Iredell_Well Abandonment_20220627

FELL ABANDONMENT RECORD 1 ar lrt ertt:tl t��7NI,l
TWs form can be wed for single artltillipte wells
1,Wen Contractor lnfnrma�tign; LVELL ABANIII i MENT DET.Aii ti -
Robert Miller 7a.dumber of twits being abandoned 1
tli'kal Contractor taote iot%wlL o�trin persnrall4 nbandoi"@%iatt on IiWlter progeny) Feu• ,riatdople Nr..itehair w wl-i,airer sand„I. nvfhi ONTI +stab rlt. moie
arrasrrnctax�:yti,u rl,urxa,Kar,g�rz c,t,t.sahanrr wt Baran.
2675
7b.Appn►ximate cohtuue of•sate•remaining in well(s)F/A
NC'tSPe1t4'�ttlA�ort'�•tYisr�lit+ta lWrnaNer
FOR%Ikr%`1ERSi1PPIVUIFl.TSOT-,-x.v: lr� L;E lb
SAEDACCO Inc 4 , =
CcInvilay Name 7e'41te of disinfectant uttcd:
2.Well Construction PCrallt 4:
t nindlit flvlrleuxldtn.rmitsri.e.t`vent,;Stub.but-sar:ce:ln,et-dut,dc' ..i!fLr,sm U Amount oftllslnfictantused' IfliOi�:4:r371 �Pi.•`'��R1�n tt.s�
3.Well use(check well use):
Water Supply well: 7C.Scatting mates ascd(check all that;tpply):
DAgrtcttikttrtt ❑Mttnicilx tldPttblic L7 Nast Cement 0 13crdttnite Chips or Feticts
❑l i.'ntlte..Rn.•+l tElcatnt,1Cgoling�atpplpl- Dkesidsntiat Water Supply{single{ ❑��Centeut Genet t7 Div C4iy
❑b dustrial-lCormaciciat ❑Rmiceutial Witter Suppl)•(slstmd) ❑Concrete Grout ❑ Drill Cutting
❑Irri atimt ❑speceattyGrout ❑Gravel
n trr5ttptilrWell: a 13eliltt[lileshim, ❑Other(ctiplawlarder7p
NNIalliloril e, DR-n-Gven
tn)ectlon Well: ?f.For each material selected shrug,provide amount of nt ttcriais used:
❑AtIniferltecharge 1101oundttater Rentaditaiatt
DAtluifer Stotuge Ili Recovery ❑salinity Barrier
❑AillaffiaTest ❑StontmattarDmittage Bentonite.:751b ,Wtr:7ga1.
❑Exp:riniental Te>hildlogy ❑Subsidence Comml 7 .Provide a brief description of ibe ab:mdnnmcat procedure:
UGaothannal(Closed loop) OTracet
Pour from surface.
l5(it otltemt►t(Flcati>yt�r aotint Ftelarn3 Cj0dtcr(ea .lain trader?•►
4.Date well(s)abandoned: 5-27-2022
ia.Well focation:
Trane
racfl€tyi€}wa r 7Vartx i7.1;;U ty]DR
tirappti thlei S.Certification;
800 Beaty St. Davidson, NC 28036 5/31/2022
Physical.Addrm,Cib.:and Ziu
Iredell fst-srfiatrri tduv,t'urrtf. 1 h rnhl'cepggt tldt the trel?rsi ipas(!germ dblandaved in
Cxtnutu ParcdId.ntificatian No.(PIN,I tartainlinacrtrihM.-isrC-ft di't':f.71r;t),�r�C.J?r�IkiicllCauastrttciittrr�dlant�#rrfs
• rtrua'lkat Eic�opt r..f tttik t•tenad Frckv r5eear,Fv-avirfarcl do tfra"rs•�17 an ati'r
56.Latitude sad tttngitttttc in degttecaltninuieslsccnntL4 nr dtximtd dd�r�as:
{iftct:ll fbJd,ota Llrfhftig i�aatrrnteal) 19,Site diagram or additional well details:
You tuay use the back of this page to provide additional uvll sitie details of tirelt
W abandontue t details. You uiay al o attaelt additiurtal pages if rtzctxsarr•.
