Mecklenburg_Well Abandonment_ (21)

WELL ABANDONMENT RECORD For luemml Uw ONLY
This form an be used fm ungle or multiple%ells
1.W cH Unntrairinr Information: WELT.ABAN66Nb1EN1 twi AtIS
Brian Ewing 'a.Numbers(walls hang abandoned: 1
Wdl('otamnur Nana for wdI..ocr VcniImIh Aundomug.cd an bnael prcperi, r•v mx)aplr nyvr6r.n rc .x•n-.nrrr r,q" .,If, V%L) rub Ibr envoi
mnrrrc.h,xo,.Jamlwor,rrrt.n,x o,m whwn:x1e fi,nn
4240-B
NC Well CoMmaaor Cenlficalion NnaaKr 7h. AppmaimAtc wlnmrof water remaining is"CHUM: fada
SABDACCO Inc FOR%%ATER SUPPLY W FLI S ONLY:
Canvas,Name 7r. I i pe of didtlfertam used:
2.Well Construction lin 0-70 0030 7 5, ,
Ls ell y*Au 1'well prr%ar n.e.Caewn,.Use.{iinwrr./"tow.ek.r lfhenra 'Id. %mount of bsinfectiat uwd:
J.Well One(chedt well suck
Water Supph Well: 7e,SaRag mahriAs u"d tchacl all that appli,1:
❑Ageuhural O61MICtI:d:Athle 0 NW Centeno(loon Cl Hcnon is Chips of Pellets
OGeotherned(Hcanrte fooling"A"A%I OReudcratal Kamer Stmpph ismele) O SmAl Cenatra(from ❑ Dn(la)
❑IndmimlJ ononc¢tal ORcialle a W Kama Srmpph lshared) 13 Cotinete Gram ❑ Drill Catnap
❑ImYalwll O Specialn Grant ❑ Grasel
Non-K Ater Supple Well: ❑ Beruomie Slum I I Otter(eythwll ummdef'v
3ldumlonuc ORaoom
Injection Well: 7L For each material wketed Abair,prmitk Annrunt of material.uwd:
❑Agmler Recturge O(irurdwala Ranediani m Neat Cem.:471b ,Wtr:3gal. Sand Cem.:lb ,Wtr;gal.
❑Aguder Stonree and Recos m ❑Salmis Hamer
❑Aguder I" ❑SlolnaUIct Urauugc —
DEspmrnemal Inlmolon ❑Slbudewc(innnrl
"L Prns irk•a brief description of theahatl&mmaat ptattttrree:
UCxothemuml lClosed Ltwpi ClTracer
tremi from the bottom to surface
l lGcotMmmllHa%un Cnolin Raaml flfhlmcrlex am mda';;1 —
I.nAta%el11 s 1 Abandoned: 11-1-22
�9'J i
SL%cH 11KLIkM:
Norfolk Southern Intetaodal Yard l.lnf
Facmin,CN.ror�,r, Facdas 1De of alplcabkl % 1 rnilicatimr; :>�if�131xv
333 Parkwood A", Charlotte, NC 28206 Brian_ Ewing 11/11/2022
Pthucal Addkv.Cm.amd ZW suaeawx al(-entfsd Wra C,nrtr..i ..,I/)"mnr DW
Mecklenburg 08301226 HI vigntrw dra joint. I hereht ,r,r,n rho dw%dhs) was Iwerrl mrrml.Fmo'd m
C.rea• l sleet hkmfeaen No 1PINI +n<amhkR'r with 114.VC Y'0Y 0011W or jr' CIA)Well Coria/ril('h„.Wm,dird.
un,l Ilan o(.pi nl thu'resin/Ik+s'b.rn pnrrrdaN,r!h�u ell uu n.•r
7h.ladfmde and Inngimde in Acgrcnlmimmiev%•amda nr decimal degrees:
Idwdl fAld .,,,c W)un_•n.n«aaoal 2 Site diagrmn or additional wail ti tails:
You nun tnc time bacl of oho Ixq, ou pros I& .nklmeoul cell ma loads or%ell
N W' abandmuneta dcuu6 )em non :ds,mtach addnanul popes of nevnsan
CONSTRUMON DETAILS OF W FLIAS)HEING ABANDONED SU MfTTAL INSTRUCTION
r....r,„mdr,!m,sl,J,l, sneer rupph
�.,v,r.nx non,0:unh v rmr+
.,rr.usLl •, ,,,r!w.:,,,:. � '^nor IBA. For All WeW: Slbrml Ihes lomi wthm tr d:ns of contplawn of %eH
6a.Kell I1)a:TMW-8 ab.dmimcru to the folloum;
134hion of W atrr Reumrcn,Information Pmcnvfrmg I nil,
6h.Total well tkpllr 15 10,1 161'NIAil Senice(cater,Raleigh.NC 2-69ii-lol-
111h. Fur IniccOnn Mells: In add,W l to wikltng dic form to the:ddtess it, lua
tw.Ik+rclxdr AlamenT:1
uMne. also sabots one jinn of this form swhul :u dons of completion of well
Iltl.l
:boidrnwem lu the•lotto"uig
Dhisitm of KAler Rmaircn,I ndrixr tmg rnind Inpcuun(mitrul Ptrans.
rid.K atcr Lind hdaw ground surfAcc: (ft.) 1636 Mail Senicer('enter.Raleigh.NC 276T)-Ia36
6e.Outer raving kngih i if Mow n r. (ft.) 11k. For Water Suarih & Inhction Wells: h1 add0moo to xtdmng the form to
the sldmgtsl abos e. also .nbnm ore cups eel Ihu form %stun Ui tlals of
completion at well abarck,nnsent to the cotuns health deparuitcn of The Coinih
6f.Inner asin�'tubing kntah(it'Rimowni: 5 dY.l rs hoc Aeudormcd
6%.Se rev.length I if Lno.a 1:10 I ft.)
t 11.".A North C'arouo U.•M%rinra of En,Imunem ard Nmoual Hesoauca-Doswii of W'ser Rswam:s kw owed Acting 2nt t