Durham_Well Abandonment_20241115

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WELL ABAISID.O.NNIENT RECORD To flitter-nal Use ONLY.,
TitislOrnt Ctin he tisetlfni•.Singte:or Utollitile.'WellS•
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I.Well'Conti act]rillffirllthOtill: WV-ILL ABAtelit)leMENT.DETAII-lt
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Chris- Suffer ' . 70.,liaallicr of wells bing alotndonctit -
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Welt enierael91Ilaote.Ott..kiiil Oplt,tAl;ISkjitillbai9111111Ati.1:011 310101'tiriipFly) Ftii, iiiiiivile tipitikur •'-sitiipti.' Cid/sr.%-ONLY •t;teth Ilm. -Rome
o'grkirmajiAir abriii:dall1110714 yin Or RJOillp,Wfilrfll,
4223-A -. 1 I .. -
74.Apprititiniate:volialite of iruter-reMuiningitiWell(s)i . - - 909
BC ikelletniirdelorCen014tionthinbet..
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SAEDACCO - .
FOR WATZIISUPPLY.WELLSIONIX: _
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°army Name . ic.TypOorillisjitfettSuittiedi. I • •
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2.WUlt Coustractiiiii Ptiithit th-,• ; • , •. .
Lid mithrplivii.Or will i.ii'i_rir;11..e f.i.e..ttiorgy:-$1i#,d'iiiiiii...e41).110iiiii,etri Inssivy
'70.,,Aifiint(if Uf.diguft*iini Wed:. • .•
Well use,(eltechlVell:use); ; - • . • .. ,
I.:flitter Supply Well; • . ' -70.'-scoiiiig:Materials used(cheekall that 10E4):
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bAgriculttiral. 13.11VIttoidp,thFublle,. ...0 Neal.cenlOg Grout ,
N.Fient0nite-Chip -Or PolletS;
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: laGcothannal(Heating4Goolitg,,,Supply) El...Residential‘Va(cr Simply(singlo cl'S114.0i11.tql GO 11 0 Dr Cla3
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- . 01114116111'6110011110431, • . OthesidentialWaterSUpply:(shooxl) 0.C96F0..'a qFPII : El Drill,Ctittiiip.
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• • Oktigation; . 0 Specialty.Giant . -
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,• El Gravel
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• l'ott-Water Supply Well: ' 'El bentonite Slimy r I' El•Other(explain under 7g)
faMuttilorine. - - •• . • Oltecovery . . . .
lulection'.Well:• •; If...FOr each litaterialselettcd alimtfprovide amount ot initterial8 used
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glAiptifci Rticharge °O.initiaiwater•Itutettiatinn • ;
°Another Ammne.mr.,1 ttio,‘, 1-2) ..13Siiiiiiii-Mabee, . :' - •
• -' ..;-•-•--- • ;- Bootoaito.:2501b.;wtr:gal.
pAnnacif Test EISIcirinwaternitli .ttaue. •
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.I3U:xpetintetita4Telutc(106, liSubsidonegointal ' 70„..PrOideahriefLitescription{tithe abatittomnept:innocedure:•: 1:16;0014010(CIOsed,Loop) • , , UTrace;
Pulled temporary well and backfilled 6". boring W/ hydrated
°Geoth .ermal(limtiten/Cooling.Return) 00thettexplain under,7g) '
• bentonite chips , ' i ' :..-', -..,', V 4--- •"Y
• - - • • t,.. ,.',-- • - •
4.11)attc Well(s).aban.doned: 11)/31/24 :. . •
474
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5.Well hteation: • • : ;
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Catsburg Country Store . . . . . . . ..,_ . .
;:11',5.,:"J“:7,-;:'''-'.'cr'. ,,.,..,.,....,:.,f.o..i.;.•1.`,1--,
8.•Gertillentliin
fieilitWOWrkrjiinee- 1,*.ilti 1DM(irupplioiblO
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1110 Old.Oxford Rd.., Durham,•NC 27704 ' Chris Ruffer i - . 11/7/2024 • . .
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Physicathidrew City..and Zip Serum of CI",..s iNsf Well tottoactnt'‘•:!r Well Oy.iks 'paw
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Durham ' • ey.s.igufug:lholimp„1 Ilerp.hi cOlify,that the ireilts,was(were)ilihartekLied.111 •
C0.10). ror..t el WsurF.IiibUtio..(P0 ,46itiffekruqii414:KOICO.r.1.q.roo_oe.i?C.0200.1f/ell:CoOslivilion Sconikiiiis:
' •eard'Ilreira'copy ofthi*,4gord hort-!§eit'r peovide.d to 11.re3rel1 owner.'.
