Onslow_Well Abandonment_20240814

WELL ABANDONMENT RECORD For lltkml(JetONLY This fort can be used for single or multiple%fells
1.Well Contraemr Information: NMFNT DCTAU C
Stefan Smith 7a.Number of sells being abandoned: 1
WepCosnacrmNaaamtaClluatrYpun,n.,rah.utl,III u�:%r:11nih:,I:clptipemI V., muffif'k dile,rtrur or row-warm rugq,h we•1i• ns1.Y with the mw
, gwrwfh,v,,ntiamhrnnnrit�niw i:atr wMmt,wre Jrlrui
3576A
NC INCH Cmsmaar(7tniftcatino Nowbel 7h.Approximate miliame of w at r rrmainint in
SAEDACCO FOR W ATT R SUPPI.V WELDS ONIA:
Contpaa)Name 7c.'fy lw III di.infectant used:chlorine
2.Well Cnmtrnetitm Permit M:
. :dl,r(tryfk,thJr 4,'!;, �. ,-non.Mae.18nare./)#oetiraa,eh:)Ithiarit 7d. moult of disinfectant u.a'd'1 OZ
3.Well use(check'nell nw)-.
Water Swpld)Well: 7r.Sealing material.u.ed(check al I that apply):
❑Aprwuhural ❑%lunicipalTubitc M Ncat Cement Gran n Berttonite chips or Pcl►a.
OGeoulicmtal Mcannjz•Coolinp Slgiph l BiRc.iderittal%Vatcr Supph Isinglc) U Said Cemem Grout ❑ Dn Clay
❑Itldusinal C"1111ncrcutl 0Rcsidential WaterSupph Isharcd) ❑ Concrete Grout ❑ Droll Cmtinl~s
❑Im 'tion 0 Specialty Grout ❑Gras Cl
Non-Water Stiplih%t rIL U Beraonite Slum I I Other(explain under 7g)
❑hlonulonng ❑Rooter_
Injection Well: X Foreach material w4ected aho.t.prntide amrwntof matcria sowd:
❑Aquifer Recharge 06roundaatcr Rcutediaiton Neat Cem. :1881b ,Wtr:15ga l. Sand Cem.:lb ,Wtr:gal.
❑Aquifer Storage and Recm m ❑Saluuh Barney
❑Aquifer Pest DStomntaler Drainage --
❑Exprnmental TMinok)g) ❑Sd)sidewe Colntol Prri.ide a brief description of the ahandimtncat pniatilunv:
UGeothemtal(Closed Loop) I_ITracer
� tremie grouted using 3/4" PE pipe and funnel.
uGeothemial Meatin -'Coolin Return) IJOtherIex .explain under 1 —
).Doh wrllht abondoincl. 7/10/24 -. •SAL%ellkication: BUG 1 !. 2024
Residential Property
trills,<t, .i Facility MM(Capplicabk) R.CrniMation: ir- N try .S i}7.'}
bpi.'..a:
212 Diane Dr, Jacksonville, NC 28540t 7/26/2024
Pthwal Address.CM.and Zip r-rtwe .Centfied Well Cmitracnnr ur Well Omer bore
Onslow Ri .crXntnx this far, I hereby cerh,4-that the well(s)was(we►tei&evidoned at
t'otua) P*Pcd Ideelifbuition No.(PINT uccunitusce bilk 1.1.4?iCAC O:C.0100 or X OM Wdl Co nr maron,VrmdrmLx
tvid drat a cvpl-of this record hm•been prm*ed to the well owner.
5b.LaNitade and kingitwtle in Ikytrceslmirartrslsernnds or decimal degrees:
(ifwcll rrld.one U1 kmp,..oll— l 9.Site diagrato or Additional well density:
34.768625\ N 77.492409 `3, You mat use the bad:of this page to pros de additional%vill site details of%ell
abatdounteut details. You Iua� also.attach:ddittowl pages if necessan
CONSTRUIL PION DETAILS OF WEU1S)REINC ABANDONED CUBMIMAL INSTRIiMONS
A(hkh well CY)MV"Cl"er,urdw a atm1a,k•. 1vu muley le injetwor a.r rY ill
wV11.r(NIA wrthrhe uuttrtwotrwowr Y nrahwenrtt.t,m,aa Rhwu,vwP m lua. For All ''clb: Subirou Ihi_r l6nn within 30 days of completion of well
64.Weil IU4:WSW-1 abairlenntent to the o'hilowing
IN%i.iun of Walter Resltnrcm.Information Processing Unit,
6b.Total wall depth-. 35 aft,► 1617 Mail Service('cuter,RaleiLh.SC 27699-1617
loth. For lnkMion Wells: lot addition to seudrug the fort to ilk::ddtess in l0a
abate. alw submit one cop% of this form within 30 days of completion of well
oe,fkintdatir diameter:2 0111.1, abandonment to the follouIng
Di.islen*(Water Rewurcos,Undetxniund Injection Contnil PM-raw.bd.'atcr keel hrktw t.rriwtwl carfare: 20 I8.) 1636 Mail Service Cenirr,Rnlci_h,NU 276N1-1636
Inc. For' Salcr opnl% & Iniectilin Wells: in addition to sending the fort to
6r.Outer casinglciipthlitlaownl: (ft) the ;Iddtesstezi abuse. also subimi one copN of this form Within 30 days of
completion of%ell abaudatmient to the coiva} lieahli departnicre of the courts}
u Ncte ahirdoncd
6f.Inner c:►vimitwhin�t<ny,Khlitl:nnunl: tut)
ft Screw Icuuth l it hm m n I:
Form GW-in North Cwohm Depanmew of Em ironarent and Natwal Rewmes-Diu ision of Water R.soulces R,%iscd August:I)1 t