Craven_Well Abandonment_20241002 (42)

WELL ABANDONMENT RECORD For Internal Use ONLY: ,
This form can be used for single or multiple wells P
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Trevor Mizelle 7a.Number of wells being abandoned: N/A
Well Contractor Name(or well owner personally abandoning well on his/her property) For nwhiple bjection or non-water supply wells ONLY with the same
co structiondabandonntent,you can snbmil one forn+.
4629C
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): NIA (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name. 7c.Type of disinfectant used: N/A
2.Well Construction Permit hl: N/A
List all applicable well petntits(i.e.County,State,Variance,Injection,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):
DAgricultural ❑MunicipaUPublic ❑Neat Cement Grout ®Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
DIndustrial/Cornmercial ❑Residential Water Supply(shared) ❑Concrete Grout El Drill Cuttings
❑Irrigation " El 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 Benton itePellets 251bs.
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test DStormwater Drainage
❑Experimental Technology OSubsidencc Control
❑Geothermal(Closed Loop) ❑Tracer 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Heating/Cooling Return) ❑Other(explaiii under 7g) Surface Pour
4.Date well(s)abandoned: 9/11/2024 O r T 112 2074
5a.Well Location:
MCAS Cherry Point D j'<<•z''"�=
Facility/Owner Name Facility lDil(if applicable) 8•C t .cation:
PIT 6 MCAS Cherry Point, NC, Havelock, NC 28532 September 18.2024
Physical Address,City,and Zip Signature of Certified Well Contractor or wner Date
CRAVEN By signing this form I hereby certify that the lvell(s)ivas(ivere)abandoned in
County Parcel Identification No."(FK- 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:
34.8983384785 Nr 76.8886173252 �, 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 SUBMI-TTAL INSTRUCTIONS
Attach well construction record(s)ifavailable. For nudtiple hyection or non-water supply
well ONLYwith the same construction abandonment,you can submil one fora, 10a.For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: 1000W10 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 18.5 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in
I Oa above,also submit one copy of this form within 30 days of completion
6c.Borehole diameter: 2 (In.) ofwell,abandonment to the following:
6d.Water level below ground surface: 910 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NIA 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
6f.Inner casing/tubing length(if known): 8.5( county where abandoned.
6g.Screen length(if known): 10(ft.)
i
P:\2024\224001-PIE-PS-CHERRY POINT-2ND SEM 2024_1ST SEM 2025 CAMP\Prr 6 WELL ABANDONMENIiFIELD\224001_GINT.GP)
R Adapted from NCDEN DWR Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Re Au sources Revised o st 2013