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Home My WebLink AboutRandolph_Well Abandonment_20220601 WELL ABANDONMENT RECORD For Irnernil Use ONLY: This form can be used for single or multiple wells 1•Well Contractor Information: Vti'FLL ABANDONMLWT DETAIU Scott Hunt, Jr 7tl.Number of wells being abandoned. 15 WettCouumcrm None(ornnitaw=pewmayalundtningAallam Maher propcn_y) For midtinle_ ivywiar or ma�lwafer simply wefts ONLY with else same tVhWrrncrux►mhandranMM('IV)NarerM�Mtirariefimt. 4561-A ?4C Well Gortlmaor rxrtitrcruurt Number 7h.Appmsfinate volume of water remaining in well(s): (tyal) SAEDACCO Inc FOR WAT WELLS ONLY, ER SEJPPUY C.otn xny Name lc.Type of disinfectant used 2.Weil Cim9ntc ion Permit#-, fist afl aprtrlkyande weld p;rmttg n':t C rani Ste.Porfatk e.lxjecttara err d ff wn 7d.Amount of disWectant used: 3.Well use(check well use): Water Supply Well: 7c.Sealing materials used(ebecl;all that apply); MAgricwrltural ❑MrmicipalfPttbl O Neat Cement Grout M Bctrtoritc chips or Pcllcsts ❑Gcolhemud(HcathieC:ooting Supply) ❑RMidelgiat WVatcr Supply(single) ❑Surd Cement Grout ❑Dry Clay ❑lrrfbstrr lCommcmial ❑ltetsidentiat%Vatcr Snppiy(sbarod) ❑Concrete Grout ❑ Drill Ctutinga 01fd Lion ❑Specialty Grout ❑Gravel Non-Water Supply Wen: 0 Bentonite Slurry ❑Other(explain under 7g) Omotrttoring ❑Reco%tty Injection Weal: 7f.For each material selected above,provide amount of materials treed: ❑Aquifer Recharge 00mtmdnater Remediation ❑Aqui@r Slosnge and Recovery ❑Salinity Barrier ❑MniferTed ❑StommaterDrainrge Bentonite.:50 per locationlb ,Wtr:gal. ❑Expesirrtental Technology ❑subsidence Control 7x.ProvidL a brill description of the abandonment procedure: ❑Geothemml(Closed Loop} OTracer Upon completion of injection, betonite poured from bottom to MeDthermart(Heali2ff,2G1JMReturn) 00ther( ainunder7 ) top iF`�E!" 'PD 4.Datc wcI1(a)abandoned: 4/21/22 Rig Sa.Well location: NCDOT Parcel 90 lOtt eL Fas:rlit MIvrerNtime Facili#1Ds 0fapDH=bl0 S.Certifttatlon: ��`� � 4443 US-311, Randleman, NC 27317 ��i9CC. /L. 5/21/2022 Physical Addmm.City,and Zip SiAMIITM orCertyw W01.Cans at:or Wetl On-Mr Drat Randolph Bi S19WIT this fermi, I►mm6y certify tAw the well fs) was(here)abandoned in Conmy Parcel IdoNlficatimt No.(PIN) acwrrhmee wah I SA MCAC 02C,0100 or 2C.6200 Mull ConstruOOn&awkr s and Ad a cop),ofthis rswrd has been prm4ded to the well owner. Sh.Latitude and longitude in degrrecatminuteslsemnds or dechnal degrees. Of-well ttetd,ortc tloortg is srdticietw) A.Site diagram or additional well detatis: You may use the back of this page to provide additional%ell site details or well t� W abandontneut details. You may also attackadtlitiotial pages if necessary. CONSTRUCTION D TAHS OF WELUS*)DUNG ABANDONED RURMTI'1°AL INSTRUCTIONS ,trdath nrtd cnmrtrrrttrrlrt nawd(�7 If ovialitablz 1"w rirallfpM rn}ecrfun ar rian•n,uer strpp!) itwhONLYwith6W saw m»s»nrtlac'obeurdwaucyu. >,rcanmrhwfiw►fi-vm. 100a. For All Wdh Submit tills farm within 30 days of completion of urll 6a.Well M#:Al-Al 5 atiandonrncntto the folloming: Division of Water Rrourccs,Information-Processing Unit, 66.Total well depth: 2 a (IY.) 1617 Mail Scivice;Center,Raleigh,NC 27619-1617 10h.For Iniecdon Wells: In addition to sending the forin to the addrrss in 10a 6c.Borehole diameter.2.25 (in•1 above,also submit one hops of Ibis form yrtiWtu 30 days of completion of%vdl abandonutent to the following: Division of Water Resources,Underground Injection Contral Program, Gel,Water lend below ground surface: 00 1636 Mail Servicc Center,Raleigh,NC 27699-1636 loc. address(es) tion Wells: In addition to sending the form to (ft) � above. a 6c.Outer eating length(if known): _ submit one copy of this form within 30 days of completion of well abandonment;to the county health department of the county 6fi beer eming/tnhing length(if hn",a): (fe) whcm abandoned: 6g.Screen length(if known): Fona M-10 North Carolim Deparinrol of En►iromncat and Natum l Rcsmuces-Division