$1y,Latitude and longitude in.degircesfiniuuteSiscentwisro r tiectimil•degreest
(irweitnekt.,otte,latiltiagirsulnktia) •9..Site diagrturn or additional well dlethils:. -. •. .
. .... Von nsty use.qi.6 hack of this pate to ployide-adititiOnal Well site details or well
W abandonment You ma'y al,ifat.talt adiiiiioU4 pugs if neeessaty,
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i:()NsTRticittiv.tiFitAil.:5.0.1?WE LUS)BEING ABANDONED SUBMITTAL.INSTRUCTIONS;
Noc;ireli tiatainigleto ntofriiei)erlgabrit Pir-*dim&Oijection or'imrti•Witie.0.344,thly - • _ ' I'
iiilliolii0 1.1-4.*.1.i.iiiii-rovitrir.qii-litidititeilioymeti.i.ivri oil ibill'itifiFei Am,: • - •- • AllW• lib •' •- - • - • -• . •
'Oa:•For elk: S mil this-farm within.,60:-days of c ompletion of will
pliant:leo-Mem.th the folloWhix 1" .
4,1.Well nig:six-19 .
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' Dlitsion uf Water Ramitreesi Information:Processing Unit,
•91
depth 6b To tal welt 1611 Mail Sericite"Center,Raleigh,fir.2.7699.11617
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10h.Arlin tee ten:Wells: In taklititin MSenditi,g.thethmt_to-lhe address In 10a
,abotr,,-;.also.solintit mie•topy•of this:form within'30-day of toinPletieit of well
6e.Rorehole diameter:2 (In.) --abaticlOtintentlothe.thllowing; 1 '
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BiviSlott:of Witter ReSources;UndergrOttud Iitieellon Contn.41•Pnigram,
601,•WateTlettliwinw glinsinlimrface:' (,0 ' - -1636 Mail'Service Ir.:entcr,Raleigh,- G27699.,.1 636
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11.0e.Fnr WatewSitioilv&It Lid Wells: In addition-to sendiq the form to
6e;Outer easinglcoOlt(if laiuwa): 8 . .(ft) the pdcifdg(4$). abeke alS0 Suhtiiit:One ediiy of IltiS•fomi tiiithiti 30 days of
. conipletion of well ahatoloitutentl toi the county health department.of the county
WIterc abandoned,
61.Inner easing/hilt:lug Length(if known): (It)
6'g.Screen lettgth(if linottn):1° '(ft.)
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Fano GW-10 North Carotim DepOumers of Entir.ommoi.411101;mi ReS114,1fCCS-gIVI.S011of Watcrftc;ioitreeR Rev cied Augug 2(113
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WELL-ABANDONMENT RECORD For Intim]Use'ONLY.; •
Iliis':fiarii6n be n",s01.-fnie 4.ingkotfiiulfip .'.w.'„ell . - -- - ' _ •
1.Wilt Coorrilifnviia.tinAl: WELLARANliONMENT-DRTARA
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Chris Suffer 7.1.NUmber of wdls ktiag aljoantlioni.41: 1
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Welt eeriet:Name Or sii4lIti"a1Fr is714in:itly•;.,)*;:indiriniss:p11:6:11idietii0111:::y) For teetpfile tiVeigion & issa-tiotillrik •sfrisiAly ills-:'• ONLY tirth ti. :•o.rfrie•
eenirreetiikvOrtir,deetneet, .0 01.1P,A746110r.VfilrIlL -
4223-A .
74.Alinr04nrini-volinreitiff.frnita--iininininiiiWv11(4i.. 000.
Re.ttNitteiinuOorecifjP4i0ittialti?et•SAEDACCO • Fog w.ogRt1pri.yvvkLI4:cliNIX:
Ccimpiey Name ie,Tipi of 41010i:4.0i*Jed:::
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2;%Vial Cinisiructiiiii P6intiff if,r, ,• - . • .
lid Pli..tylpi10#4'1011ke:VI'im/4.-:e‘Mf4,0/6 P•1r.1fr'6.4 bt1.0-.0504,*.4.9.11-1'°11• . Id:Aiittittne of disinfectant irsOidi.
