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Home My WebLink AboutBrunswick_Well Abandonment_20240514 WELL ABANDONMENT RECORD For IntemaI Use ONLY: i 1.Well Contractor Information: WELL ABANDONMENT DETAILS Trevor Mizelle 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of 4629-C wells abandoned: I NC Well Contractor Certification Number 7b.Approximate volume of water rem Aning in well(s): 3'$ (gal.) CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.VIC,County,State,Variance,etc.)ifl®otiwt - 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials,use d(check all'that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Grou``" I 'w ~-' 4i p Ct i�..�`.;'••� '�;eBepto tte Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout I ❑Dry Clay ❑hidustrial/Commercial ❑Residential Water Supply(shared) a Concrete Grout MAY A 2ONDrill Cuttings ❑Irrigation ❑ Specialty Grout ❑ Gravel e � Non-Water Supply Well: IT iii`7r c.cAc;l 7 }:74--,: 1 t r PP Y ❑Bentonite Slurry � . �]FStltCtJ'explain under 7g) RMonitoring ❑Recovery Injection Well: 7f.For each material selected above,'provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets 20 lbs ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage Concrete 151b ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer ' ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Well abandoned in place with hydrated bentonite pellets and topped with concrete to existing grade. 4.Date well(s)abandoned: 4I3OIZO24 5a.Well location: NCDEQ-Varnamtown Contry Store Unknown Facility/Owner Name Facility ID#(ifapplicable) 8.Certification 325 Varnamtown Rd., Supply 28462 5/2/2024 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Brunswick NA By signing this farm, 1 hereby certify that the ivell(s) ivas (were) abandoned in County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards and that a copy of this record has been provided to the ivell oivner. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details: 33.9416019739221 N -78.24007568281651 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 Hell consinictia»records)ifavailable. For multiple injection or non-watersupply wells ONLY with the gone constructionlabandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#• MW-1 abandonment to the following: i' Division of Water Resources,Information Processing Unit, 6b.Total well depth: 13 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition.to sending the form to the address in 10a 6c.Borehole diameter: 2 (in.) above, also submit one copy of this forin within 30 days of completion of well abandonment to the following: 5.26 Division of water Resources,Underground Injection Control Program, 6d.Water level below ground surface: (ft.) 1636 Mail Service Cente�lr,Raleigh,NC 27699-1636 6e.Outer casing length(if known): N/A (ft.) loc.For Water Supply&Injection Wells: In addition to sending the form to the address(es)above,also submit one cop},of this form within 30 days of completion of well abandonment to the county health department of the county where 6f.Inner casing/tubing length(if known): 3 (ft.) abandoned. 6g.Screen length(if known): 10 t Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 r ' WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well'Contractor Information: WELL ABANDONMENT DETAILS i Trevor Mizelle 7a.For Geoprobe/DPT or Closed-LI op Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-36 is needed. Indicate TOTAL NUMBER of 4629-C wells abandoned: NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 3'6 (gal.) CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown 7d.Amount of disinfectant used:. 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Gro F—r; ABentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Gro.t •�'C��..z q�)y Clay ❑Industrial/Commercial OResidential Water Supply(shared) a Concrete Grout MAY M^V I �� 0 C�Drill Cuttings ❑hTigation ElSpecialty Grout (u4 Gravel Non-Water Supply Well: ❑ Bentonite Slurrk-si;:jnc.;YE,1b�,QtkiYer(explain under 7g) RMonitoring ❑Recovery Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets 20 lbs ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage Concrete 15Ib ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer ❑Geothermal(Heating/Cooling Return) ❑other(explain under 7g) Well abandoned in place.with hydrated bentonite pellets and topped with concrete to existing grade. 4.Date well(s)abandoned: 4/30/2024 5a.Well location: NCDEQ-Varnamtown Contry Store Unknown Facility/Owner Name Facility ID#(if applicable) 8.Certification: 325 Varnamtown Rd., Supply 28462 5/2/2024 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Brunswick NA By signing This form, 1 hereby certify that the we!!(s) was (were) abandoned in County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 oi-2C.0200 Well Construction Standards , Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner. (if well field,one lat/long is sufficient) 9.Site diagram or additional well details: 33.9416019739221 N -78.24007568281651 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 Apache,ellconslructimirecord(s)ifavailable. Forimillipleirjectionornon-iraterstipplyirelis ONLY with the same construction abandonment,you can submit one forin. