Craven_Well Abandonment_20240403 (16)

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 hells 0NL1'with the same
conrtnrction/abandonment,you can submit one fonn.
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.County,State,Variance,L jection,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 0Bentolute Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) El Sand Cement Grout ❑Dry Clay
❑IndustriaVCommercial ❑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: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation. Bentonite Pellets +/-5 lbs.
El 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 then concrete to surface.
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 Well contractor or Well Owner Date
CRAVEN By signing this form I hereby certify that the ivell(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 latllong is sufficient) 9.Site diagram or additional well details:
34.90799365 N -76.88964722 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
Allach well construction record(s)if available. For multiple byection or non-water supply
well ONLY with the srnr:e construction abandonment,you can submit o»eformt 10a.For All Wells: Submit this form Within 30 days of completion of well
6a.Well ID#: P4-TW38 "(^ . V/s abandonment to the following:
...+ i `D
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) APR � 2�24 1617 Mail Service Center,Raleigh,NC 27699-1617
tnh�oryr*.x ien Usli 10h.For Infection Wells: In addition to sending the form to the address in
aa:�,�Q}2O; I Oa above,also submit one copy of this form within 30 days of completion
6c.Borehole diameter: 2 (In.) of well abandonment to the following:
6d.Water level below ground surface: 7.8 (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&Injection 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
6E Inner casing/tubing length(if known): 5 (ft.) county where abandoned.
I ,
6g.Screen length(if known): 10 (ft.)
\2023\223060-PIE-PS-CHERRY POINT-DELINEATION,WELL INSTALL_ABANDONMENT AND INJECTION PROJECTS\PIT 4-PHASE 11 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 CA
LI
Wfmr�ctton,Raleigh.Washington, j 1V
Charleston Engineers and scientists
WELL LOG idroo n,NC SHEET 1 OF 1
lningta 060
W
PROJECT NO.: 223060 STATE: NC COUNTY: CRAVEN LOCATION: Havelock
PROJECT: PIT 4 - PIT 5 area aboard MCAS Cherry .LOGGED BY: Ashley Jessen WELL ID:
Point DRILLER: Au'.stin Fowler P4-TW38
NORTHING: 428170 1 EASTING: 2632643 CREW: Sl Chasteen
SYSTEM: NCSP NAD 83 USft DRILL MACHINE: Power Probe ! T.O.C.ELEV.: 23.77
VERT.DATUM: NAVD88 USft METHOD: DPT 0 HOUR DTW: 11.0 TOTAL DEPTH: 16.0
START DATE: 11/30/23 END DATE: 11/30/23 124 HOUR DTW: 10.8 1 WELL DEPTH: 15.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft ft 0 0.5 .5ft 0.5ft (PPM) s G DEPTH DESCRIPTION ELEVATION DETAIL
0.0 Land Surface 23.8 0.0
CONCRETE 0.0
1.0 1.0 22.8 -
Direct Push 14.2 M (SM)-Tan to gray,Silty,v.f.to f.SAND. No HCO _
2.0 2.0 21.8 > _
a _
SAA -
t -_
Direct Push 12.1 M
-
4.0
4.0 19.8 _
SAA
Direct 24 5.0
.5 M -
Push -
6.0 6.0 17.8
(SP)-Tan,v.f.to f.SAND. Slight HCO
Direct 238.2 M
Push -
8.0 : 8.0----------------------- 15.8 _
(SP)-Tan to gray,0.to f.SAND. Strong HCO
Direct 2460 W
.
Push -
o> -
10.0 1.0.0 13.8 00 _
o�
SAA t
Direct
Push 456.8 W
-
12.0 12.0 ----------------------
11.8
4 (SP)-Tan to gray,v.f.to f.SAND,w/minor clay lenses.
Direct 108.E W Strong HCO _
Push
14.0 14.0 9.8 -
SAA
Direct 82 4 W 15.0
Push
16.0 16.0 7.8 16.0
BORING TERMINATED AT ELEVATION 7.8 ft
Ix
Ix
LL
Stratigraphy color(LOG) represents inferred stratum
permeability as follows:
■ VERY LOW E] MEDIUM [0 VERY HIGH
■ LOW 0 HIGH
F-INative Backfill