Craven_Well Abandonment_20240403 (9)

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONI%IENT 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 nn ltiple injection or non-water supply trells ONLY with the same
constnrctioniabandonmem,you can submit one form.
2927A
NC Well Contractor Certification Number 7b.Approximate volume i f 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,h jection,etc.)ifknmen 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 E Bentonite Clips 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
❑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
5a.Well Location:
PIE-PS
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
�Y
PIT 4, Havelock, NC 28532 •---'=`""� l Janua 22.2024
Physical Address,City,and Zip Signature of Certified Well C ntractor or Well Owner Date
CRAVEN By signing this form 1 hereby certify that the hvell(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 IatAong is sufficient) 9.Site diagram or additional well details:
34.90874696 N -76.89024663 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)ifavailable. For multiple h jection or non-water supply
well ONLY with the same construction abandonment,you can submit oneform 10a.For All Wells: Submit this form within 30 days of completion of well
Ga.Well ID#: P4-TW24 F� -�•' r,1 -1, abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 15 (ft.) APR U 4%" 2024 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in
Inrvs.3 a3 c I1 `� "31rr¢' v?'t 10a above,also submit one copy of this form within 30 days of completion
6e.Borehole diameter: 2 (in.) CWC3.i'50G of well abandonment to the following:
6d.Water level below ground surface: 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 loc.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.) l
\2023\223060-PIE-PS-CHERRY POINT-DELINEATION,WELL INSTALL ABANDONMENT AND INJECTION PROJECTSU'IT 4-PHASE II LNAPL DELINEATIONWIELD ITEMS1223060_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
I

ENVIRONMENTAL,CIVIL CATLIN
GEOTECHNICALWlrrinntan,Raleigh.Wa shington,
CharlestoWELL LOG 223 06 0 n Engineers and Scientists
WIMV o n,NC SHEET 1 OF 1
NAlrringlo
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: William J. Miller P4-TW24
NORTHING: 428440 1 EASTING: 2632458 CREW: Sj Chasteen
SYSTEM: NCSP NAD 83 USft DRILL MACHINE: Power Probe T.O.C.ELEV.: 22.88
VERT.DATUM: NAVD88 USft METHOD: DPT 0 HOUR DTW: N/A I TOTAL DEPTH: 16.0
START DATE: 11/27/23 END DATE: 11/27/23 24 HOUR DTW: 10.4 1 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 22.9 0.0
0.0 ASPHALT 0.0
Direct 540 M (SM)-Dark brown,to gray Silty,v.f.to f.SAND. No
. _
Push HCO _
2.0 2.0 20.9 a
SAA Q -
t -
Direct Push 50.2 M o
rn
3.7 19.2
4.0 (SP)-Tan to light brown,v.f.SAND. Slight HCO
Direct Push 43.1 M
-
6.0 6.0----------------------- 16.9
(SP)-Dark gray,v.f.to f.SAND w/minor clay lenses.
Direct No HCO
M
Push 42.0
8.0 8.0----------------------- 14.9 _
(SP)-Light gray,v.f.to f.SAND. No HCO
Direct Push 39.9 M
-
o� "
10.0 12.9 0°'
10.0 ---------------------- - sQ -
(SP)-Medium to dark gray,v.f.to f.SAND w/minor clay _
Direct lenses. No HCO
Push 32.3 W
12.0 12.0 ----------------------10.9 _
(SP)-Dark gray,0.to f.SAND. No HCO
Direct 37.5 W -
Push
1a.o a.s
14.0
SAA
Direct 36.6 W 15.0
Push
16.0 16.0 6.9 ti 16.0
BORING TERMINATED AT ELEVATION 6.9 ft
Stratigraphy color(LOG)represents inferred stratum
permeability as follows:
■ VERY LOW 0 MEDIUM , VERY HIGH
■ LOW HIGH
Native Backfill i
f