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: MW-2 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 13 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Injection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: 2 (in.) above, also submit one copy of this;form within 30 days of completion of well abandonment to the following: 6d.Water level below ground surface: 5•99 Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 I ; 6e.Outer casing length(if known): N/A (ft.) 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 county where 6f.Inner casing/tubing length(if known): 3 (ft.) abandoned. 6g.Screen length(if known): 10 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 I f WELL ABANDONMENT RECORD For Intern I Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS Trevor Mizelle 7a.For Geoprobe/DPT or Closed-L loop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of 4629-C wells abandoned: I NC Well Contractor Certification Number 7b.Approximate volume of water re maining in well(s): 4'1 (gal.) CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: 2.Well Construction Permit#: List all applicable srell construction penniis(i.e.UiC,County,State,Variance,etc)ifknown 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials•used-(checkall thati nply) ❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ��a�. y )' '�f `Bntbnite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout /� y ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) S Concrete Grout MAY 1 41021 Drill Cuttings ❑irrigation ❑ Specialty Grout ..�. ••-n ^-..•-,�, ;-❑trray_el Non-Water Supply Well: ❑ Bentonite Slurry{f �7c.r,a.v ht( .wf theeii rj+fp(�"�*� Ct Other(explain under 7g) MMonitoring ❑Recovery Injection Well: 7f.For each material selected above,,provide amount of materials used: ❑Aquifer Recharge ❑Groundwater Remediation Bentonite Pellets 20 lbs ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage Concrete 30lbs ❑Experimental Technology ❑Subsidence Control i 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Well abandoned in place with hydrated bentonite pellets. Well pad was removed and topped with a.Date well(s)abandoned: 4/30/2024 concrete to existing grade. 5a.Well location: NCDEQ-Varnamtown Contry Store Unknown Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: 325 Varnamtown Rd., Supply 28462 5/2/2024 Physical Address,City,and Zip Signature of Certified Well Contractor or Wc11 Owner Date Brunswick NA By signing this farm, I hereby certify that the ivell(s) was(were) abandoned in County Parcel Identification No.(PIN) accordance ivith 15A NCAC 02C.0100 or 2C.0200 Well Consir fiction Standards and that a copy of this record has been provided to the ivell owner. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details: 33.9416019739221 N -78.24007568281651 ,1 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 Altaclzweliconstruclionrecord(s)ifm,ailable. For multiple itjectionor non-water supply wells ONLY with the same constntctionlabandonmem,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#• MW 3 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 13 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 i 10b.For Injection Wells: In addition,to sending the form to the address in 10a 6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: i 6d.Water level below ground surface: 4.92 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): NIA (ft.) 10c.For Water Supply&Injection Wells:I 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 i ealth department of the county where 6f.Inner casing/tubing length(if known): 3 abandoned. i 6g.Screen length(if known): 10 Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 i WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAIiJS Trevor Mizelle 7a.For Geoprobe/DPT or Closed-Ll op Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of 4629-C wells abandoned: NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 4.3 (gal.) CATL.IN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY: Company Name i 7c.Type of disinfectant used: ' 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIC,County,Slate, Variance,etc)tfknown 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all that apply): ❑Agricultural ❑MunicipaVPublic ❑ Neat Cement Gr ut,, a Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) El Sand Cement Gr uh, R4 fij`,' gEh>a ry Clay ❑hidustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout MAY ❑ I3nll Cuttings ❑ ElM Irrigation Specialty Grout AY �� 20240 Gravel Non-Water Supply Well: ❑ Bentonite Slu a Other(explain under 7g) eMonitoring ❑Recovery Injection Well: 7f.For each material seleCY" fxbo�'e� rovide amount of materials used: r. []Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets 82 Ibs ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage TOpSOII 40IbS ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the,abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer ❑Geothermal(Heating/Cooling Return) . ❑Other(explain under 7g) Well was removed from ground. Abandoned with hydrated bentonite pellets and topped with topsoil to existing grade. a.Date well(s)abandoned: 4/30/2024 Well shield and pad removed. 