Mecklenburg_Well Abandonment_ (15)

_WELL ABANDONMENT RECORD 1,,, 1 .MINI
This farm can be used for single or m shiple wells
1.Well('nntrAcmr Infarntanon: 'A ELL ABANDONMENT OFT Ali
Brian Ewing 'a.Number of wells bente abandoned: 1
N'[Il(I!Ifl'Je1P1:',.n0.IJ1%010xlkr P6in.1K Jbandmng Mill On he tiff punkin, plr n..... •x -•rarer .upjA xeh ONLY atA Ito feet
,.n.rrn,wxi,Aa•rtl,a,w.xr n•.,.exwlwuxv tivnl
4240-B
7b.Appmtimale,ulemr•of%jiff remaining in wtillsl: Igal.)
N("%bll Gnxmdxt Crriifr�linn NxxM
FOR WATER SUPPIA WFLISONI.A'.
SAEDACCO Inc
Canipam Nark
'r.'1\pf of dwnftt'tant umA:
2.W'dl Cumtmetloa Permit 0t70003075, ,
i. 1 ., 'p, eIN, n. .,.0 y e ('AIM.UWr. Innaxe' turn tv,n.", Jr rv...,:
' 'd. \rnoum nl di,inkv'tjnl uvd:
J.Wdl u.wIched:writ vw): —
W uer Supph Well: 7r-Sealing materials uvd,chrcL all that apph I:
fl iemnhuml ❑MuniciPAIrublc ® Ncat fcmcnl Gnkn C1 Benlonnc Chips or PCIIGI,
0(irotherud IBeaune Cooling SuITIN I 011apdemml Amer Supph Isingic) D Sdtd(ermm(wont ❑ Un Cla,
❑InldusimlI onouc¢ml ❑Resider al Wmff Supph Ishated) O Cm¢rcm Grout ❑ Unu Cu11mFs
''Im^Iorl ❑ Spml* Grout 0 Gmel
Ron-W akt Supph Well: 0 peloomte Slum f l Other lesphom mdel 'v
S6101111onne ❑Reconen
Injection Well: X For each material sciectrd alone,pro iAc anmmot of matrriAk mwd:
❑Agmfer Recharge OGnnudnater Rcnw&xr(m Seat Cem.:471b ,Wtr:3gal. Sand Cem. :lb ,Wtr:gal.
❑Agmfer Storage and Reconen ❑Salem Darner
❑Agmfn lest DSlonnmaler Urmetgc
DE.Aperi TwhwID&% ❑Subsidence('ommt 7g.P"tide a brief dewrilnino td the abandon rssut pnrcadom.
045cothrnml tMscd Impi UTracer
lremi from the bottom to uurfact.
OGaotM.mal tFl(ttun -'Coolil Return) uOthnes amunder' I
i.Dam went,)abandoned: 11-1-22 NOV 2 S 2022
5'.Well hwalton: IDfOffE,7ijC� ?f�C9Ggth- Unit
Norfolk Southern Intermodwl Yard
Faclle.'Oa ar Nair Fxila.IDa ofapplcah6 h,f rnilleatiim:
333 Parkwood Ave, Charlotte, NC 28206 Brian Ewing 11/11/2022
Ph,scat Addim.Cn,1d Zip \Iuuln:c al C.mlwd A 0Ifonll.I i It*., DW
Mecklenburg 08301126 Ill ugnnrx this fii m. 1 htnbt Thor the irrl!(r) wm men, dmmhared in
t'mua7 I'acd I.Lmdralnn N. IPINI Iut,miame wed,1JA. C4C 0X'.Ulfal(u:, O'0011.ell('(menu lino.Vum4vd.
,md Ilmd d,M oJrhix rmod hat been provided to the well oa nee
th.lalim ide and longitude in dslpmtminuteurtsmdn nr darimal degrtt+:
(if ell Wd :II.U knl „iOtieml 9.Site diagram or additional we*details:
V"ou our me tlx baci,of dais page to pro,de addrnoiul cell site Malts or%ell
Abardonnlerm detail, You rtiai also mwit aWrtmitil pages if necc n
CONSTRU( WIN Dial kit_SOFWF:LIfSIBE1.NG A8\\DONFD St NNIMAL INSTRUCTIONS
11"k.'ft :A,fSM. Fiv urn ,n wrry•A
xdhovi.1 • ,.,wmy.•mr.sit 10a. For .All Wells: Slitinal [tits leri miflunr ;11 dims of completion of uell
6a.Well 111/:TNW-2 Amidcnmem m the follnem
Dm,iun of Wafer Resimmm Information Protesting twit.
6h.Total hell depth: 24 IYLI 161'Alain Sfnicr(-enter.Ralemb.N('2-61194617
Inb. Fur luledbe Walls: In addmou lu scidisig the lino to ibe:ddifm ul lea
:boi c. eta, submit once cep\ of this form%ohm in d:ns,A nnnplct[on of ndl
6r.Boordolc Alarmtcr;1 lln.l
ahaidunnlenl lu the lollo%uLL
tiA.Water In'd firkin Imwnd welfare: Dmmon x(Water Rcwurto,1.ndcrgniund Injection fowled►"gram.
16J6%tail'-muff(enter.Rakish.SC 27N9-16J6
Inc. Fxr Water Sruiol, A Infection Welic In addition to sending the form to
Inc.Outer cairns lrn;th l if l.no%nc lh.) Ilk :ddresve,I abo,e. also ,tbum ome coin of Ih(s form within III dass of
;onlplamn of,sell atimdannnnl to the comb health driummmt of the cmrm
for.Inerr rasing�tulrinr length if Maaol: 14 Ih.l w titre.Ih:udnncd
M1s.Scum lemur 1,1 if Low n r 10 (a l
f .I l,tr-:I� NnnA('aohm lAtunncia olEm wunkm jrd N:uuml fltwurces Dls own of%jiff Ne,oun�s P,,ed Augur Hill