Craven_Well Abandonment_20240403 (13)

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
William J. Miller 7a.Number of wells being;abandoned: N/A
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.
2927A
7b
NC Well Contractor Certification Number .Approximate volume jf water remaining in well(s): N/A (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: N/A
2.Well Construction Permit#: N/A
List all applicable well perms(i.e.County,State,Variance,Ljeclion,etc.)ifknou'n 7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ®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
❑Irrigation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
■Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite Pellets +/-5 lbs.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑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) All well materials removed from boring then backfilled
with bentonite pellets;for+/-0.5 feet below land surface.
4.Date well(s)abandoned: 12/19/2023
5a.Well Location:
PIE-PS
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
PIT 4, Havelock, NC 28532 January 22.2024
Physical Address,City,and Zip Signature of Certified WelI 6ntractor or Well Owner Date
CRAVEN 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 2C 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 lat/long is sufficient) 9.Site diagram or additional well details:
34.90753523 N -76.88961006 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 ifnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction records)ifavailable. For multiple injection or non-water supply
we/1 ONLYwilli thesame construction abandonment,you can submit oneform 10a.For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: P4-TW40 ��7 a=,: i'~w abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 14 (ft.) APR 0 v r10Z4' 1617 Mail Service Center,Raleigh,NC 27699-1617
Vglt 106.For Infection Wells: In addition to sending the form to the address in
�,, 10a above,also submit one copy of this form within 30 days of completion
6c.Borehole diameter: 2(in.) lydC`�3�a ofwell abandonment to the following:
6d.Water level below ground surface: 6 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
1
6e.Outer casing length(if known): N/A 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
6f.Inner casing/tubing length(if known): 4(ft.) county where abandoned.
6g.Screen length(if known): 10 (ft.)
\2023\223060-PIE-PS-CHERRY POINT-DELINEATION,WELL INSTALL ABANDONMENT AND INJECTION PROJECTSIPIT 4-PHASE II LNAPL DELINEATIOMFIELD ITEMS\223060_PIT4_CHERRYPOINT.GPJ
Adapted from NCDENR-DWR Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water ReIsources Revised August 2013

ENVIRONMENTAL,CIVIL
GEOTECHNICAL CA TL
I
N1mrQton,Raleigh.Wash!Von, t�
char WELL LOG 2 2306023106t0n Engineers and Scientists
Nlrrington,NC SHEET 1 OF 1
PROJECT NO.: 223060 STATE: NC COUNTY: CRAVEN LOCATION: Havelock
PROJECT: PIT 4 - PIT 5 area aboard MICAS Cherry LOGGED BY: Ashley Jessen WELL ID:
Point DRILLER: Austin Fowler p4-TW40
NORTHING: 428003 1 EASTING: 2632658 CREW: S} Chasteen
SYSTEM: NCSP NAD 83 USft DRILL MACHINE: Power Probe 1' T.O.C.ELEV.: 25.89
VERT.DATUM: NAVD88 USft METHOD: DPT 0 HOUR DTW: 11.8 TOTAL DEPTH: 16.0
START DATE: 12/01/23 END DATE: 12/01/23 124 HOUR'DTW: 12.7 1 WELL DEPTH: 14.0
DEPTH BLOW COUNT OVA LA8 0 o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) s G DEPTH DESCRIPTION ELEVATION DETAIL
1.0
0.0 Land Surface 24.9 0.0
0.0 (SM)-Dark brown,Silty,f.to med.SAND. No HCO -
Direct v
Push 14.4 M a.. -
v
2.0 22.9 = -
2.0
SAA
Direct Push 13.2 M
4.0 4.0_____________ ' __ ___--20.9 4.0
(SM)-Dark gray,Silty,v.f.to f.SAND. Slight HCO -
Direct Push 18.4 M -
6.0
6.0 18.9
SAA
Direct Push 148.4 M -
8.0
8.0 16.9 -
SAA o
Direct Push 187.E M Dd -
a
�r
10.0 10.0 14.9 _
SAA
Direct Push 102.9 M
12.0 1-2. ----------------------12.9 _
(SM)-Tan to gray,Silty,v.f.to f.SAND. Strong HCO
Direct Push 357.3 M -
14.0 14.0 10.9 14.0 -
SAA --
Direct 137.E M
Push
EL
16.0 16.0 8.9 16.0
BORING TERMINATED AT ELEVATION 8.9 ft
Stratigraphy color(LOG)represents inferred stratum
permeability as follows:
■ VERY LOW MM MEDIUM VERY HIGH
LOW Ej HIGH }
Native Backfill
i