5a.Well location: NCDEQ-Varnamtown Contry Store Unknown Facility/Owner Name Facility ID#(if applicable) 8.Certification: 325 Varnamtown Rd., Supply 28462 5/2/2024 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Brunswick NA By signing this form, 1 hereby certify'lhat the ivell(s) was (were) abandoned in County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards and that a copy of this record has been provided to the ivell owner. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (ifwcll field,one lat/long is sufficient) 9.Site diagram or additional well details: 33.9416019739221 N -78.24007568281651 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 Attachtirelicmtsirnctionrecord(s)ifavailable.For tnuhiplehyectionornon-water supply wells ONLY with the same consiruction,abandonnrent,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well 6a.Well ID#: M W-4 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth- 13 1611 Mail Service Center,Raleigh,NC 27699-1617 10b.For Infection Wells: In addition to sending the form to the address in 10a 6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: 6d.Water level below ground surface: 4.43 (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 (ft) 10c.For Water Suably&Infection Wells: hi 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 couny health department of the county where 6f.Inner casing/tubing length(if known): 3 (ft.) abandoned. 6g.Screen length(if known): 10 Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 I WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAITJS I Trevor Mizelle 7a.For Geoprobe/DPT or Closed-Lpop Geothermal Wells having the same Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 i needed. Indicate TOTAL NUMBER of 4629-C wells abandoned: I NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 4'6 (gal.) CATLI N Engineers and Scientists FOR WATER SUPPLY WELLS ONLY: Company Name I' 7c.Type of disinfectant used: t 2.Well Construction Permit#: List all applicable well construction permits(i.e.WC,County,State,Variance,etc)!/known 7d.Amount of disinfectant used: 3.Well use(check well use): Water Supply Well: 7e.Sealing materials used(check all,that apply): ❑Agricultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Gj'�;L{i C a ®'� ++!t'(J Pi}Clay ❑IndustriaUCommercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings ❑hrigation ElSpecialty Grout MAY 1 << 20240 Gravel Non-Water Supply Well: ❑ Bentonite Slurry a Other(explain under 7g) RMonitoring :igy Injection Well: 7f.For each material sele&d" ba4Wrovide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets 23 Ibs ❑Aquifer Storage and Recovery ❑Salinity Barrier ❑Aquifer Test ❑StormwaterDrainage Topsoil 25lb ❑Experimental Technology ❑Subsidence Control 7g.Provide a brief.description of the abandonment procedure: ❑Geothermal(Closed Loop) ❑Tracer ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Well abandoned in place with hydrated bentonite pellets and topped with topsoil to existing grade. 4.Date well(s)abandoned: 4/30/2024 ' Well shield and pad removed. 5a.Well location: NCDEQ-Varnant town Contry Store Unknown Facility/Owner Name Facility ID#(if applicable) 8.Certification: 325 Varnamtown Rd., Supply 28462 9w-e 5/2/2024 Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date Brunswick NA By signing this fornt, I hereby certify!that the ivell(s) was(were) abandoned in County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards and that a copy of this retard has been provided to the ivell owner. 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lattlong is sufficient) 9.Site diagram or additional well details: 33.9416019739221 N -78.24007568281651 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(SJ BEING ABANDONED SUBMITTAL INSTRUCTIONS Attach well consirnction records)ifavailable.For multiple injection or non-water supply wells ONLY with 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#: M W 5 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 15 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617 10b.For Iniection Wells: In addition;to sending the form to the address in 10a 6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well abandonment to the following: 6d.Water level below ground surface: 5.94 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 6e.Outer casing length(if known): NIA (ft.) 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 county where 6f.Inner casing/tubing length(if known): 5 (ft.) abandoned. 6g.Screen length(if known): 10 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016