New Hanover_Well Abandonment_20240306

WELL ABANDONMENT RECORD For Internal Use ONLY:
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1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott M. Werley 7a.For Geoprobe/DPT or Closed I-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
3344-A wells abandoned:0-
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 0.65 (gal.)
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ECS Southeast, LLC FOR WATER SUPPLY WELLS ONLY:
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
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(ehgele all;•t�aLappl :
❑Agricultural ❑MunicipaVPublic a Neat Cement Groitt�. L. i i� entonite Chips or Pellets
❑Geothenmal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grou OAK 0 b 20Z4 ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout i ❑ Drill Cuttings
❑Irri ation ❑ Specialty GrgRgOrA;aU8;1 IIAOXavel
Non-Water Supply Well: ❑ Bentonite Slurry DWQ''BOG ❑ Other(explain under 7g)
IMMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat cement —20 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StontnvaterDrainage Bentonite 20 ibS
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer
7g.Provide a brief description of the abandonment procedure:❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Bentonite - gravity feed from 12 to 5 ft bgs
Neat cement - pour from 5 ft bgs to surface
4.Date well(s)abandoned: 2/19/2024 ,
Sa.Well location: i
Richard Yang 00-0-0000035295
Facility/Owner Name Facility ID#(ifapplicable) tifieation:
7617 Carolina Beach Road 2/26/2024
Physical Address,City,and Zip Signature of Certified We Co ractor'or Well Owner Date
New Hanover R08514-003-006-001
By signing this fornt, I hereby cer•tij�that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C'.0100 or 2C.0200 IVell Construction Standards
and that a copy ofthis record has'been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: f
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.4284419 N -78.0624517 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
Attachwellcmrsu•uctiarrecord(s)ifavailable.For•nurllipleinjectionornon-wa(ersnppl},wells
ONLY with the same consu•rtciion/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-1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 12 (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: 6.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
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6d.Water level below ground surface: 8.00 (ft) Division of Water Resources`Underground Injection Control Program,
1636 Mail Service iCenter,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft) 10c.For Water Suaaly&Infection Wells: In addition to sending the form to the
address(es)above,also submit onb copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 2 (ft.) abandoned.
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6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016