COMSTRi CTION DETAIL4 OF WELL(St l3Eiillt'.ABANDONED M141KiTTAL i14.TR TCTtt7''1^
?lfwrl i,edl r[r vntrt�ura rrcrrn(;st 1t'w�u!t,�4!u. d'%v trofrlo�ri jrttiicirt ru'i:eat-u�rter r�;ttj!ir - _-
11VIN ONLI'toad f1w 10a. For All We1Lc• Suhtnil tuts fart within 30 days,of completion of vrell
6a,Well ID#•MW-12 lbanderment to the following:
Divir{on of Arater Resnur eea,Informathm Proemsing Unit,
6b,Total well depth: 44' {ft.) 1617 Mall Service Center.Raleittti.NC 27699-1617
10b.Fr3r Ittik ti n_t;'cils: In addition to sending tine€ortet to tine adilms in l0a
He.Barelwlt dlameter�2" {iu.) above.also subutit ant:ups of this forut widlin 3(i days of uutpiciiou of ni_9l
abaudountent to tine fallowing:
Division of 1S:tterResources,Undergrrllud Injection Control Program,
6d.!Voter Icsti below ground sarfacc: 1636 Mail Serniec ,enter.Ralcigh,X(!27699-1636
10c,Llr cgr, in addition to scrding file form to
Gc.Outer casing,length{if imntn): 34' S & uri
the address(es) abode. also sul roh one cope of this form Within, aft days of
completion of hell alt3ndatur-1 to the county health depntiment of the co,argy
11ISL'fC:t�9rnio trend.
6f.Inner casingimbing length of known): tft)
6g.Screen length(if lat0tvn):10' (ft.)
Fonu Dorian! NutthCarobna Dept timm of anal Natural Resources-Diymon of Walcr Iksomoz- ttn(sed,lugatsa'L3t';

NVELL ABANDOMMENT RECORD rotlreewIVvONLY:
TltiLs fbtnt rau be used for,single or rnullipte tiuelii
1.YVelt Votttractur information: WELL ABA'dD(1Nd1ENT DETAit S
Robert hiller la,©lumber of hells being abaudnued 1
- 1's11' f7lirlfJlllt' tt(it*th�ue w' rnarr.trrrteJ +tr,�l!h• nvi[e O,YLt` �rrtr 11.� sate
NwI ll et-n oorTtanrc for well otitrfsr Nriamgliy alr 0joain8 uou 0a ltivUr Propene) �:rt,�rrerarNr uhra ety, ,f(of
2675
7b,approximate tvilume of grater r emuitttuifln
NC WoU Coto actor CIO Iffcride"1`4nrbcr Z '
SAEDACCO Inc 6QR WATER S0PPLV WitL4.S ON IX!
J U N 2 7:2022
cnnvany Mute 7e.Type of llisinfiwtant used:
2.iVell Coustruci'ron Pertnit 0:. _. MM;RM�irO'��PrL'C,G:!`.9 Un"
i�.VQ1V013
i�u€�1,1,rrtttir{+icy u�fl lv'isrity ri.e:l trJrrn•.5tii�r•.S ur�watr,ln,'YLYfGfL LIC.i i1&tnimrr �V.:Lmauut of disinfetkant tt�cd' ---
3.LVidI use(shed:meU u;re):
3.Wel use(e,^Well: 7e Sealing materials used(check all that apply):
❑Water
uttartt ptvtttnici�diPtthtic 0 cat Cement Cinnit Q Hcntonitc Cfiips or P►11cts
❑Cit;+othemlal(licatin;+Cooling Supply) ❑11 a7detitiat Water 4ttlttth't�inglc� ❑Sam r`elnetu Gtuut ❑ Div fit??
❑1ndusnialiComnicrci tl ❑itcq utiat Treater Supply(stimed) ❑Concrete Grout ❑Drill Culiings
❑$rti•atiou ❑ Special y Grutd ❑Gravel
Nan-Water Sappy Well, 3 Beotonile Shur)' rI i7ther(eNplain tinder 7g)
IMMoiritorine ❑Ile o! n
injection Wclt; 7f.For each matcrFal scle4ted abo!c provide amount of ovate-tints used:
❑lquikrRecharge ❑ mundunferftntedimiun
❑Aquifer Storage.and RCCMT ; ❑Salirlity Harrier
❑Arptifcr Test Drainabe❑Slor»ttra[er Bentonite.:751b ,Wtr:7ga1.
❑Esp:rinietual Techttolgy ❑Subsidence Control 7g:Provide a brief description of the abaadm ncut pnueedure:
06-codter►rmd'Closed l nopi ElTracer
Pour from surface.
