Craven_Well Abandonment_20240403 (5)

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 nnihiple injection or non-water supply wells ONLY with the same
constnictioriabandonntent,you can;submil 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.County,Siate,Mariance,b 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 ®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 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.
El Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) El 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 TD#(if applicable) 8•Certification:
. .. ...............
PIT 4, Havelock, NC 28532 January 22.2024
Physical Address,City,and Zip Signature of Certified Well.0ontractor or Well Owner Date
CRAVEN By signing thisforin I hereby certify that the we11(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA 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:
34.90907822 N -76.89041687 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 construction record(s)if available. For multiple injection or non-water supply
well ONLYwith the same construction abandonment,you can submit one form 10a.For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: P4-TVV28 '-.• - _' ' a' abandonment to the following:
r ' `�
t'p.,
t 1 •�' Division of Water Resources,Information Processing Unit,
6b.Total well depth: 13 (ft.) pp �� 202� 1617 Mail Service Center,Raleigh,NC 27699-1617
n 10b.For Iniection Wells: In addition to sending the form to the address in
6c.Borehole diameter: 2 (In.) tn;v::t 3:t�1?r ^.rt�r �UnR I Oa above,also submit one copy of this form within 30 days of completion
of well abandonment to the following:
L`'ddC�r`L;3f3 '
6d.Water level below ground surface: 4.5 (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
6E Inner casing/tubing length(if known): 4.15(ft.) county where abandoned. '
,I
6g.Screen length(if known): 8.85(ft.)
\2023\223060-PIE-PS-CHERRY POINT-DELINEATION,WELL INSTALL ABANDONMENT AND INJECTION PROJECTSU'IT 4-PHASE II 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 Rd sources Revised August 2013
I

ENVIRONMENTAL,CIVIL CA
GEOTECHNICAL TLI
Wlnimnon,Raleigh.WaslHngfon, j�
C3106t0n Engineers and Scientists
WELL LOG 223060
Whington,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: Ashle Jessen WELL ID:
Point DRILLER: William J. Miller P4-TW28
NORTHING: 428559 1 EASTING: 2632404 CREW: S. Chasteen
SYSTEM: NCSP NAD 83 USft DRILL MACHINE: Power Probe T.O.C.ELEV.: 22.04
VERT.DATUM: NAVD88 USft METHOD: DPT 0 HOUR DTW: 8.9 TOTAL DEPTH: 16.0
START DATE: 11/28/23 END DATE: 11/28/23 124 HOUR DTW: 9.4 1 WELL DEPTH: 13.0
DEPTH BLOW COUNT OVA LAB o o SOIL AND ROCK WELL
0.5ft 0.5ft 0.5ft 0.5ft (PPM) s DEPTH DESCRIPTION ELEVATION DETAIL
0.9
0.0 Land Surface 1 21.2 0.0
0.0 (SP)-Tan to gray,0.to f.SAND,minor red staining.
=
Direct No HCO
Push 8 2 M > -
a
0
2 0 2.0 19.2 _
SAA U)
Direct Push 9 3` M
4.0 =:? 4.0----------------------- 17.2 4.2 _
(SP)-Tan,0.to f.SAND. No HCO _
Direct 10.6 M
Push -
6.0 6.0 15.2
SAA
Direct Push 10.9 M
-
8.0 .8:4. .................................................................13..2. O>
XX (SP)-SAA. Slight HCO o a
60
v
Direct Push 10.9 M
-CO
-
10.0 10.0 11.2
SAA -
Direct $ 8 W
Push
12.0 12.0 9.2 -
SAA
Direct 13.0
10.3 W _
Push -
14.0 c 1-4. ----------------------�.2 �-
(SP)-Dark gray,v.f.to f.SAND. Slight HCO
Direct Push 10.2 W
16.0 1s.o 5.2 ,: 16.0
BORING TERMINATED AT ELEVATION 5.2 ft
Stratigraphy color(LOG)represents inferred stratum
permeability as follows:
■ VERY LOW MEDIUM VERY HIGH
■ LOW HIGH
Native Backfill
i