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Home My WebLink AboutMoore_Well Abandonment_20241115 .... . WELL ABANDONMENT RECORD • t.gii4 _.,V',- Nmth Carolina Department ofruwiresmzeut audNatural Resomces-Division Of Water Quality .. • WELL commAcrok purrivicKnori# 9 flz -4 L WELL COM:flit-MR: - IL WEIL DEEM& • 4441 1 '-e g. 14/1-•%--. . . ' a.Thud Depttr (clt ! IL Dime= -36 . Well Copactor(hurividul)Nama . h.WaterLevel(BeInvaSeasuring Pain* 3S- ff. 2le11'666-.ALdi4=-tiLL41111...SP-LK..... Measaliagpointbg Le..041.-above landau/fate. .Weil Comtactor Company Name STREET ADDIUESS' 0&46 ibri ' 3 6. CASING: ,• Length Diameter a _ bdej r•-- t/4 Arc ai7.3171,. a.CasingDepth(ifintninX '344 It.• aty or Ibten- Sbie rap Code b.lasing Rama : IL '3 8 in. . Alt )_ 1)13- 3ars2- ,,,, - Area code-Phone lumber_ 7. DISINFECIION: fiV e-11 4i .-4- • . Z.WELL DWORMATION: (Ainonntof69Y0-7556 cakilunItypothkette used) Al I-z i b . .SITE WEIL IDU(jiopplica' Me) - a STALINGMATIML4i: ' and Caned . . STATENVELL REREITT ft gappricablel Mg1Topi •-- Canent,_______Lb. 44..courairvimu.meant ofapsicabioEt.gei a water lo 4 gaL Vista—gal _ • - DWQ ar OMER moan*(ifapplicabte) ftEithtft • 0 R i '., . •:.(.. --' ";--, ..---) WELL Mt(Cheek AppricabIeBox):0 Monitoring esidentia'1 - --,'-'q...-; ii • 1 Bentatiite " 0 Muoteipalfrablie 0 Indusirtal/Consmereial Ll Agrieullural Type:Sh iny T • 1 E., 2024 . — Clammy Intjacbx a C Irrigation NOV , Water —gaL 00ther(fist use) .. . . . . Other i 1 I-;!•:..;:•:-.1.,..--•": ;:'''''.•-•:?.-q:,:•!,,Yi,Iiil?/ 3..WELL LOCATION: ' 1ypc" azatecial eit'AI - ri Tmkil . cOUNTY 'MIA QUADEAN'GLENAME Amount i NEARESr TOWN:::_D.1 ''-- 1 te..., -3/45 ..5 i(AU IM 4/kie...04-Afc-. - ._ •- OtortlittidNeskIfumber.03amoity.Sulxitisioo:LotDa.PwArD Cod* a-.RPLADIBIE3110D OFEMPILACESIENr OF MATERIAL: . _ . , . TOPOGRAPHIC%I.ANDIETTING: U.ANtl- ei Al . PoJZ—rAwico; • °Slope UValley-Mat thlidge u Other • • - . •(Check,PT0621.0x09' • . ' ... . •ill V" itie ke fee.S /08 LA--- LiffiroDE ' ' .• x-a,,,, I ..--epi,i) •n i . .tY- piLIS':. 44---irp-a r..Leraia . '"1 -I " Afryboiedegrom id =bps,moods,win a . •-•- - LONGITUDE_7(if.2 tt i 9'i' to. WELL DIAGRAM:DET/t a desaileddreath ofthe well Gotha baelcorthis - Latitude/longitude source: igg oTopolgaphic map fannthringtatal depth',depth amd&maw ofscreens(thaw)=lain' ing •: goeailoa appall rasa be shown on alEaStqxrzetapand in the sellAgaval imemal,intervals efauing pmfoudiam,and&Otis and - " to attricharldsfann frmtuskeGPS.) types affill matetiabese& t• . _ 42.11ACILTIY-lbourme aftlebtobless whose the web lotted.Comilete4aaad4A mikofid IL DATENVKILL ABANDOMD i 1'6— (Ifs sweil.slip 4g-oimplece4b.weitinmeriatztaatio'a oily.) FACILITY ID Rit'applipobto) I DOBEREBY OIRTIPYTEIATTHIS WELLWASADANDONEDINAOXIDDANCE WM ISANCAC=WELL CONSTRIICDONSTANDARMANDIHAT AODPY OF . NAME OF FACDITY •- ms-476,11-i. TOTHEWELL OWNER. STREETADDRESS . ikAIS 1. - • . - - .,-,.‘,. Iv 4.thr WELL CONDUCIVE . DATE city orTown -State rap Code .... - [ . • 4fr.Comrscr=mop/mama.oveagm, . • • - /5 SIGNATUREOIFPRIVATZWELI:• OWISRABANDONING=EWELL •DATE r,amkat 14-114 ell- 1-tZ 61-C-1.14 tlerriPte 4, (Therobaseedl ownertoostbeaabitlividoalvdsopetwalle abandons hisfintlisidatialvdt . STREET ADDRESS 1 Z.4515'. 61.15. 4-G4i .......4 •i4v1-.e....ft-. in amid!!ce Id&ISAIVACF 13..) .. A14t•C:.P. E:.