QGcodwrioul(Heatitrlt<'CoolblaReturn) 00thtir(et. iain under^r,)
d.Date wgtl(s)abandolled: 5-27-2022
Su,Well location:
Trane
ra.Cllilr/Lht•ocrWtum Facilely IM drapplicablea S.CrrtlttcaHloa:
800 Beaty St. Davidson, NC 28036 5/31/2022
Plr.sia'dAddress.Cite,and gig Sicz[tr.' •!!''F.'> -J %d'. soon llatL
Iredell 4v s;.;ink' tots trrrrrr. 1lrerelry c r'ti'j:lk,7t tk sreftrci;t•c�r(aeon ahantkr, d rx
Q.'iesrut� trar'ci l mitt tirrn'Pfo.cr4�1 €rccwrtl ou-'s wid?.rJ:f'("'A'0! ,0100 or 2C t 200 Well Crinstiwdivii Stanuharels
trod drat ar copy of this retard Las houtxrm ideal to lire.tr'ell owner.
Sh,Lititude and longitude in dt meshuttatttiMsecondi or devimal ttcgre x
(iftcelt fold,mQ Ltr l;mi;u iwo-1 Stu) 9.Site diagram or additional well&tails;
You twly ase the baei,of this page to provide additional well site details or well
N W abandooaent details. You art) also attach addttiunal Pages if atesessatl
t,.0NS'rR1tC'noj*Q DE'TAIL.4 OF W1u US1 BEING ABANDONED C TRAtEffAi CNSTRLTI"t70'tTe
nlrrdc s,'eil wr,L-nctr'atr mean t:+'+rf avajh'lft'. Ar fmf1 rple iiy rla0ia fir rWn.nztter-*'!r"Yrr'
oelk ONLY with&e owtec-um mirtifix Ian.For All Wells• `ubinii this form nitbin 30 dives of completion of well
6a YVett IUd:MW-7 altymdamucnt to the follotcingr-
Division of sVater Rmourcm,Information Prvicessina Unit,
6b.Total well depth: 4 9' (ft.) 1617 NMI Swrlice Center,Raleigh,NC 27699-1617
lob.Far ltrimilon R'cll+: In addition to sewliug tit;farm to the address in l0a
ahv%i;_also gubutit otte cap!•of this form laithin !0 days of completion of well
rc.Elon hale ddantetcr 2" tin.) abandamttcul to the follo"ing:
Division of WaterResources,Underground injectiwn Control Prorwam.
6r1,Water level hc[mr ground urclktcc: (ft.) 1636 Mail Servicc Center,Raleigh,NC 27699-1636
lac ror Wafer Sam h ec iyb1 inn We11a: in addition to sciming the forte)to
Ge fluter casing length(If iatt►an): 39 f eft•) the address(esy abode. also submit one copy of this f6iiii within 0 days of
c(nupictiou or ucii ibandann-cnt to the cottuty health depiw9nialit of the coutay
wlwc abartdowd,
fif.lnaer Basin;hahiaa(raKth(if knolcu): eft)
6g!Screen lenl;Hh(if knoeFn)"O r (R)
PC=MM-3f) Nitinh Carotirrt D satin ten afE trirattrnem.air!Natural Resciv.es-D14 Lao71 of Water Rowan.-S Pwvised rtnw, ZMA

WELL ABANDQNLIENT RECORD F,31-I ic"I"11UWONLX
Titis fen}can be used for single or muliiple wvells
t.Well Cnn#rartnr infiermation: t6F[G ABAti nQN_hIKNT I}1::TAILS
Robert Miller 7a.Number of wells Irein);abandoned:
, Fr eMyd�trdr #rv�p,•>lae' fEqt4Atar€rafEe€wU, ar rruiiu +,pp- Wolff 03L} With sryF
t,ei
jvaft calf r.eNna u ft fi ern,
2675 7h.Apprtudmate%vilume of vrata•itetttatinitr2-in weii
N[W1stt Ct,a„ructc+rC•vtliru;at,;a Ndu0irt
sAEDACCo Inc FOR WATER.$1jPPLY��LI-5 ONLY: J U N '1.
