Alexander_Well Abandonment_20240423

WELL ABANDONMENT RECORD Forintamal Use ONLY:
1.wet Coubuctur Informatimc WELL ABAND®NNIEW MARS
t ,
Tammy Marlowe =-
WonComiacturt�lame(orvodl'owncrpam�mlfyafiaodbaiagwsnantfslbcrpropcny). w�tl�fdep�l�ontSri���S Indi+�ta��1�AfE�iii�E�eF
w�abandoned: I !
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RCWdIOV&MtQrCMd&MfiDnNmnbcr 76�pprnamAber noreofti*ateer iamgin�ell(s): i¢al,)
CompanyNffie 7� oitr feec�nt Clorox Pool&Spa Shock
2.Wen Construction Permh WATT
9d:Amouuiofdisiat'eetan�tued`�
3.Wc]l nse(c6eclr�cu use}:
WaterSbpply We1L• 7e.Stngmattrisisnsed(c6a9lttrstappty):
i3trgtintl[tt 13iNuuiclt/?dlilic :L3 Y'�eatGelfieattCuoltr { L3seritolmteCOP{isnrf'ei[eit:
❑Geo*eund(HeadndCoormg Supply) OResidmiW 9lWa Supply(single) . .13 Sand Cement Gmut-- �, I O Dry Clay
131ndushial/CommcmW ORarflcnoalWata Supply(dnmd) 13ConctctcGrout QDMCMtbE's
t7 lieu D;Speeiatty:Gitiuf i laamt-
Noa-Water Simply We1L i7 Bentonite Slang i ❑(ftlier(exp[ain under?g)
injection Well: 7E For each material sslcted'above;piraicleamoust of noeted2is used:
t7i47(tuft i KetTi3rge- Mhumuhrmer Omen
OAquiferStorageandltemei} OSalinhyBaaier i' I
OAqu'iferlest l7StomiwaWDrjingp
aS perirnental Teid oto - IjSiftidence CbiitrbI-
7g
DGewhemml(Closed Loop) Emmeer`t]t�eotherma (Ileatingl- - I2etum} DOi$ert Iain:u�7 y '
level and poured 6 in",_,Iyg APR 2 s
sa.well I�atian 2
024
Tammmm :
Tr+.'k'`.8ii'
Facirdy/OW=Naae RWIRy ID11(damlaable) &Certification:
2646:-O,1d,-Wilkeshom..Rd.-Taylorsvilie-28691-_ 411124
PhysiadAddcess C►y-dZip STm=afCe*&WeUCarA& orWeBOwer nm
Alexander ins t he>min 1oertry�har:tl►e,crff(s}Imsome ironed in
�' !m
aat3" Pan=14daitirmstiuie.No.-O.JM drzomria*e M•r hCAC®2C OlMor2C:v�rdFelf }birsrai�dards
- = .>uetrii�a.�Fy�t�u>�v,:i�S�enpmv�C�'mrhe,�r7ton�r
Sit.Latitude_attd.ftt�itaditi_ ; ordet�t:degmes:..
.•+ (ifwdlfm&I,we latrloag asolG�t) 9:�e dtagrameraddilicwaldetm'L�
35-degrees:57'2P' N.81-Aecgrees l ' -37" :p _a mat:Will d il�,o_��,-
af udonmemddailk Youmayarsoanaefiaddittonai'pagesifiteoessary.
C MNTK1'R� trr1ia5AI+'RM':7:isTUM' G lkisAN13QNT3r SU13iNUAL ITIMMUMONS.
Atmdrwellmris4vitiunrrcnrilrs)ijmm7uhte_.Forniultipreiajecaieu�w+fuu-mtersr�plY�'�-'- _ -. -- - - - - -
O:V Y riiti semepmest�r alatimaio pw+cansuhmirarejmax i0n..Eor stt t Submit this fttm v►ithin 30 dqs of compWas of well
6a.WeII tDf): - abandonment to the following:
-Dividon of W2terRtm"V&;;inlo=mation'1' ;fTilit,,
6b:Total welidepth:2T OL) 1617 Mail Service Cent,Raleigh,NC 276994617
10b.For Injection Wets In addition to sendigg We.fora to the addms in 10a
6e.11orc�oletlimmeler:��' (Iitj - iiboz�-adsasu6aii)oae"�sgo�t6isfat:s� 3tt-ciay�sficflt�sias�a�-�clt4,
ubandonmeotmthefollfl�vi�
6&WaterTeVdb&w jllnlsmat s l - .- l c s
ground ) 1636 Man Service Omter,Italtigte,NC 27699-1636
� F
_ 10FaF.l3raEcsis �io1�' ?atuseuilaigiEistfiaiitrlirtTie
g�Oriresu;i;greflt( linaurn (ILT
addresses)aboee also stilsmitaneeW oftbs fotm witl>m 30 daysofcampldion
'ad,we0_aboadGntrttea`*the iaa ttity.'hea[th-:d4wtm=tof the.a umtx.where_
6f.lowercasingltnbingtengthQf mow* (k) abandoned
6g,Screen leugtb Cif lm(wrn):m
Form Gw-M NorthCuorma nepanmeatoftncvimemenml Quality-OWiCmnof&amrResomm Revised 2-22-2016

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70 dS clay