Guilford_Well Abandonment_20231006 (2)

WELL ABANDONMENT RECORD For lnlanWUWONLY: p
Mils film sail be useri.foi siijgto:oe ntuUip[e.titi'clls I ,
I.Vell Contrainbi•inforntationr i,UL ABANDONMENT DE:TAIt S.
Brian Ewing '?ra.Number of ivells being;abando nc d: 1
Wen&rsradbrir'aold(4ruclIa'w erpC—M-hallyyli41d4 ineiwll.0-H,Plttitr A61 finulflirf, lgfartac a morraitrfer;su,�tAh wells- -ONLY with Ike srun.+
C?rt.4fPTfct1011.6V O1XirNIr71�72f,)Yrrr C;Tr x r'j Idt Mehra'
9290-8 1
1VCWc®Conlydci6rCsnlrrcaliotrNiiiiibd ?I►.�1pl�rn�cimafc�nlumcuffv:it ttin in"�ie1lQ�ji ( uL)
SAEDACCO FOR WAT'TRAUPPLY WELLSONLY;
CouS}5uny Nam. Tr,Tv'pc prdlsiurM_aut 6Sed:
1 well Consttuetion,Perutit ti:. �
Lt3f rrdi.�/inrlC r6i�.rie�F ftrmiZti(,a:CurrrrN•Sttb�.l'arlrurc�.lirJrtt�rJr;;r1i J ffulrrrV.
7d .,tinoutit ofdlsintectunt used:.
3.Welt usr(eiredd:it•elf
Water Suplily Weth 70:Sealing inatcrialstised(chscic all thit apOly)
pr�srisultttntt C7htitriigpaIll'ttblrc. CI'.Ngt'Ccmoni.Crttiat r�'" ? `p 5d�entnri ec.Chips or Rllcts
C](icathcrinnl Hcatin Cook •*$i t• 13i2csidetrtiat LVater Sli in le E3 Saiisl CetnitU Cimut ❑E-Y Wit'
❑bidus<dal;Comntcrcial ❑ltcsidential%Vater Supply.(shamd) O.Conct,;te'G,wut OCTb [ itlltlttiings
❑Ini fiou ' b.speriwty'Otqut O Z17`��ratcl
i�an 1Vatcr Supply-VV.cll: ❑Bet)tonite Sluizy ln,;,, ti s�;t t'r.= CNL itlayl{£s�laitt under?g)
®1vlogitgring:, ORecoten•.
Tujcctian Welt: ?f,'For.each-ntaterialsdccted above+provide amount'af.materiatsrued:
OAquiferRecharge: l76r6uiid%}j:t irRentedi;iiioii
OAi 4u r Sionigr at 17Salinily Barticr
Bentonite.:501b ,Wtr:gal.
❑Ayuifi�Test ❑Sfoititt��atrr Uniinage. .
I7E t rinietital 1itilittdie�Rv pSubsideltcL`C otvil 7g Pinvidc a brief d6trini-of bc'ptio .t• a i;i dOhnicat rrtrciduiei.
Meodmun<t(dosed Loopy ❑Tracer- . . .
Removed temporary well and backfilled boring w/ hydrated
❑Gcothertual(11calin&'Coolln Return) ❑Other(cx plain_undcr 7g), .
bentonite chips
3,pair ti'cU(s).ahandoncdE 9719-23
I
5iL Well hrcation. I '
Kimball Auto Glass
raCiliiF/�5vtxr Nttmc rxitity M'(ifapplicabk} >3.CCtYlflenlioy:
798.N..Main.St. High Point, NC.27262 Brig 11_ E-11Y I n 9/26/2023.
