): NA (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name NA'.
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used: NA
3.Well use(check well use):
Water Supply Well: 7e.Scaling materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout 19 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ; ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout 1 ❑Drill Cuttings
❑Irri ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets
❑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
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Well backfilled with Bentonite pellets to surface.
4.Date well(s)abandoned: 1-1 5-2024
Sa.Well location:
Cherry Point EAD NA
Facility/Owner Name Facility ID#(if applicable) 8.C_ cation:
Cherry Point, North Carolina, 28533 2-6-2024
Physical Address,City,and Zip Signature of Certified Well Contactor or Well Owner Date
Craven NA
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 1C.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 laVlong is sufficient) 9.Site diagram or additional well details:
34.902078 N -76.890638 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 wellconsiructionrecord(s)ifavailable.For multiple injection ornon-watersupplywells
ONLY with the some construction abandonment,you can submit one form.
72GW27 IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#' abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 38.0 (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. 8.25 (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:
8.4 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): 28.4 (ft.) 10c.For Water Supply&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
33.0 abandoned.
6E Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): 5'0 (ft) FEB 1 2 2024
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Reso_ycs sP�� .mc� �� Revised 2-22-2016
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