of Water Rrsotwocs Revised Aupsi 20 tI WELL"ANDONMENT RECORD For lrs=lUscONLY; This form can be used for single or multiple wells 1,Wen Contractor information: FELL ABAPTDISN_MLNT DETAtI Scott Hunt, Jr 7L Number of wells behq;abandoned: 12 Myer[Coutrador Nam(ornxetlonaerpermnai9y ationloningKellanhiMierpmppnv) Fw• MlyMple Hlfieetfan or Mn-11wer supply gaffs ONLY with the swie celvrsfrrtctkNi'ahalrchlluwmif,rein cYur salxuJt aie fatwc 4561-A NC Well Coolmaar Cettificatlon Nvtmber 7b.Approximate volume of wat&remaining;in well(s): (pal.) SA$DACCO Inc FOR WATER SUPPLY WELLS ONLY. Caalpany Name 7e.Type of disinfectant ustd: 2.Well Construction Permit fist atl hpp�lkxtAfe trelt frNrltrfLc a.e_C4MMty,SWe,t'urfomV.Iiyertlarv,efr_)y kawrl 7d.Aelonal of distafeamt used: 3.Well use(Cheek wen nse): Water Supply Well: 7e.Sealing materials used(checiK all that apply): QAgrku tuTal phAtmicipttlN'ttblic ❑Neat Ccmcett Grout M Betitorhe Chips or Pclicls ❑Gcpthcmnl(14eatineCootino Supply) ❑ltcsicicntiatt Water Supply(single) ❑ Sari CcmeM Grout D Dry CIn1' ❑wistriallcornn cn ial ❑Residential Water St"ly(shared) ❑Concrete Group ❑ Drill Cuttings ❑irti Lion ❑ Specially Grout ❑Gtmd ikon-Water Supply Wen: ®Bentonite Slurry ®other(explain under 7g) ❑Mouttoring ❑Recotrty itnjeeti0n Well: j X For each material selected above,provide amount of materials treed: ❑Agmifer Recharge ®Grpnndwnter Remiedi®lion ❑Aquifer Storage attd ReaMety ❑Salinity Harder ❑AtluiferTed ❑Stommvrter hatrwge ! Bentonite.:50 lb per locationlb ,Wtr:gal. ❑Experimental Technology ❑subsittmce cmNml 7 r,Prtnitllc a brief description a the abaodnmmtmt pn►ecdure: i7Creothemxtt(Closed Loop) OTracer jIIpon completion of injections per location, betonite from Meothemial(Heati ti Retum) 00tbartaggainunder7 ) bottom to top '_� ;,Date well(s)(a)abandoned: �� (1 51L Wen location: r NCDOT Parcel 90 F=r1itytO ,mrNume FacilityiDMtfapp1table) S.Certlllcaflom: Int-Mu'l �CGC �t DwojSOG t- �'Ce&7 4509 US-311, Randleman, NC 27350 cur 5/21/2022 Physicat Addtcss,City,and Zip s'gemMirc of C41M lion Will CMr lwor Well On-wr Dot@ Randolph fay.signing this Ami, 1 hereby certify that the well(s)was prer'd)abandoned in ceauty ftM IdendtlddMnNo.(PIN) acwrrhrnca with 15A NCAC(t2e.0100 or 2C.0200 MWI Owl;rurtion&aani*rds and then'a n'Rl,ofthis recursd how been provided to the well owner, ft.Latitude and long Pde in degr+eestmfnuteslsecondsordecimal degrees: (irueu t`wd,wie Wwla is siditc") 4.Site diagram or additional well detafls: You may use the back of this page to pride additional hell site details or t»11 N W abandonmeta details. You may also attach additional pages if necessatiy- CONSTRUMON.DETAILS OF WELDS)BEING ABANDONED SU M1'7'I'AL INSTRUCTIONS :tfNidr well erlmrJruefrstrt r,!cvre�tA!-Jf etrolft�itc. f'ur muftipk iltjecffate rxr raan•nxttav',�pph, arfk ONLY with the maw mm*waou obwiykw ao.i.la vari.sr))mtt lute furor 10s. For All Wells: Submit this foam within 30 days of completion of well 6a.Well ID#:B1-B-12 abandonmcnt to the following: Division of Water Rextiurces,Information Proceming Unit, 6b.Total well depth: 30 ( ) 1617 mail Service;Cotter,Raleigh,NC 276"-1617 10b.Sir Inlecdaan Wdlc: Ice addition to sending the form to the address In 10a 6c.Borehole diameter.2.25 Bn,} above,also snbmli one bogy of ibis form within 30 days of completion of tva abandonment to the following: Division of Water Resources,Underground Injeaton Conlin[Program, 64L Water level below grand surface: (ell.) 1636 Mail Scrticc Ccnter,RvleiP,h,NC 27699-16M 6c.Outer easier 1 if Imown): (fW Ift,For above.12ft!l itection M ejft in addition to sending the form to fi length( _- submit one copy of this form within 30 days of Completion of well abandonment to the county health department of the county w abandoned, 6f.Innereasi6tkubi'ng hen)Mb(if Arrtsnsm): (t1.) 6gr Ski length(if Itnown): Faun GW-10 Nonh Carolina Depuanxes of miironment and Miami Resources-Division of VPatar R<satatacs Revised AupM 20 B