3,Welt usi;(ellegic1-wlill use): • , • . • . •
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Water Sppplir Welk - •1.n.-. calinit inatOriAl s.0.44(0.104•all that apirly);
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13Agrictrintral• itMiroiiipali.P!,114/in-. U Ncat cooeiit,driliti: tA113OntOniid'chiOsnr Pellas
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13biolheanal(Hcaang/COolint Supply) f30.xs.14ritial WaiirSiimily(5ingli) El sqi4., 56
TcY11- !111 i. - -13 1 ,,c.*•
ClinalueniatiCoinnicsOlol. OftisAderitialiVatit Supplb--.(iliartz d). 'El:..C9i1F17#PPM. p poy..:coiliilis.
13 litigation . . . . . "CI'SO;cialo•Grout -. -1:1 Or**_1.
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Ntkg-Watee&TOY WO; • 0-1_31,1001te Sligq • - 1, Cl Oilier(expirlin.nab!.713)
ISMonilosilig, .- ElRecovety • . .
Inieetinn-N110;_ • , 7K--,Fsir each material selected abintflohnidO Antonin ntmaterials used:
1;11nif41{CctiiitgF , ,r;-.03niriaw.afOek?.ut4liaiinn i
OM. itif.;c'g.$tifnigg,p4414. 6y,0:_v Oltiliiii ti/13arrier.
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Bentonite.:2501b ,Wtr:gal.
PAilnit'et Test . tISItitinunle:.Oraiitaio .
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• p#xpointentqltea.linniogy 0$nhi...iden5e:-"Contrpt:
7g..•Pea'idelyhtiOf ii*iits tia:i. nirthe ithintlijunteqt Pr.t.q:Olurt:- •
rkieothenmi(Closed Loop) -1:3Trqcgi.
. L Pulled,temporary wella and.backfilled 6". boring w/ hydrated
OCrentormal(liviiingiCoolina•Retarn). 1:10Elier,(explain under:7g) i.
bentonite chips . 1 . •
4-1iate wnft(s).atriindonal: 1°/31/24 - .
• * -. V ;.•!..1,......',....$as--. 1—' "'
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U.Well location; .
- F.1024.
• Catsburg country.Store . -. ii•
S.Certificittinit:• i• • • 7. r,-.',V7.14.:,.71,gUill
Failil)idicrorNiiii3O' ' yaiiit#um oropotkatorol ... , ;7-1
1110 Old.Oxford Rd.., Durham, NC-27704 Chris .Ruffer.
11/7/2024
P•hysicalAddreE,,an-Anil-Zip . •Sl*Ilac or CtzitilW W.4.41 cf-000::.mt o.r W.410%110 pate
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Durham • , • Bp sigpitig;thqAnp,,1 hem#y,Feilik that the we110 wax(were)qbarglatzeil 111.
•CilillitY' " Parcel 10,:ailtecIthabia.(PO ii-piliftknce'w.fili'IS:4 AVAC 02:C..':0100_ittj 2C.620,0 Well earstrYitei Sttiai1ai:4
• tted.that tr:cpj.,of thi*t:t.17ord httsh.eittftri:ovided tol4j4;e11 Ortnet.• .1
.A.1:0:Latitude And Inneindi in rtqiii*ini:i.int6($icOndi:or di#Inialfdigitrtp.
(iiven nact,4,p;latillipgii..iitneioi) r. " " ". -9.Site diagram or Additional'IRO details:
You in4y tise.rlie b00:of this NO tn"prOde:infditiOiii well Ate details•or well
Ti. • W "abandonnini'd&iiifs: You-mar AlsnAitocli additional poggi if stecissaky.
tt(INSTRIII.:TION.DRTAILS OR WELL(Si BRINt;AHANIX)NRIS • •.SUBMITTAI.INSTRUCTIONS' • •
:Iliad mill coextreetiart il!tv.i7t16).,i):-(avo.1 Wk. Pcir ereltiple.ijoectgeo w.;etvi,watil-'iuji?.(10 •
,iiitepiAi.,with the t.gere.:e.pgiere•o-ptie.kiyupytei4it.you:.,,,ne rliti.g.ie!ehpre. - :10w: Fat All Wells Siihniil iliES brat within,3tk days•of completion of will '
d SDC-20
. aliapdonniintin ttio folliiWing-- •
Diyisian pf%get'Resnpre:±:4 Information-Poces.sing Unit,
61k-Tatill well depth: 18. -014 160.41ail Seiti6 0.titer,Ritlej:11),NC.476994617
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' 10b.For In ieesinn Wellk lit nduitibil to-sehditig..11 .fornt Jo the attilrois in.10a
above;plso.sitlintit one cops:of dies'..fon!s•ssithin'S041yS•ot:man:lie0*ef well •
6c:Borehole diameter 2 00, abut:46=01:a:lief:glow**
li .- • -
.gon:0 Water Re.iiiunc.04.1idtisinl In (Ion Cnutrol Proigrastu.