Mysical Adits.City;acid Zip r,r-V4 0wM*r Dino
i
Guilford 4v ar0rirkq this fFirar, t liemhy c Jive usH('s)was(here)a6mi tarred hi
Clntiuty 1xr 0 ldknjil5iyi11nit Nn.(PIN riixvi ifrrt:is tr idlr]'l.�C.,IC 02C;'01'gO ur-2C.0200 l e11:Cpisthidimi Stijiarhiril,';
' and llrirt,u caPe oftlris record lius beers pint i�'etlao ihesrcll ou•irer.'
$b.;l ittitude'and longitude In tic ccslitilttutesFsscbnds or de'dinAdegi�3:
(if ii t 11 rfold,utrc tom,";tssrrtrtcirry) 9.Site diagram or additional Fell iietalls:
-You.gmy use die:ba&bf Otis page io:peoyid6 additional trell.site.datnils:oi well
>t W aGaodo, teutdecaiLs Youi*alsa utaehadditiot�lpaosiftWICes'saty_
GONSTRttc nN.12PTA1L5 6V WELLiS)BP-mr.ABANDONED SITBNrt7TAL tNSTRUCTfONS �.
.trtrrtir 5rr11 ctirrrretefirrrr rucurdjs)'ij aikiftia!ite. 1�ru•irr><trpre rJ�c�cr;eirz.ur'nnrr.5rxrrrr siippl�
netdsUhrLYSriNrrlcs5iurcawrsrrc�nrle'iziarrrhirrrrrentizucansulinitarrfarm' 10a: Air All Wells Subinit this (bru'tiithin 30-tlrt'�of completion of tell
&I.Neil ID#:TMW75 abandonmcnttb thd'followinr.
i.
EHvisinn of Water Res;oo'mm,Information Pruces up Unit
fi517 Ntail"Senicc Ccrtret� Ralci},li itC 2?69'I=16t7
Gb.Total well.depth:.30 (rt)
lob.Tar Iiiiection Well : In iddifibn to sending thofornt to the addtess in 101a
Gc.Bareltole diameter: (iit;)' 'above.`also,snbntft,oni cope-of this Prot%%itliiit'3©4%of couipteiiou of►cell
abiittitontneut to the,11611ott•injr. p
.DiAslon.of Water 116ourres;.Undergrourid Lijcctirin Control PrSogrrim,
fail.Water tevrl.ba lam ground stirfaccE 1636 Ntail Scut ice, tntn,Ralci l!,NC 27699-1636
6c.Outcr casing tcnrtL.(if lmmvn): 20 (ft) lac..Gnr Water Srmnh'&iutd•etinrg�Ye11Q: to addition to sending the form to
lhe::address(es).abo�•e, also subrnit.oue copy of this fbmt witliin 30 da)•s of
completion of Well abi adatuireni to tiic county lieirith deponent of the county
G,f.inn&easing/tubitig lenyvth(if taratrn)q (ft.)
ti•Itcrc abandloncd,
Gg.Suti�en Iengtlt(If Imott n):10 (ft.) I'
Faun GtV-9a Noah Carolim Depattitum a.Em lroampit a-W Natural Resomces-Division of Water llrsourms Revised Aupud 20 B

WELL ABANDONNEENT RECORD For lritcrwl Usd ONLY:
"This fain call be-ukil.fbr sing*04 of nuthilik wells
1.Well,Co 11travirit.InforniAlitin: 3NFLL ARAN00NNIENT DETAILS
Brian Ewing '7a.Number of vdis being abandativh
I 11irecuolt or. I ft,Y .sjrpph- wolfs UNLY wab ike, sane
pin Cwt.olvilk INJ'0,01ral,
4240-B
NC Weil
7b.Ajilimvfflaie volume ofivatel-r1ran.Mining in Nidl(N):
SAEDACCO FOR WATER.SUPPLY WHUS ONLY:
7e,Tylke oftli5inkvitant iised-
2AVelt Construction Pernilt 0:
7d.Amoun i of disitiNctaut used:..
