Iredell_Well Abandonment_20240731

WELL ABANDONMENT RECORD For Internal L)w ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Billy Joe Payne Jr. 7a.For CeoprobelDPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personalty abandoning well on his/her property) well construction/depth,only i GW-30 is needed. Indicate TOTAL NUMBER of
4532-B wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in welks): �5 (gal.)
Excel-SRP Environmentau r ! s` FOR WATER SUPPLY WELLS ONLY:
—�—Company Name 7c.Type of disinfectant used: Chlorination-CA(OCL)2
2.Well Construction Permit#: JUL 3 1 20?4
List all applicable well construction permits r.e.UIC,Caunly.State.Variance.etc.)ijknown
Irv(^,:,".:r �,s r', a*r 7d.Amount of disinfectant used: 3-OZ
3.Well use(check well use): IN^s t{-
Water Supply Weil: 7e.Sealing materials used(cheek all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
nlndustrial/Comrnercial ❑Residential Water Supply(shared) a Concrete Grout ❑Drill Cuttings
❑kri ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
eMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
UAquiferRecharge 116mundwaterRemediation Bentonite— 30 Ibs concrete — 15 Ibs
()Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test []StormwaterDrainage neat cement— 10 Ibs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) []Tracer Dropped Calcium Hypochlorite into well and filled
❑Geothermal (Heating/Cooling Return) ❑Other lain under 7g)
casing with bentonite pellets and poured neat cement
4.Date well(s)abandoned: 7/2/2024
until approx 2-tbgl and poured concrete inside casing
5a.Well location: to near TOC and fill ault with concrete
Gordon Iron & Metal MO-3735
Facility/Owner Nanic Facility IDtt(if applicable) g•Ce
1300 Salisbury Rd, Statesville, NC 28677 L., L
Physical Address,City,and Zip S- ted wen et n or Wen Ow r —
Iredell 4744819411.000
By signing this form, 1 hereby certify that the wellls) war( ere)abandoned in
County Parcel Identification No.(PiN) accordance with 15A NCAC 02C.0100 or lC.0200 Well Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(if well field,one lat/long is sufficient) 9.Site diagram or additional well diAiffills:
35.773476 N (-)80.858403 W You may use the back of tins page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Aaach well construciion record6)ifavailable. For multiple injection or non-watersutpp/v wits
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well fD#: UST-Well abandonment to the following:
Division or Water Resources,farormalfea Processing Unit,
6b.Total well depth: 36 (fL) 1617 Mait Service Center,Raleigh,NC 27699-1617
10b.For IMection Wells: in addition to sending the form to the address in 10a
6c.Borehole diameter: 2 above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface. --26 (ft) Division of Water Resources,Underground mjeetion Control Program,
16%Mail Service Center,Raldgb,NC 276994636
6e.Outer casing length(if known): na (fL 10c.For Water Sapph,&injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known):_na (1L) abandoned.
6g.Screen length(if known): UNK W.)