d
Con.:�rd„y i+-10C 7e.Type of disinfectant Lewd:
lnformaUen PPL4t 00,2.,S3 rtat
2.`Veil Construction Pertnit#:,
lava vpl cr,�11 ,ttrlc,rell;ia+rtrif,.r fire.Ct,Jr€r,.Share.t unane.lr,'a'tTarrvr,c%i ra if knowr gd.Atntlttnt of tliSlnfCChaltt ltttA:
3.Well use(check-Well use):
Water 5upplF Walt- 7e.Scaling materials used(check all that apply):
G], rer?tEtursE ❑S�lttni�ip ttPttl!Fic 0 Ncol Cetnem Grwrt Q Rcivanilc Chips or POWs
❑t}eorlteetn tl(Hc tl%n 'Cr�01in Snpply} ❑li i etuiat Water$uppty Wn00 ❑Sand Content Grout ❑ Div C113V
❑tndnslrial76otmnetciai 1311tsidentiat%V:arcr Supp€v(sha rpd) ❑Cbneinte Grout 17 Drill Cedtings
❑irti Clan ❑Specialty Grout ❑Gravel
tlatr-tVatcr SappN•Well: �Benionile slutly U Otltet te�itiltain under 7g1
Hl`dotttt0ting ❑ttt`•<.av�en•
Inmouttn in Well.
7f,1For each material selected above.ptvrvide amonot of inatterints used,
❑AquiferRechatrge ❑Cirtawtdv%tter ttrtr�:di.ttit tt
❑Aquifer Stentge aiki Rtxovem IISalinity Barrier
❑AquikrTest ❑StoronvaterDraittatc Bentonite.:501b ,Atr:7ga1.
OExpwinewal 1echualogy Mubsidetr-e C utml "t g.Provide a brief de"pokin of the abandonment promdut=
L13kodiatar-.al(Closet!Loop) OTracer
❑G thermat(Heari!lCoolingReturn) flt7tttLrte� lain under L1 Pour from surface.
:4,Dateweli(s)abandoned: 5-27-2022
5a.WL41 laration:
Trans
S.Certification:
Fat ilik?- scrr r Na r";M v 1.10 0rapplitblo
800 Beaty St. Davidson, NC 28036 5/31/2022
Ph%siea!Adalr .Gat:r,dZip 'ateet:,.: ";Fox-
Tv,, i :croc 4
Iredell 73,t••signigg this.thmm, I here-ky eerwA,ikar the n+c111st tvr,s nrerc>,ahcuir oned att
coutat Natal IdwatiEQ11 it No.tP*,) nrkrds
mid drat a cr.,ar eof lltis record hiss heat,provided to ke,1t-tll owner-.
5b,Latitude-and longitude in deiivestminutesiscconds or dedinal degrees:
titrvall€told:.`}tom L,tcinng issaml t* 9.Site diatstram or additional well details:
You may we the back of this page to provide additional%►it site details or well
11 iY *utidauntenl details. You true}'als6 attach additional parges if necessaty_
C t3 trS CHirf'ftOY DI tAI1L.�tyr 11 RLIA }H9tNG ABAtlfQgN—LED LIT WTTAI T&STRrl Ttf)1•15
;rdad Well inavireadizirt irce,reMa Y'ar's"ib. d gx 11-4 o bl;vrtito al.Ma-vw.er vfrr.lr
a'Nlkv ONLY 1nAl tik,ATmle tv, Ytfi rmfvt*0f-,rW!k1,?1ak',i6.,Yiri edq 23r1 all cbi;YFP1it Ma. For All Vclis ;uhmit this farm within 30 4,s of ComplCtion of well
Gat.Weft tll#•MW-15 ab%wonracal to the following;
Division of W:tterltesaurces,Information Processing,Unit,
16171Iaii Service Center,Raleigh.NC 27699-1617
frb..Total%cell depth: 251
10b.Car.T%ti tlan tVntir: to addition to sending the farm to the addtr-'Ss in 10a
Gc,13©r�holedtattuKew 21, (in.} atbmt,;also subrrtit ctte i:•upy of this form within'50 dates of co€npldion of well
sdtandaanteni to tare failown1g:
fd.Water tcicl below titut►%l Surface, (R) Division of Witter 11twurces,'Gnderground IniectfouControl Program.t63011i:til Service C..entrr,Raleigh.NC 27699 Ita36
15, Me.Far AVater P.unniv,R tniertta `.Ils: In addition 10 sla:dioR dn-form to
be l)u#erttsinglengW(fCima%%nt (DJ the atddress(es}above. also submit one Copp of this food w%ithiu 30 days Of
completiou of%veil a6anc omnent to the counti.ftstdttt&-patrtatod of tf,c Connh;
a herc abindoncd.
66 Inner casiugl'cnhin};hyr„Kh(if lttavtul: (fit.)
6g.Scrum length(if Imowtn):10" tilt.)
Frusta CAM-?n Ui-;isionoM,titer tt ioatw; itc,iscG stiuptost xtat w