ffig.,iivAtcr*Vifirvioir 00!„1114 surrAc '::: - do . 163( Mail StrViCc CCrtter,Ita/c1211,NC 2709,1636 —
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f0c.Fa r Water.Stinnly&Infection Weill: In additicirrto sentling the form to
6e.Outer ming fellgil Of!mown): _a) ._
the aildres(e§,.nb*,. also subunit.One,copy of tins form within 30 doss of
coniolctiOn of will eligncionut6ne to die dainty-health-ikpartinelt.of the eon*
i*tc al?an'Onts:l.
6r.ltenercaSimiltubing Length edialtlAiii): ft.).
60,Settiet1 length(W1110%110:1° (ft.)
1
Fe,170 GW-30 ticinhearolina Pcixorrpzrfi cifan:insealgat and Natural Reseigces-1:11s.lgion of VititerMotp:!;:s. Iles15cd Auass2015
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WELL AllANDONNIt NT RECORD Fortinemal-Usd ONLY.; 1 • •
This form bin be 4-e'd pi siot4:01:tindifilire.*DS
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I:Wed ContiiierorInforrimiiont WELL-ABANI)t)IYMENT.DEFADA . • .
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Chris Ruffer _ 7a.Ninnlier of it ells being allandoni.4 1,:--
. %Vett CcOOrsciOr:IN;Onte.(M-yi..§11.ot.iaor p.3.tii).rilly pb:iildpiditill'ost 1011.0 liffith:3.1%) Fir eaiiittlie• Ofeimlif or flonkrii* Opply ii...1.6.• ONLY limb th e
...smaii
emirsuer01,01panyiti)frai.-?it.„vey i cti.utpleiiSt:iy!efbrin, , . . '
4223-A• 1 1 ••- • . -
• •lb -0, i„iatgiudrAitil(8).,. . . .' .. G.*.k..i..)
• plc svoibii,,,uoarsvi-or,,,,o,„gintho.• .i.
. . FO!3.WATPICSUPPLYW;F:LL,S..1)NLY:-
SAEDACCO- .
Ctimpany tiainc • . ie.Thie:pfdis.infeetant iisedi,-•1'' ' . _. .
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1.Well CU astructEriti Pernik fi:., ; • ' -
1.1.4441,iliipheiipte tie],pery fixf.l.e.rtopo.„.yidite,l'Zirie.r.0..t(qiivere.i(fleAelfa 7d
.. . . .Ainount oldiiiiifeetatit tisedi.
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3.Welt uSe(c.lierIA-101110e); • • -
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'Water Sttpp6r.WO:: , 7.e. caliti,g,iMiterialSOAed(cbtel;:all that ifpfily);,
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GiAgrimiltriral • GR4tmkPai/POWirc' GI"Neat pernOt(laiiii: '. ' C;I•DenMaite:Chkisor Pellets
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. -1=ideedleimal(Heatintinilirit Simply) .0tderni;t1 Wo(cr Simpfy(Singlc) 0''Slilj ('-11i41..Grilbt . El Dry eltii.
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El Indostrialleoramereill EIResidoodat-Wiser Suppilk-6hanx1). •CI:•cobcfer,e'Pront .13 Diillsc.nning,t.
ClIkrisatiOn. . . . . 1:1..Specialty:drout. . : . . .13.Gfavl.
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NMI-Wafer Sttpp.ty Welli . El Bentonite Slurry . • ClOther(explainundet 7g),
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• INIMunitcaring: . , Glitecoveiy • . • .
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•fuicetioa Well: • • . . , 7E For each material seletted above,provide antoititt Of materials used:
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CIAraiifeCItecharge : Ochatiatia:ater:Rentediiiiiim.
pAnuil'ii:$/ninv and iti.. iv.eil', Ogiiiiiiiii:Dartier, .
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'Bentonite.:2501b.,wtr:gal.
ittAipiifer•Tt. . ' 1:1$1Orialiter.btainatte . .