-, • ..a:3,71---k , - — . ;.. .. . . . 1.,e..s' „,,dm.. .,-P. 1 QC • A10-4111/ :.- : . PREITZDNAMBODPERSONADAX!DONIESTREWELL • - '. • sfty et Towit. rtp Code- - ' • ' ' - C116 )- loi t 0, • 4itSiT-- . Am:toxic-Phone:ander • ' - I ' _ ',... -• . . . Submit a eapy la theamer and the origin]to the Division unit:der Qoardy within 30 days. . . Fenn GW-30 • Attn:Information blanagasent,1617 Mail Servike Center-WWI,NC 27699-1617, Bone No.(919)733-701Sest568. - Rev.4106 • 1 I 1 - . . . _ . .------• . . t 1 i WELL ABANDONMENT RECORD For Internal use oNLY: 1. 1.Well Contractor Information: WELL ABANDONMENT DETAILS Scott M. Werley 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 GV'30 is needed. indicate TOTAL NUMBER of 3344-A wells abandoned:ere I 1 i NC Well Contractor Certification Number 7b.Approximate volume of water i i remaining in well(s): 0'75 (gal.) ECS Southeast, LLC FOR WATER SUPPLY WELLS ONLY: Company Name W M 0601317 7c.Type of disinfectant used: ' 1 2.Well Construction Permit#: List all applicable well construction permits(i.e.UIC.County,State,Variance,etc.)if known 7d.Amount of disinfectant used: 3.Well use(check well use): , Water Supply Well: 7e.Sealing materials used(checklall that apply): ❑Agricultural ❑Municipal/Public • Neat Cement Grout •Bentonite Chips or Pellets Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay 0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings 0 Irrigation 0 Specialty Grout I 0 Gravel Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g) •Monitoring ❑Recovery , Injection Well: 7f.For each material selected above,provide amount of materials used: ❑Aquifer Recharge ❑GroundwaterRemediation Bentonite - 50 lbs ❑Aquifer Storage and Recovery OSalinity Barrier ❑Aquifer Test ❑Stormwater Drainage Neat Cement - 115 lbs ❑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) Gravity feed bentonite from 37 to 10' bgs Remove 10 ft or riser. 4.Date well(s)abandoned: 10-28-2024 Pour neat cement;from 10' bgs to surface 5a.Well location: - '''- Morganton Rd Enterprises N/A y,- Facility/Owner Name Facility ID#(if applicable) 8.Certification: N U V 1 t 2024 Carolina Green Pkwy, Southern Pines, 28387 _ _ 1 / 0/2024 Physical Address,City,and Zip Signature ofCertific ell ontractor02,WCIeNii ern;,.:_ Ifatc. Moore 857100588078 . ' "' ` `..'`' By signing this form, I hereby certif'that the well('.) was (were) abandoned in County Parcel Identification No.(PIN) accordance with ISA NCAC 02C.0I00 or 2C.0200 Well Construction Standards and that a cope 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 Iatllong is sufficient) 9.Site diagram or additional well Idel ails: 35.172068 N 79.414324 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 r•eca'd(s)((available. 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 7- 6a.Well ID#: I W-1 abandonment to the following: Division of Water Resources,Information Processing Unit, 6b.Total well depth: 37 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617 i 10b.For Injection Wells: In addition to sending the form to the address in l0a 6c.Borehole diameter: 6 • (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: 32.45 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 1 j 6e.Outer casing length-(if known): NA (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): 27 (ft.) abandoned. 