Craven_Well Abandonment_20240403 (3)

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 itecuon or non-water supply wells ONLY with the same
constructimtlabmtdonmeni,you can submit one fornz.
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 7e.Type of disinfectant used: N/A
2.Well Construction Permit#: N/A
List all applicable well permits(i.e.County,State,Variance,Itjection,etc.)ifknmvn 7d.Amount of disinfectant used N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials use&(cheek all that apply):
❑Agricultural ❑MunicipaUPublic ❑Neat Cement Grout 0Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout El 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: 7E 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#(ifapplicable) $•Certification:
................
PIT 4, Havelock, NC 28532 --`"`-- January 22,2024
Physical Address,City,and Zip Signature of Certified WelIX-61ltractor or Well Owner Date
CRAVEN By signing this form I hereby,certify that the lvell(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:
You may use the back of this page to provide additional well site details or well
34.9087647 N -76.8905241 q,
abandonment details. You may also attach additional pages ifnecessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For multiple injection or non-water supply
well ONLY with the same construction abandonment,you can submit one fern, 10a.For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: P4-TW30 2T abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft) 2024 1617 Mail Service Center,Raleigh,NC 27699-1617
APR 0 �'. 10b.For Iniection Wells: In addition to sending the form to the address in
6c.Borehole diameter: 2 (In.) krViv it 1L11uy�.10a above,also submit one copy of this form within 30 days of completion
64,wno of well abandonment to the following:
6d.Water level below ground surface: 6.3 (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
6E Inner casing/tubing length(if known): 5 (ft.) county where abandoned.
6g.Screen length(if known): 10 (ft.) l
�0231223060-PIE-PS-CHERRY POINT-DELINEATION,WELL INSTALL ABANDONMENT AND INJECTION PROJECTS\PIT 4-PHASE It LNAPL DELINEATION\FIELD ITEMS\223060_PIT4_CHERRYPOINT.GPJ
Adapted from NCDENR-DWR Form GW-30 North Carolina Department of Envwnment and Natural Resources-Division of Water Resources Revised August 2013

ENVIRONMENTAL,CIVIL
GEOTECHNICAL AT IN
W:Irringtcn,Raleigh.Nhshiriglon, Ljl�
CharlestoWELL LOG 223 n Engineers and Scientists
Wilmington,NC SHEET 1 OF 1
PROJECT NO.: 223060 STATE: NC I COUNTY: CRAVEN LOCATION: Havelock
PROJECT: PIT 4 - PIT 5 area aboard MCAS Cherry LOGGED BY: AshIeV Jessen WELL ID:
Point DRILLER: William J. Miller P4-TW30
NORTHING: 428445 1 EASTING: 2632374 CREW: S'. Chasteen
SYSTEM: NCSP NAD 83 USft DRILL MACHINE: Power Probe T.O.C.ELEV.: 23.68
VERT.DATUM: NAVD88 USft METHOD: DPT 0 HOUR DTW: 10.7 TOTAL DEPTH: 16.0
START DATE: 11/28/23 END DATE: 11/28/23 124 HOUR DTW: 14.0 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
0.0 Land Surface 23.7 0.0
CONCRETE 0.0 -
1.0 1.0 22.7
Direct 22 7 M (SP)-Tan to light brown,v.f.to f.SAND,w/minor clay
Push 2 0 lenses. No HCO 21 7 > -
2.0 a
SAA _
Direct t
Push
24.8 M co°
-
4.0 4.0 19.7 _
SAA -
Direct 27 5 M 5.0 -
Push -
6.0 17.7
6.0 --------------------------
(SP)-Brown to light gray,0.to f.SAND,w/minor clay
Direct lenses. Slight HCO _
Push 39.8 M
8.0 �-
80----------------------- 15.7
(SP)-Light gray,0.SAND. Strong HCO
Direct
Push 50.5 M
o�
10.0 10.0 --------------...------ 13.7 ov
(SP)-Light gray to dark gray,v.f.to f.SAND. Saturated t _
n
with product. Strong HCO �'
Direct Push 224.7 M -
12.0 12.0 11.7
SAA -
Direct Push 400.0 W -
14.0 14.0 _______________ - __---- 9.7 =
(SP)-Dark gray,v.f.to f.SAND Slight HCO
Direct Push 193.7 VV 15.0
16.0 16.0 7.7 16.0
BORING TERMINATED AT ELEVATION 7.7 ft
Ix
Ix
LL
Stratigraphy color(LOG)represents inferred stratum
permeability as follows:
■ VERY LOW a MEDIUM VERY HIGH
■ LOW 0 HIGH I
i
r
Native Backfill
I