Cleveland_Well Abandonment_20231006

WELL ABANDONMENT RECORD For tnicmill3wONLY;
This fonn can be used for sin�ale or multiple wells
I,Well'Coutractor information: WELL ABANDONMENT DETAMS
Scott Hunt, Jr 7a.Nuni6erofisdL%being abandtiiled: 1
Wdl CerfraciorNante(or%tellaw,"perwnally Agnilmdne wA1.on.iistlter prepern) For trnJopte. at;e ifeoi a+ tma")ttcircr suy)pLY wells ONLY w71h the swue
rnristnreUnuuerhUJYlfiJfnle7!f)ti!M[4UPS:JfnfltldJa'ftPnl,
4561-A
-76.Arprnsimate t•altime of ivat&rentaining in Ivell(r;)Q (gai.)
NC.Wcll Comrdoore-citiftiation Nnnrbcr
SAEDACCO FOR WATER SUPPLY WELLS ONLY.
Companp Naote 7e,Type of di4nfietant nixed:
2:Well Construction Permit M:,
LittMlagf!lhrrLtp.urltrmitr{%atCotirrtr,Surd•1'trrtratr<a,Lrrrctiurr,elc}f4ltuwa
7d:_?mount of dislnfccti>.nl nsivl:
3.Well use(shed.-well nse):
Water Supply Weill: 7e,Scaling material s usctf(check ailthat apply):
❑Agricuhursl. ❑1dunicilmlMiblic ®Neat Ccnicut.Grout la 13crrtonlicChips or Pcllcto
❑Cienthcrnxd(Hcatin 'Cooling Suppl<j' 011tesidCnihil Watcr.St) (sin 1c) q Sand Cement Grout ❑Div Clay
❑hu[u5triaUCatnntcn:ial ❑Rcsidcnli;d 1Vnter Snppt,}•(sbaird) .. - 'b
❑bri'� ❑fioil Specialty Grout ' ❑ +Giavrl
Nbn=Water Sutiplc Wcll: — d Betrlotute Slurry O C T Q b 202Qtha(etplain under 7g)
29Mm1[torine ❑Recovery
Injection Well: 7f.For each nraterihfi's6rMed!dbbti"&,dlrrts d". tt�ttit of ittaterials used:
t..,,. 3
❑A u[ferRcchar• ❑Growidimicr•Remedlation "" 1'�
q � Neat Cem.:651b ,Wtr:5ga1. Sand Cem.:lb ,Wtr:gal.
❑Aqu[fer Stonigealxf Recovery ❑Salinily Barrier
❑Aquifer Test ❑S lonlnsatcr Dra[Ilage
1313Npetintetual Te'chnolog_y OSubsidence Columl 7g.Provide a brief dcscripdoa of the ah andnurnent pr9igqure.-
Meotltennal(ClosedLoop) ❑Tracer
trimmy.from bottom to top
1:16w0 rthal(NcitinyJCoolinaRemm) 130 ttirlca laiuundcr7g)
4•Datelvell(s).abandoned: 9-6-2 3
5a.Well location:
Celanese Holdings, LLC
Lacili>iolvrRrNdrt6e ra:iltty 169 CiNpplimblc) S.Certification:
2525 Blacksburg Rd Grover, NC 28073 ��.+9C.C. l 9/18/2023
PhysicalAddres_City,mid Zip $LyworcarCestiricvt Well Can .toiorNVellontur D,qa
Cleveland i,si'viNg this fa il. I Itemby certify that uelljs)aas.(lcerr)abondw!ed in
Cona(y PsRel ldC1itil16a11ail Nu.(PIN) a6wrtfance ndth RTA%C:C 02C.0100 or 2C.02110 ffrelf Conviniction Sfanihwds
and lira?a ctmrTajilris'i•ecord huv hetn priovitled_to the well otrner.
Sb.I.:ttitude and tnug tulle in dcgrecOmfoutcstseconds or dccitnAdegrecs:
(if..w0l i`5;ld,ow L't111ottgigiii1firOct-A) 9,Site diagram or additional well details:
You tuay rue-the ba&of t1►is page to provide additional hell site details or.irell
N W abaudountetudetaik You tuay aLso'attacli aMiticiial pipes if ilec ssarv.
Ct7NSTRIiG"I'm OFT-41b;OF WELL0011ONG ABANDONED SITBRff7'f Ai iNSTRI1CTfO YS
fftaeff tt It_Cg25'L'JCifO/i n-curi A)ij a"lOMEi rim.=11161le illetrfnir iat t n•nxrhY su}!t!tu
Melk ONLY 111111 11.1 sii»re+cvasrrxtrvn a!+arikanucut ieu cuu rl,rcit i»te/nary LOa: For All Well-.- ,S.u1nnil IliEs fnrnt within 30 dn)-s.ui'couiplction of wellGa.Well Qr.:•
,t•B-34 ibandonnicni to thc.rollowiliG;
'
Divis[on uf,YVaterRtsoureLs,:Infotmatioti Proct-sing(Unit,
61r.Total a•d[dep(h: 35
1617 Mail ScnicKcutcr,Raleigh NC 27699-1617
(ff.}
10b.Ror inlyoIon Welts: In addilion to Roding 11re fora(to the addiess in 103
fc.t3archolc diaatetcr.2 du.) abo%h:-aLW sublidt otte Copy of ibis forul within 30 day5 Of completion of tl_ell
abandountetu to the following;
rd,\Vatcr tcvd,hcton•piiund atarfitcc•.15 (ft•) Di islotl of Waler Rt�ourc I,Underground Inje5 Con Control Program.
I636 1llail..Se nice Center,Raleigh,NC 2769l 1636
Ge:Outer casing Icngt h(if!mown): (fL) 1tic.For�Y:a rr. m ly.l'•Lyle tlon Welly; In addiliatr to sending the form to
the address(es) abode:also subinh bue copy of this-fotni within all daps of
completion of well abandotuneni to the county lientih departnictil of the county
GC Lnucc casin Jtnbin;;[eIgtb(f latawn): (ft.) whcm ibafidoned. I .
Gg•Screen length(If lntonrt): (ft)
I
Fona GW-30 Nonh Caroliw Depamiroa of Ent fronment and Natural Resowres-Division of WaterAC;ourms Rcviscd Auwsi 2013