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tixpis-intentyl Teehmilogy, 0SubsicLeie 7j.,'PriiVideii•hrieftleSeiiptinii of the aharidtinment nraiteduire:-
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OGeodtemial(Closed.toop) GITracer- .
,Pulled temporary well and backfilled.6" boring w/ hydrated
OGeothennal(triVit •
itig/COotihRlstethrh) . 130ther.te.volainnixter.7131
. bentonite chips . . .
4.:Date*ego):awodonegi::.1.0/31/24. . I; V'l,:,..'!,---...L,'il..:1 V ..)....,,__
,.il.74,1.41110co!lon: " ' ... NOV 1 ;-. 2024
Catsburg Country.Store . : .
ri,i
VaeilititOKuric ' . iiii,.irxj ciropoit60 A.ceralleadfith:
. . 1:1riff..:F;;;... P--,-.,"•,.5•%.;;.,,,,i,j'..,n'.1. .
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1110 Old.Oxford Rd.,-Durham, NC-27704 . Zhils- Ruf-fer- : r.-)-",;,..:1.-31::,..:3
11/7/2024
PhyskatAditress;CilliAllii Zip -stig.liiiip or Co ilieit tyett Coimicg'orWeli.()into- Date
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Durham . 13)'4!?'.,Ting,i1IP iii)?0,-:1 liemikzcerilb,il.iat.the-we140 was(were)04174011M 411
. Cctinjiy . P41-;10Nzniff,i.c.iiiiiittito;(PIN) ' .irtivnkincg-tifIli'1,14 APIC fIX'.-0100.or X.02P0-Veil romdratctiori Sieidaras
rot Mac icc:opy of/hi..&Orel hasheivr.firoyided tp-Itreicell owner.. .-.
Akl,'Latitude and iimet0t4 hi.itegreciifiniantif.Sepnidia-r deciiiiiii.dtrei.i:
fif no/field,01!4,1atiiiig is-inflk:limfi • . . -9.Site diagyara or additional well derails:. ... . • ,
You ina_c•itse.i.lieb. al*.Of this page to prevideidditiOnal well site derails•or-well
lir . _ W abanikitnitein&rails. Yon al a' nISO•M tack additiona(tiages ikgetesia4y. -
i:t1NSTRlit.41•14IN.DETAIL.5 OF WELIUS)Bgi NC:AlEcANHONkli • rs11113M1T1r At.INSTRUCTIONS , •
Audi*Nat cot's/radii*evcvert0.-if.4i-14,145k, .Kir iquItiple igjeoibre or-rmrpmite.i.-xupply- -
ir011e ONLY iiitb Ilk sow:tpirstpu:rnar.tlarmprtlommewt.y.tirt mu slfklilitolethisre. - 1111a; Pat All Weis: Siknill iliis farm'within JO:cloys of edriiplOtion of well
;•ItiatidOritrient fp Ate folloliiirg:' !,
da,We'll ifig:SDC-21 _ • ,,,
Division of Water ReStiiiret. Information•Prneessing Unit,
61i,,Total well dePth: 20 tn.) I617'..111sit 5eitiee Other,Raleigh,NC.27694-i61.7
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IOU.For in iter itat:%Veils: TM oddil Mii to sending..11 •ftinit_to'lle;address iu.iTiS
•above,.rilso-sobniii,.orie•topy of this form mithin304ayS 61'0;4dt:don of well
6e.-Bo reliole diameter? (i it) abandtiaindit to the.folloaing: r
I: •
.Diirisiort:.of Wiiter ReioureUndeigtintnd litijeciliiii Control Program,
lid.,Waterleitl'heitiry grMinit surface: (fr.) 163(1 Mail S- rvict:(-:enfer,Italeizti,NC:27699-16M
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' .roe..FOr Water,Satmtv 8c-Tideetirin Wells: hi addidorkto seddirig the form to
6e.'Outer essinglenWr(if known): 10 (ft) aboyi als • • - • •
.. the adtirdss(0)- ti submit "MIS op of[hit forth within 30'days-of
• cvmpiction of well-abandonitilint tci the county-health'department of'the'comay
• where alpadoted
• dfjarrcsAirntlorgmath(if Imavn):. qt.) ,
• I
6g.Screen length(iikunl 0:10 (ft.)
Fonu Gw,39 .149mIleanilina Pep:own!of Eni trontsera an:114:timpt Rosonrces-Division of Winer,deionite,s tywkset.1 Anvil 200'
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