Onslow_Well Abandonment_20240306

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Lawrence D. Opper 7a.Number of wells being abandoned. 19
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply wells ONLY with the same
construction/abandonment,you can submit one form.
3322-A
7b.Approximate volume of water remaining in well(s): 0 (gal.)
NC Well Contractor Certification Number
Regional Probing Services FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown 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 Grout j El 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 ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation bentonite chips:1.6 Ibs/ft(20-56lbs/well)
❑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) ❑Tracet Filled/hydrated from bottom-up. Capped with concrete.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
MW-1(15'),MW-2R(20'),MW-3R(20'),MW-4(15'),MW-5(14'),MW-6(14'),MW-7(14')
4.Date well(s)abandoned: 1/19/2024 MW-8(14'),MW-9(13'),MW-10(15'),MW-12R(15'),MW-13R(15'),MW-14(15')
Sa.Well location:. MW-16R(15%MW-1 7(15'),MW-1 8(15'),T-2(35%T-3(35')-
Former Buck's Shell
Facility/Owner Name Facility IDk(ifapplicable) g•Certification: ^��D�
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100 Wilmington Street, Richlands Lawrence% pp ' "�-,,�, R / 2024
; .�,
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow By signing this form, I hereby certify that the w �a4, v, )'abned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Y e Cction 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:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.898984 - 77.546750 You may use the back of this page to provide additional well site details or well
N 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#: Monitoring Wells-see 7g abandonment to the following:
I
Division of Water Quality,Information Processing Unit,
66.Total well depth:
13-35 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
,
10b.For Iniection Wells: In addition to sending the form to the address in 10a
well I.D.=2.0 above,also submit one copy of this'form within 30 days of completion of well
6c.Borehole diameter: (►n•) abandonment to the following: i
approX 4 Division of Water-Quality,Underground Injection Control Program,...
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
loc.For Water Supply&Iniection Wells:,In addition to sending the form to
6e.Outer casing length(if known):'• (ft.) 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 abandoned.
6E Inner casing/tubing length(if known): (ft.)
fig.Screen Screen length(if known): (ft.)
I
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013