Craven_Well Abandonment_20240403 (17)

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 nmliiple injection or non-watersupply wells ONLY with file same
constntciionlabondontnent,you can subfnii 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 irell permits(i.e.County,State,Variance,ltyection,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 IRBentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout El 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 ❑Stotmwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Heating/CoolingReturn) ❑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#(ifapplicable) g•Certification:
PIT 4, Havelock, NC 28532 �� ` _- _.._..._. Janua 22.2024
Physical Address,City,and Zip Signature of Certified Well.-6ntrraactto`r-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 15ANCAC 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:
34.90829067 N -76.88947785 W You may use the back of tivs 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 construction record(s)ifavailable. For multiple inyection or norrwatersupply
well ONLYwilb file same construction abandonment,you can submit ate form 10a.For All Wells: Submit this form within 30 days of completion of well
6a.Well ID# P4-TW37 abandonment to the following:
'• IL l--L V I_m D Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) APR 0 20Z4
1617 Mail Service Center,Raleigh,NC 27699-1617
�
10b.For Infection Wells: In addition to sending the form to the address in
6e.Borehole diameter: 2 (in.) lnfO+7rCP%:i8 1r � L' V'n?3 10a above,also submit one copy of this form within 30 days of completion
of well abandonment to the following:
Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: s.s (ft.)
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.
6g.Screen length(if known): 10 (ft.) ;
\20231223060-PIE-PS-CHERRY POINT-DELINEATION,WELL INSTALL ABANDONMENT AND INJECTION PROJECTSU'IT 4-PHASE II LNAPL DELINEATIOJ\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

r
ENVIRONMENTAL,CIVIL
GEOTECRaWgh.Wlnirmtcn,Raleigh.Washtrrc�ton, CATLIN
CharlestoWELL LOG 223 n Engineers and Scientists
Nhlninoon,NC SHEET 1 OF 1
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: Adstin Fowler P4-TW37
NORTHING: 428279 1 EASTING: 2632692 CREW: S. Chasteen
SYSTEM: NCSP NAD 83 USft DRILL MACHINE: Power Probe T.O.C.ELEV.: 23.15
VERT.DATUM: NAVD88 USft METHOD: DPT 0 HOUR DTW: 10.4 TOTAL DEPTH: 16.0
START DATE: 11/30/23 END DATE: 11/30/23 124 HOUR DTW: 11.0 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
1� &
.0 Land Surface 23.2 0.0
CONCRETE 0.0 -
1.0 .0 2202
Direct (SM)-Tan to reddish brown,Silty,f.to med.SAND _
Push 48.8 Mz 0 w/minor clay lenses. No HCO 21 2 > -
2.0 -----------------=--------
(SM)-Dark gray to tan,Silty,f.to med.SAND,w/minor a
Direct clay lenses. Slight HCO
Push 20.0 M
4.0 .0 19.2 _
SAA
Direct 212 M 5.0 -
Push
6.00 17.2 _
SAA
Direct Push 26.9 M
8 0 8.0 15.2 _
(SP)-Light gray,v.f.to f.SAND. Strong HCO
Direct Push 252 8 W -
-
oj
10.0 132 00.
10.0 -
SAA t -
Direct Push -
366.7 W
12.0 : 12.0 ---------------------- 11.2
(SP)-Tan to light gray,v.f.to f.SAND w/minor clay -
Direct , lenses. Strong HCO _
Push 182.8 W
14.0 :R 14.0 9.2 -
SAA
Direct 101.2 W 15.0 -
Push
16.0 's 16.0 7.2 - 16.0
BORING TERMINATED AT ELEVATION 7.2 ft
I
Stratigraphy color(LOG)represents inferred stratum
permeability as follows:
■ VERY LOW E; MEDIUM F!:: VERY HIGH
LOW 0 HIGH
Native Backfill