Durham_Well Abandonment_20241001

WELL ABANDONMENT RECORD ✓ For lalemnl Use OWN
This form can be used for single or multiple sells \
1.W'ell Crintr•aemr Information: WFLI.ABANDONMENT DCTAIIS
Brian Ewing 7A,Number of wt•Ils being abandoned: 8
Well Contractor NanxlofaellowurrpenonallyahaMomng%ell onhn lie rpropcmr i.0 nmdupk rnleeo.ur or soar-soarer• rwppA **Ns ON5 reth rhea swat,
r. Vrrra f/wr rrtirJrMhulnAYrl.Lrw,rUr,N(Vrllf.err farm
4240-B
'b.Approximate%olunrr(of water rrntaininy m arll(sl: Igal.l
NC 1Gcn Canl rn lr.t(rtt nii-.tl ua:lnnhrT
SAEDACCO FOR W A'f F R M VPI I W Ft 1.S 0,.11:
Comm Name 7c. I Inc of duinArlant uwil:
2.Wdl C WMCtlar PerMk M:L_L WI0501142 _
Lcudt yrp(aaG1, writ+,•nr,Me n.l.Curege , !,Mawe• Lrlr,fian,rk ,It Am.nr
"d, lrnount of disinfcctanl uxd:
3.W'di use(check well use):
Water Suppl}Will; 7e.Sealing materials used(check all that appl}):
❑Apncuhural ❑1Numcipal:public O Near Ccmcnt Gran W Bcntonnc Chips or Pellets
❑Gcothcnn:d(Hcatmg1'oolinit Suppl)) 011modcrttnal Water Supph ivirgle) O Sand Cement Grout ❑Dn(la}
❑i dusmal:Commcruial ❑Rcsidcnnal Water Smpph)shaved) O Concrete Groin ❑Drill Culunps
❑Im •tnul( ❑Speaalt}Grout ❑Gra%el
Non-W Ater Sappl.%1%vll: O Bertorute Sluts H Other(explain under 7g)
O Mantonne ❑Reco%en
n W'ell: 7f.For each material w4ecied aho%e,prat idr amount of materials toed:
❑Aquiter Recharge ❑Groundwater Remed(auon
❑Arpnfer Storage and Recoxen ❑Salnun Darner
Bentonite.:501b ,Wtr:gal.
❑Ayuder 7 esl ❑Sbnmsa(a Uratnuge —•
❑Ezpennncnral 1 Lchnolog� ❑sdfsidence Control 7g•Prruvitk a brief drxriptinn of the abandirnmrut pro i.,dun:
OGcothennal(Closed Loop I-1Tracer
HYDRAULICLY PUSHED BENTONITE
❑Geothemral(Hearn0Boling Retuml 09Othcr 4explain under 7 )
(.Date well)%)abandoned: 8-28-24 /
'A.11e11 location: ?024
Malcom Pinkston Property
1"'11q%(h%ncr Nau, Facihts IDw r of applewbk) S.Certification:
•
1915 Chapel Hill Rd. Durham, NC 27707 _Brian Ewing 9/11/2024
Ph%dial Aeldres�.Ceh.aril Zap Crµratt•r of CCntlied W'cn(braraetnr:sr+A flair D6we
Durham B'i .sigmtW thus Joan, 1 hereby cerfz#-flirt the well(xt ens(were/dhwtduned ur
u n 1',t,d Idetntf catnu No (ply, arvorthou'e with 19.4. CAC 02C.010A or Y' 0YK)(Cell(agxt►wvPr;,Vanrlefrd%
and thaw a cqp3,of this reward hm•beert prrn•kh-d to rfre well owner.
th,Latitude And irngitutk in(kyp+reslmimtte%.,%caind%err dccim it degity :
((1 acll fill.orei Levlrwg a uJiw:ecri t 9.Site diagram or additional well d riads:
You our%(be the back of this page to p"ide additional well site details or%sell
\ W abandonment details. You rna% also mach JdditWlr►I pages if sec a ssan
(O\.I RI( 110\ DE I All.S OF 1\E:I.IASl IIEING ABANDONED ti_(RAIITTAL INSTRUCTIONS
,fta,lr a.i;a r.lrv.lna+n"u,r.l v{J orwhkyr .- , rrnr.,t—I—,aa!%9'rwjq.i,
ree'11r ONLY w,th the wmr ztm,frw or,Y aharvh-nnorni e.re eau whine!rule'Nkwr Ina. For .All %cI6.- 5ubmu this form within �0 days of completion of well
6a.%1c11 11)a-A-2 - A-16 (EVENS) abatdonnicn to the following
Diiisiou of Water Rewnrces,Information Processing Unit.
6b.Total wall depth;
17.25 (fl.) 1617 Mail Senior Center,RAki=b.1%C 2 76"4617
IOb. Fnr luleetiva Wells: [it addition to widu(R de form to the address In Ira
2.25 abu%e.also submit one copy of this fonn anhne I(+dins of cumpletion of %%ell
6c.Borehole diameter: (le.) ahardonoenu to the follo%rutg
Dhislon of Walcr Rtwources,L:ndertnwwi Inkcdun Control Pmwam,
6d.Water k•%el hcbm Yrnnnd surface: (ft.) 1636 Mail ticnier Cener.Rakigh,NC 27699-1636
10c. For Water Sunul% & InkYtimwFor Water & Wit: In Wilson to sending the fomt to
6c.Outer cmung length Iifkno%%nI: (8L) the addresses) abote. also subnm one cop% of this form %silhin III dabs of
completion of Hell abardotmum to the covets heahh department of the coum
6f.Inner casing/tubing kn>Kah/if I:naa n): (ft.l w here aharidoncd
6t.Screen Ic"Llh(if lum%%nl:
Fomt(,W-90 Nonh Carohm Dquilatcan of En troanea ad Natural Resowces-Di%tston of Water Rewards Re%rscd August NI I