New Hanover_Well Abandonment_20240306 (2)

WELL ABANDONMENT RECORD For Internal Use ONLY:
f
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott M. Werley 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 I GVI 30 is needed. Indicate TOTAL NUMBER of
3344-A wells abandoned:0- 1
NC Well Contractor Certification Number 7b.Approximate volume of wateri remaining in well(s): 0.65_(gal.)
ECS Southeast, LLC FOR WATER SUPPLY WELLS
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State, Variance,etc.)lfknown
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 19 Neat Cement Grout N Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout -- �, Clay
❑Industrial/Conmicrcial ❑Residential Water Supply(shared) ❑ Concrete Grout ��;---�. a L!i. trilttttings
❑Irri ation ❑ Specialty Grout MAN !r6 �O i Gravel
Non-Water Supply Well: ❑ Bentonite Slurry !1 Cher(explain under 7g)
CMonitoring El Recovery I �i'r t 1? . Sic
Injection Well: 7f.For each material selecte �ovc, rl Mt of materials used:
DAquifer Recharge ❑GroundwaterRemediation Neat cement —20 ibs
❑Aquifer Storage and Recovery ❑Salinity,Barrier
Bentonite "20 ibS
❑Aquifer Test ❑StotmwaterDrainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) []Tracer Bentonite - gravity feed from 12 to 5 ft bgs
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
Neat cement - pour from 5 ft bgs to surface
4.Date well(s)abandoned: 2/19/2024 ,
5a.Well location:
Richard Yang 00-0-0000035295
Facility/Owner Name Facility ID#(if applicable) C rtification:
7617 Carolina Beach Road 2/26/2024
Physical Address,City,and Zip Signature of Ccrtifie Well C itractor or Well Owner Date
New Hanover R08514-003-006-001
By signing this for I Irerehy certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C 0100 or 2C.0200 YYe!!Construction Standards
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell 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
Attach welicortstraction record(s)ifavailable. Formnitiple injection or•non-watersupply wells
ONLY with the same construction/abandonment,volt can submit one form.
I�lI 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: 'V'W-2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 12 (ft.) 1617 Mail ServiceICenter,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: 1
6d.Water level below ground surface: 7.98 (ft.) Division of Water Resources;Underground Injection Control Program,
1636 Mail ServiceCenter,Raleigh,NC 27699-1636
N/A 10c.For Water Supplv&Injection Wells: 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
6f.Inner casing/tubing length(if known): 2 (ft.) abandoned.
r
6g.Screen length(if known): 10 (ft.)
Fornr GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016