Onslow_Well Abandonment_20240624 (4)

WELL ABANDONMENT RECORD FathnermlUicONLY: I �
• T$tis fo'mi min be.ased for sitlgle or utu]Iiple `ells'
1.Welt Cautracfir loformrttipu: WELL A14ANDONNIENT DETARN
Stefan Smith 7a,Number o6vt*being;ab wdonl dl.l
\1TcltCorrtietortr' orsliitawrid tSorralt:ali5e* tt,,u if ru a Fq' tetrlapts. fntecw•ar r; nrnmi'nderl supphl wens- ONLY with +rye' stme.
. ( Ik, S.• >� p. lx 9) r+arsrrnrcniNi;rabnrrdaiinrent,,trtri ciim.srlvrrrt�rxreJFirut,
3576A
74.Approsiinute voluiite of vtattr rem doing In viell(�)i f at.j
NG1VcgConlr�aarCsn(fiadiouNnnlbcr - -
SAEDACCO FOR WA7'EIt SUPPLY WE.LtS ONLY:_
ConVanr Nante
7c,Type tiEdisinfi'ctaut uxetl:
.2.%VdlConsttvctltln Permit ff:, , 1
Itu u11 rrvplkubte:rixtlta rntli. (Ze-(txlrtfV,Srr4a,)7rriilmee.Lr}raidi.,�tr./J Rrnrwn 7d.Amount of di$Infcctunt tied:3''oz
3:�wdt uyr(cbecictv'ell u:tr}: -
�Vater Supply`Yelp Tel.Sealing irolatctirtls used(chcelc-all that apply):
I7Agricirlhtty[ C]fvltiniciptlil'uhtic (k Ncat6nic0t,Gmut a-Mmonitc.Chips ofPellets
130ccoft mat(Hcatinef t,000no$apply) bIRcsicicnti,'tl%Vatcr'Supp4'(singlq} Cl Saud Cantetlt GM'ut D Dry ckv
❑htdustriallComriurCial pl3csidtmia[.�V,�tcr$trpPly(�I>nird). ❑CbMete Gwut ❑Drill Cuttinp
❑Irui lieu 'O Speci�lt}Grotit ❑Geit+el
Non-1Yntcr Supply Wcll: 0 Bentonite Sloop Cl Other oxs lain uudcr 7g).
DMmittorine DR&oticty .
lajection NYcU• 717.For.etch material selected abov,provide aruount of materials uiW:
13Agttiferitecbar9e DGroundnalerRcmediiuion Neat Cem.:1881b ,Wtr:15gal. Sand Cem::lb ,Wtr:gal.
EjAiinifei Storage ai#i R,"Lovely DSalinity Nnier .
DAquifei•Test DStomricaterDtairutge" Bentonite.:31b ,Wtr:gal. j
DEyreiiriteulnl Technology DSuibsidxt a Corytnl 7.Providea.brief d6criptipn of t6 ir4aadnnmetlt pr#4-dure:
DGeoodwnml(Closed Loopy DTracer i
®Geothetnlal(Heitltintrr`Coo6gRehtm} 00tker(ei lain under LA)
_abandoned via tremi e .
5/15/24
t �.�..
d.DatcwcU{3).abandoned; � L..
S�.`Nell Eoentiooi _. ;• ..r .
William Lee Locke r �'Fr8 iZ �'rr8r°wY•=.y
racrlii}sti"aw--rNuiec FailityID9(ifappIk4le) :GcrtiRcrtdiai �rrri t;it"�C
115 Vera Court Jacksonville 28540 5/27/2024
Pln-sisal Addtcs.Cite;and Zip S' .Irtre CedMW Well Corur rclar at-Well Qivner pale
Onslow 13)+sig1rh1g PhEv;ierin, I lrerrlry_eert jy•thnt the wellly)was(here)ahundoried,in '
Cauuiy ltareei lg_IWrhiWAitNo.WIN) aicwnhrrrce tv rlr'15if_1'�tG_b3C;(1It10 err 2C.boo ft%e!I Cciitatizr�iun Stanikrrds
' rmcl llra(rr coP3�o�`tlris rccurrll�rzs bear prat i�'iarl to tlrs.lrell of}•rier.
Sb.X;ztittidc and lon�itudc in dcgr�ces7ioticiutwaJsc�vitids oc dccitutil dgsrecs:
(irne11 rtld,qlw tilih*ig is;sitlricktx) 9.Slti1 diagram or addidoilat hell iletalls:
You ma}'.tise ilk baek-W'this pagOitq',provide'additional ukll site.details orwill
39.769898 * 77:492576 ��+ :aluuldomitetttdecails: Youtuayi6o:aitaolladdilionatpagesifrkt sate'_
C(1NSTRIl1"'rtON.DF.TAiL5 OF WFLLISF REIN(.ARANnONED CLTRMI m—A1.t*,TRLif:TIOMk 1
Attach lrieli tv,2WIkYi-rocvrzfls)11'gimltrsrh- Rev mafupie itr*i-aidn iir Mn-x iiL,srgph
x�17s OVL)'li liL t1k�dome trurstnurtrorc'abnmlotxAenl.Jvu nxr urbMta wre f�rrn llla: For Alt Wells: Submit tliEt l foriu tiittliu 30 days of cotiipiction of hell
abandtiatucnt la lure following. !,
Dlvisinlr of Wutcr L4esource,,lnfptuvrtion' Protrs.'ing.11nit,
I617 llLtuf Sei vise Center,lI rl �h.NC 27G99-1GI7'
6b:Total well depth: 139 (Dt•
IM f1gr loge"Clop Wells; h1 addition to ssuding,tlie futnt to the addmess'lu(Da
tec.-RorelioM-diameter 2 (in.) above,Aso-suliptit ono.topy of this faint witl(in'30 dilys Of comptetiou of well .
abandontncni to thefbildiving:
Dhiston of Water Resduries6jUuderkround ul Leitan Control Program,
6d.Water level below ground surface: 19 00 I63G Mail genies Center,RaId r,N('V699-1636
6c.Outer casing length(iffImown). unknown (fL) Ioc.For MIM Sttntily C LtlectinIII a; In addition.to sending The form to
Hip address(esi above. also submit oue copy of this.Ibirtt•within 30 drys of
completion of vt�dl abm doun;.nt t't6c sonny tt6tth dcpadnicni of the county
unknown where abandoned,
Gf.Lmer a tsin�Jtuli ig;tengt4(if lnr6n'n): (ft.)
ft Screen length([f known):
Fomt GW-39 Naalf Camllm DeputuicM orEnOwumeat.aW Natuml Resomms-Dtvlslonof Water Rcsoirrns Revacd Attelrst 200%
I