1 6g.Screen length(if known): 1 0 (ft.) 1 Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016 WELL ABANDONMENT RECORD For Internal Use ONLY: 1.Well Contractor Information: WELL ABANDONMENT DETAILS It Scott M. Werle Y 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 3344-A wells abandoned:One 1 i NC Well Contractor Certification Number 7b.Approximate volume of water riemaining in well(s): 1 .90 (gal.) ECS Southeast, LLC FOR WATER SUPPLY WELLS ONLY: Company Name 7c.Type of disinfectant used: • 2.Well Construction Permit#: WM0601 31 7 List all applicable well construction permits(i.e.UK.County,State.Variance,etc.)if 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 C Neat Cement Grout U Bentonite Chips or Pellets ❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay ❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 1, 0 Drill Cuttings 0 Irrigation 0 Specialty Grout i 0 Gravel Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g) UMonitoring 0 Recovery Injection Well: 7f.For each material selected above,provide amount o_f materials used: --- OAquiferRecharge - OGroundwaterRemediation Bentonite '" 50 lbs ❑Aquifer Storage and Recovery ❑Salinity Barrier DAquifer Test ❑StowaterDrainage Neat Cement 200 lbs rm 0 Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure: ❑Geothermal(Closed Loop) OTracer ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Gravity feed Bentonite from 47 to 20' bgs Remove 20 ft of riser;. 4.Date well(s)abandoned: 10-28-2024 Pour neat cement from 20' bgs to surface 5a.Well location: i, Morganton Rd Enterprises N/A 77: _ Facility/Owner Name Facility IDN(if applicable) 8.C rtification: I L%,.n.t;,.,,+3.-L, ir' Li..,, '„r Carolina Green Pkwy, Southern Pines, 28387 Y NOV. 1 i; 702410/30/2024 Physical Address,City,and Zip Signature of Certified Well Co actor or Well Owner Date Moore 857100588078 Ir,f, .'''- ,:>--- , +t.rx �' e . By signing this form, I hereby cer(ij+thatfheitvell(s).avus`(icere7"abandoned in County Parcel Identification No.(PIN) accordance with ISA NCAC 02C.0100 or 2C.02001 c41 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: 35.172068 N 79.414324- W You may use the back of this pagejto 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)rfavailable. For nudt:ple injection or nnn=wcitersunply 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#: TW-2 abandonment to the following: ' Division of Water Resources,Information Processing Unit, 1617 Mail Service Center,Raleigh,NC 27699-1617 6b.Total well depth: 47 (ft.) 10b. For Injection Wells: In additioni to sending the form to the address in 10a 6c.Borehole diameter: 6 (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: 35.32 (ft.) Division of Water Resources,Underground Injection Control Program, 1636 Mail Service Center,Raleigh,NC 27699-1636 I 6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Injection Wells: In addition to sending the form to the address(es)above,also submit one copy of this font within 30 days of completion of well abandonment to the county'health department of the county where 6f.Inner casing/tubing length(if known): 27 (ft.) abandoned. i 6g.Screen length(if known): 20 (ft.) Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources . Revised 2-22-2016