Mecklenburg_Well Abandonment_20240529

WELL ABANDONMENT RECORD � rrtlkk ialy cONI.v
This fomi can be used for sin*of nutltlPk wells \�
I.Wes Contrarwr Inforgtatioa: ` WEI.1-ANANn1 NNkN9'OF:7At1 5
Stefan Smith 7a.Number of hells be t rlwndutwil: 1
M`c4 V1}WXUA Kim Ulf%Cll trgh/ rlu-illiU,1"%CH Oil lusher nc n%I i w wwNJl* rnh'&w w• m,N-+tester aka* *4,4 ONLY wah W wwte
['tiY(t/Hl(NNI+aI'rpabHli9t'ttt,I.*t,kY
357"
NC*01ronlmr:bxfetHAQtimNaabcr 7h.Atgtmxitgalem111rMeuft►utcrrrmaiain;;mNrll(�1?1 {�tll
8AZDACCo FOR WATER SUFFLV W)f H S UNLV:
ray Name 7c T,rpt tit d Audi clam awed:
2.Wen CaaattttctNrn Per"#:50000162,
Liu,r!(, riKW�4 w yr.CadMil'.57Yk.1urPlmcC hrtrcGrnt iMc:r r�Att+PwvJ 74L Amm"t nPdislufectant u.cd:
1161,01 n k.(check N tit nstl•
Wdtt•r*"1lgyth 1%ell: 7v...Sraliat matrt(a14i uwd(ttkAk all that appliv):
E34,molitiral Cihhlnicipimthltc a Ncat t'cmeul Grua rl R'CrAimac(114Ts(if Kilery
Oticotlk-mral(HcanncrCooling 544*v1 Gilt.Idet*131.A•atcr SUPPh INIII..`O O Sitikl CYINVIY(item Cl Dn Ctn
Clltdustri:tiXoninwNttl 0kAxxktktal%V:na uipph Wtakvd) ❑Ctwtdc C"M ❑DWI fistimp
E31nigatimi O Sptx't*GRIu1 Cl Citawl
Now-Wont,Supply WcH: Ci Beta(mi a 41(an 17(totes tcxplato under"31
aNlutatonnt. r3krco%ety
leje."inn W01, 7f Par each maRtialKitcv-4f AWN y.Jim"idk•a11wn1tlt fit aifittrialsOW. d:
OAgaiter Rekharge ❑Ciroutwhvatei Rettsadi:utou hest Cem,:501b ,wtr:4gal. Sand Cem.:lb ,Wtr:gal.
OAt uder Stvmw and kthw%'M iJSJlllun Hatter
O Ailtnhr l'esi Dsaonimaict Dratmige --- - ---
❑Expettutcitud lodmolttln t3Subsidewc Cbtrirol '�.11i,ivide.i hriefilmrilttittu of the abauthnitlx•nt pr"ttihare:
UGeodwitmilIClosed Loup► UTracer
Tremie grouted.
CJ -mik"Tw Huai '•CAolife!ROW" LI00ki( .Ilam olklct
4.Ilatrnrlps! llyndunrd: 4-29-24 MAY .ji ' 202as
{a.N'cll plcation:
ATP Site L r.`:.. t_• .'
i".v;dHt t1ttrlM Vanr PaeNNy t12Y(Ir:q,t ale;,l(IIe1
It.CrtUlkttNoa:
6800 Solectron Dr. Charlotte, NC 28262 - 4/30/2024
Pliyweal-Addicts.City.,ud Zip tml
Ceuiried Wag(:ntlnuKmt tx Weil(ytvtaCr I1w(
Kacklanbwr r. 04711203 Iiv.vtf(,rJr{iE rhes,h:rrot. 1 here*i,Ierho,r/xu rhr wrths'P "to nrrr+rr ahatuhns d tit
tatafU I':a:e(ltIcAlliv d pit No r111`1 14-tis Al(k'e 4rrh I U'V(;R,(!Y'.01410 or X 0.'"Owl(ivis"cntm swe(tmtx
ruts!ikrtr a *v well mixer.
