Durham_Well Abandonment_20240318

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott M. W e rl ey 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on Iris/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
3344-A wells abandoned:—
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 2.0 (g,a1.)
ECS Southeast, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: 'A'V/„
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(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a 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)
RMonitoring ❑Recovery
Injection Well: 71. For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite — 25 I b s
❑Aquifer Storage and Recovery ❑Salinity Barrier --
❑AquiferTest ❑StormwaterDrainage Neat Cement 30 Ibs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Bentonite - gravity feed from 20' to 5' bgs
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
Neat Cement - pour from 5' bgs to surface
4.Date well(s)abandoned: 3/7/2024
5a.Well location:
Trinity Trust Partners N/A
Facility/Owner Name Facility ID#(ifapplicablc) A• r ' anon:
723 Rigsbee Ave., Durham 27701 2
Physical Address,City,and Zip Signature of Certified Well C cto r Well Owner Date
Durham 105118
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
1 i t%+ell field.one Iat/long is sufficient) 9.Site diagram or additional well details:
36 00' 13" N 78 54' 00" You may use the back of this paple^to Frmvide pdditien ;ygl(,tgite details or well
abandonment details. You may al. attac'6 Ud�i�Tj sYf�re�essary.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS AAc V
Attach well consina i m r rcord(.v)ifavailable. For multiple injection or non-water supply wells MAN K 1 8 2024
ONLY with the same constniction%abandonment,you can submit one form.
10a. For All Wells: Submit this fora. wiV 30 days of completion of well
6a.Well ID#: M W-1 abandonment to the following: �Lk*
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Infection 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: 7.44 (ft) Division of Water Resources,Underground Injection Control Program,
/�
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): N/A (ft) 10c.For Water Supply&Infection 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
6L Inner casing/tubing length(if known): 5 (ft.) abandoned.
6g.Screen length(if known): 15 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016