3.Well Uk(j�jlevk*eu Use):
Water.Supikk Well:
EIA9*111tuml 0,Ncat CCn1c.0CGfqiPt
00milicrml(Scatillecooling Supply) QRcs dcnript Water S)ipply(sifigie) El S�fid cg'jlt��, ot� j P D ly C kky
za L_i, e 9— J,
r,d) 1:1 P
0hidusirtit'Comnic rcial Mc5ideubt%VatqSu pp4,(rl,,, -B Drill Cititin
❑irti lion b 8peialty-Owtit OCT 062023 b dr-avel
Non-Water sup-Aywell. .0 Be ntonite Sl.ut.w -z.g Uln`l 00 1 t.licir(exTiain under 7g)
!"icction NVC-11. 7f.For eachtuateekil sek b W, ri Isusc.E3Aqni1[4r.Ri:rliaq6' 0310'ami6ler Rewdixidii
Mqudki Siosage ailki Recovery d alftlditv Dander
0A.il.nikr Test ris tonknvu(cr D,nitmaje Bentonite.:50lb Wtr:gal,.
EiSubsid-e0ce Uniml -lde a 7g.Jim brief d6criptirniattk abandonment prijeedurM.
Mothemal(Closed Loop) '13;rmcer
Removed temporary well aiid-backfilled boring wl hydrated
Maothennal WeadnWiCoofina Return) CjGtIi6,r(enlainuudSr7P),
bentonite chips
4.Daickvaf(s)abantloned: 9-14-23
511.Well location.;
Kimball Auto Glass
racHitriC tvmrNimic rxilit%;091(Itappikab1c)
7418N. Main St. High Point, NC 27262 Brian Ewi 0/26/2023
Physical Address,City,-arid Zip Si�iihirc of Cii tried 1V01 Co i ttrj6oi 1.7 vv.it Owtur villa
Guilford
111e itlelljsj was firare)Awidoned he
and'M fa cup,of
record Inis been pmilded/a dre.0-ell ciuiier.
5b"Utitude and Nugitodc in. es7niiatateslsccnncls or deldniAl degrees:
(Irlviq 11 rwK o1w L-ItAong is"�Jarlcp.cm) 9.Site diagram or aMtiouat well details:
You.tuay.use dib bii&of m 0 ja to pi6vidd additi o*nal
lkie �'(ail _L 'l'aM
N w J�#Jik I also ittac i itio uar paggs if liecessan,
abandoin fit e U43
coNsiritut-noN.fiF:Tmvq OF wE WSV UK UNG ABANDON 0 0 _StTRNInTAL tNSTRt1CTION, .5
_Ift Fiar All Wells Subukil,thLq farm xxithin 30 days of wulpletion of=11
6g,%,eli ID#:TMW-6 ibandanni,crtt to the rolloivlkq-.
DiVi4i6n.of Water Rc�tkntvek,Information-Pr0cessing Unit;
6b.Total well depth: 30 Ift.j 1617 Mail Stnim Center;.Raleigh,RC.2769 9-1617
10b.Eir InleclUtin Wells: hiodditibu.to sending The form to the additss in l6a
-above.ak subuth one copy of this formN%iddfi 30,4,!;of catitp'letioll of uva
6c.-Horehole dianicter. ;ibandotunela to the 1`iijIUN1.j1;i
6d,Waterlevel.belo* Dhislon-9f Water Rvoiries;.Utidergrouud'liijLCtt'a Contain Vrdgra o,
ground btrfucC; 1636 Mail Senice Cc*i rkaldgh,XC 27699-1636 6r,.Outer casing leno,th(if hnown), 20 tita-Liddress(es) ;tboye. also su!Jtuit.One- In addifion w sending the fortri.to
copy of this font wit.hiu.30 days of
completion of well nbandururkent to 6 county health dCiNkrinicid of the county
6f. if linown): 00
45n.,Suwu length(Iflakowl)-.10
tbmi G1F-30 Nonh'Catotlm DcpJtljwra of Esiviyoriment and Naluml Rcsowccs-Dh,isic Revised August 2013