Wk L.atitudt and l anfitu*in tkgrr+ry iiantrslstennda for decimal dcxrm.-
(J"-Ch rrrhl.one U• hunt n<wutt:tad) 9.Slty diagram or dd(NtiUnil NCH Math;
1"wt miff (nu(lie batk cif this pagt to pic'n I&addi(kn at Well site 4d"of Wd
_ 35.311956 N 80.780951 W ab:udunnketu tktails. You mu%also ailacli:tddowtial wgp N if t ccftmi ,
UON.rRt;( flu.N llIJAILS OF III l:l.HS1 BEING A ANDONFO 4t�eNjj jj+t,INSTRLTC. •bY3
.tiwisir rr.tJ�rxa�b'tr,.x+.,r ra•t.4•.Jrs;r;�,w.'uhh•. t•.w!rrt,l,it+,k rye.JPn,r,w,i•irt�4.u"rr Yalrg•ii• "
wti*ar0!V1Y wuri the Naar:I irtJmrrnr Iaswal Karteor.imv nai tmSwto mw bmf tea. For All w�_w Sttbmtt flits [i IVI wtthin :+0 dFa%% of CatttPldwo A feel)
Wet 1l lO-3 ab.utdotimcm In the rallowine
Division of WaterRemiurv.,lnlutmiatimi ProrewK,Ihiii.
6k Total*It depth: 35.5 1ft.1 1617 Mail'mice Center,Ralvi;h.%('276 r►-1617
111b.For Inircting Wrlltk tit iWili xi let.,1,J'.,i dw f01m to Ilk-iotltcss tit lo-d
atwvr,Aw submit otic alp} of flns fow .(ttl iii 41,dms of cuulPiction of,Adi
oc.1Lu'lhnle di;tnlckv:2 I,in.l *3tw timew to the fallo(vnte
1lhishm a(Water Rraiatr(.,I nderuni end Inoctitin Conwil Profraut,
I.il.\latrr Fes ii-Alien �rround.uliacc: 35 (R.) 1636 Mail Service Crater,Raleigh,N('276"-163Ct
bc.Outer cuung knfth(if knee nt: 25.5 lIT► 111t.F2[wour Seunly isItti$-'IuIM w1s: to r1di(tno tit scti m19 11K form 1e
elk ;tddtcss(ast kow. also sul:niii eme copy 4 flits fottu %ithiwi n dms of
:ompletwn a) well$lniltmncnt to the:outny lumbit dcpamuero of the coijm
v.lure ah irtdtancd
o(.Inner casine�tnbint!ten;Khrif'lalnwni: tfl.l
tit.sci-mo It!"Uth(if W14011n1:10 lh.i
FannCily`-Nt NiMhl'a[ullm il.putnea ufEa(Iniattie It and"JatttiA R.�ra rocs-Mrsiose[Watt R 1uMKat R.ttied.August 2(i1

WELL ABANDOnglie N(ME�NT RECOR ,ita D F,rt,ftlUw o,., y
ils
1.Weill Contracmr Information: MFNT DET411.11 ---
Stefan Smith \ 7i•Number to(wc113 heft abunduncd: 1
Well(lniracun Nana for well owiwr 1m inalh ahaodnmaa Nell an hterlaf propert%i f,w rrminph' tmA,,trot or oww-warm e1gyVi .Oe< OAV -(rh tM:r .,tarot
Iv)✓y1R1YttMYi.tlnvitMtttarrrf,NtN s1Wr.,vhwot ewer Finn
3576-A
N('N'cll Commeiar c cnd><aims Nrtntxi 7b.Approximate volume of water tttitrititR it wel 4
SAEDACCO FOR W ATF.R SUPP1.V WHLLS ONLY:
Conlpon>Naha 7c.Tipr rif dis4nft�rtaM used:
2.Well Constriction Permit 0:1000417, ,
J,- .!r ""Maubf, ueel IJyettitie,eta,rf k*AWff 7d.Amlmnt of disinfectant used;
J.W dl use(check vi ell u.e 1:
W'atcr Sappli Well; 7e.Staling ma"alls used(!heel:all that apply):
❑,Agncultural ❑Municipal Public I I Neat Cement Gto(a W Hertontnc Chips or Pellets
GGcothcrmal McannG'Coding"Aq*N l ❑Rcsidcttud Water Supph ivn_I,1 ❑ Sand Cerntem(omit ❑ bn Cla}
❑Indusnnal,Conmtcrcnal ORcsndcrmal Water Supph uhvn'.l ❑Cotncwte Grout ❑boll Cuttings
Ultirtgailitin ❑ Specialh Gtuut 17 Gruel
Nom-Water Supph Well: i]Belao lte SI(irn I i Other(explain under'g)
i➢Ntomtonng ❑Rcto%rn
Injection Well: ?<For each tuatri ial wkaftrd aboote.prmidr ammat of materials ased;
❑Aquifer Recharge ❑Groundumcr Rentedmiton
❑Aquifer Storage and RcCrn en Dsalinun Hamcr
❑Agnufer
Bentonite. :491b ,Wtr:gal.
