Craven_Well Abandonment_20240403 (15)

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 narltiple it jeclion or non-water supply wells ONLJ'with the same
corutnIction/abandonment,you can smbntit one form.
2927A
NC Well Contractor Certification Number 7b.Approximate volume of 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 permits(i.e.Cmnuy,State,Variance,Injection,etc.)ifknown 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 0Bentonite 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
El Experimental Technology El 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 then concrete to surface.
5a.Well Location:
PIE-PS
Facility/Owner Name Facility ID#(if applicable) g•Certification:
PIT 4,Havelock, NC 28532 --� `-� January 22.2024
Physical Address,City,and Zip Signature of Certified Well C--ontractor or Well Owner Date
CRAVEN By signing thisform 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:
34.90799403 Nt -76.88989805 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 well conviruction record(s)if available. For multiple injection or non-water supply
well ONLY with the same consintction abandonment,you can submit one form 10a.For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: P4-TW39 ;L.ti I . )� abandonment to the following:
APR a r, 2024 Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.)
1617 Mail Service Center,Raleigh,NC 27699-1617
1nk07a +E;ti tocn,O"rgy;q I�^ 10b.For Iniection Wells: In addition to sending the form to the address in
6c.Borehole diameter: 2 (in.) I Oa 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: 7.5 (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 10c.For Water Supply&Iniection 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): 5 (ft.) county where abandoned.
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6g.Screen length(if known): 10 (ft.)
\2023\223060-PIE-PS-CHERRY POINT-DELINEATION,WELL INSTALL ABANDONMENT AND INJECTION PROJECTS\PIT 4-PHASE R LNAPL DELINEATION\FIELD ITEMS\223060_PIT4_CHERRYPOINT.GPJ
Adapted from NCDENR-DWR Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013

ENVIRONMENTAL,CIVIL
GEOTECHNICAL WELL LOGCATLINesto
Nllrrinntan,Raleigh.Washington,
har
c1n Engineers and Scientists
223 06060
Wilmington,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: AshleV Jessen WELL ID:
Point DRILLER: Au'stin Fowler P4-TW39
NORTHING: 428168 1 EASTING: 2632568 CREW: S� Chasteen
SYSTEM: NCSP NAD 83 USft DRILL MACHINE: Power Probe T.O.C.ELEV.: 23.89
VERT.DATUM: NAVD88 USft METHOD: DPT 0 HOUR DTW: 11.8 TOTAL DEPTH: 16.0
START DATE: 11/30/23 END DATE: 11/30/23 124 HOUR DTW: 10.7 WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) s G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 Land Surface 23.9 0.0
CONCRETE 0.0 -
1.0 1.0 22.9
Direct (SM)-Tan to light brown,Silty,f.to med.SAND. No _
Push 8.4 M
2.0 2.0 HCO 21.9 > _
a
SAA 0
Direct 10.8 M
Push fA -
4.0 a.o---------- --------is.s
(SM)-Gray to light brown,Silty,f.to med.SAND,
Direct w/gray clay lenses. Slight HCO 5.0 -
Push 29.7 M -
6.0 6.0 17.9 -
(SP)-Gray,f.to med.SAND w/gray clay lenses. Slight
Direct HCO
Push 176.1 M -
8.0 8.0_________________ 15.9
(SP)-Tan,0.to f.SAND. Strong HCO
Direct 167.4 M -
Push -
o> "
10.0 13.9 °
10.0 -
SAA r -
Direct 178.1 M
Push
12.0 12.0 11.9
(SP)-Gray,f.to med.SAND w/minor clay lenses.
Direct Strong HCO _
Push 98.2 W
14.0 14.0 s.s
SAA
Direct '` 15.0
Push 66.4 W
16.0 16.0 7.9 16.0
BORING TERMINATED AT ELEVATION 7.9 ft
LL
Stratigraphy color(LOG)represents inferred stratum
permeability as follows:
■ VERY LOW 0 MEDIUM VERY HIGH
■ LOWEj HIGH
F Native Backfill
4
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