'Pest ❑Stomn%arer brauuigc --
❑Eyienmetual Tech nolotn r3substdcloce Conarol - Pin,hoc.i biid de,,i il:•n.oi n)the abindonnncnl procetJurct
r-
OGeothernial 417bsed Loops 17Tiaccr �p
�'�"'h • 1
OGcothenttal(Head 1Coolin Rehtml r:"hicr(explain under'. ) Pour (r 1.�..".
i"y % 2024
�.Date aclltsl ahandunrd: 4-26-24
Set.Well location: -
Metropolitan Redevelopment
FaciltN�Chs rCt Nptta Facilq.Inw(if applia%hkl
K,Crnlillcalitm:
1200 Metropolitan Ave, Charlotte, NC 28204 4/30/2024
Ph.sisal Address.Clo.aid Zip S+Lrwun (•tml'lod 0.'cll('anrrxtiar or W'¢tl sMmr Dak
Mecklenburg Ift %itnitrig this Jiwm, 1 hereby cern/V that the well(s1 was iwrre, (thmt(hlaed of
(L1,1111, Pmttl lokiddicalion N„ WIM atrunhnx'r with PU MAC OX.0f00 or X O_'Wi Well Cunshvc(lon Van(limh
anti that is tYynr of this the well owner.
Sh,Latitude and Inneittide in dtyperslminutrsisrrrind%ur decimal clegrecit:
(u Ncll fold one Lot G,ng 1,.ull)carf 1 9.Site diagram or additional well 4"9:
You m;n the the back of this page to pra%ode additional Well site details or%tell
35.211237 N 80.836369 W obi nduutncm dccaib You am also attach addawntal pages if nieeessar%
CONSTRUCTION DETAILS OF W ELIa11 BEIM:ABANDOM1ED SUBMiTTAi.INSTRUCTiONS
.lirtkh)reel LY)2,9r tJ&M na,)rdr11{l aiwlahW hat nrultipir )Ve,(j m u.test- 01e),wlgeh'
xvUr 0ti1.1'ltnh rhe,mmw twr.,tor whm)tarekww 10a.For All WCB.ti: SuhnW Ihes tams %»thin ?0 da%s of completton of well
abandonment to the folkiuing
Dhishin of W'aar Remiarces,Information Pnittwrig Unit,
6b.Tamil well depth: 34 1617 Ma6 service Center,Raleigh.M'276"-1617
106. For Inkrtlan Willa; lu atklitio%t lit,cidnig the funs to ilk;ddicss m itia
fc,Mirrnwilediatnrler;2 tin.) abu%e-also subinit out ccip;% of this lenn%%ulna ;It"s of cuntplefoon of tell
abandonnicnn to the"lowing!
19 4 Dhisiea of Walter Resuirm,I nder;ntund Injec•Nun Ctmtrirl Pnigram,
ad.Water king hrhia gnriatnnl soignee: (C►•) 1636 Ma6%mice(atcr.Rrlri,h.NC 276"4636
19 Irk.For Water Sum►h & Injection Wrlbi: In aMition to sending the font to
f:r.Uuhrcasiuglengrli of knor%n1: (fret the address(esi abuse. also submit (qk cop of this form %%olhon %u da%s of
completion of ucll abaidomient to the cournN health department of the counofN
6f.loner ca.ing.+robing loenlah(if kwaun): (fi.l u here abartdnned
6g.Scorn length 4if known1;15 Ifs.►
Fotnt GW-3n Reti tied Augtsi N I t