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Iredell_Well Abandonment_ (2)
WELL ABANDONMENT RECORD Forlmcrttal Use ONLY- Tdlis fusty taro be used Of siltnle Of utetlliplya wells 1.Well Contractor infortuatiott: WELL AMN_Q TNMEN'r DETAiI_5 Robert Miller 7a.Number of lis being abandoned trt 1 Well Comimietnr N"an!e der tcell awpef Perhom y ttlm%douinr%Loll chid hivitia[irapem r r'v irrtrlrtni� trt at.totr cc� rntrt-rrirtea i d9!.tr wells ONLYr!h th nut+e c'attLii?wStdf�+lx75rurrii39a![�!f.S,•tN,�Rt ittivaiiP etc.fnr.il 2675 ?y,Approvmate volume of tvater semaining in yell(%)F/A tgaLl NC'iR�etl�snncac+rCcnifualinn Natn:hcr SAEDACCO Inc &.k V r—Uv Cantprtny N tr!w lc.Type of disinki1ant used: bff+ rllflppproGltu 4lperitiud.c.(;varh SZutRlurturr:.Lrf-ec4ini;cfrrilX=+��iy Id..tiu6tlntefdbinfectxantu%t.d' Irt7;ii'+'."3'{,`�1 �(i !^.y3_lln�! 3.Well use(cbeci:vrcll rose): Water Supple'%Veil: t7ts4tmici[xtlr 7e Scaling tnatcrials usctf(:clierfi all that apply): ❑A ric 1 1 'Ptiiilic; Ncat Cem tsnn ent ot 0 Bcnionitc Chips or Pcllcta g n tarn ❑DIV Clsv 5a Cerrtent Gtviit ❑(.`rcnlltenrcll S;Hcatin��Costbn�vnpPty) ❑R�,i�f:tttanl Water�uttpl}(ainGte) ❑ � . :r ❑IndmorillComniercial ❑ltcrtidential Waler buppic'(,stmed) ❑►-'onctcte Grout ❑lltilt Ctiuiri ❑Ittia tion ❑Sgxia[ty Grout ❑Gravel i (ia-%Vatcr 4upph•Well; M Belvottite Slaril ri odwr(eNplahi tuder 7g) iujoction Well, X.For each material ariccted above.provide amount of mrttcrials used: ❑Agttlisr Rectiarge ❑Grptuxi'udr 161wdia ion ❑Agnifer Starage and Recovery ❑Salinity Barrier ❑Agviferl'est ❑Stmm�waterDtaitu-20 Bentonite.:751b Wtr:7ga1., ❑ExTeritnettial Tevintulogy ❑Subsidence Control 7g.Provide a brki'dL.scriptipu of the abandamttcnt procc+iurc: iJGeottlernial Wlosed l oopt i3Tracer Pour from surface. G1G.aotltemtat iT3e ttiOa Caolinit Retumi 00ther hc. lain under ZA; d.Date wctl(s):tbandoned: 5-27-2022 ;a.Well location: Trane r=WtyXhvncrN n-, Rr.iifty TD4 draPR -lizablc? .Ccrtifka[ion: 800 Beaty St. Davidson, NC 28036 _ 5/31/2022 Pltysical.Addrevs.City.end Zip Si_K>�a;:n!"i:F e.t� >9 :::'>. ir'^y'°sr+an r Dim! Iredell By st„aare ,thiv bunt. 1 lrelvh'e rt�,11tr11fs lvelltvi was prerrx abase oned in Comm ftrel 1J.-Ha6wliuu No,4111 tl arrohlim r.wilk 114 bC•[i_"CtX.0100 or 2C,0200 it e'11��j.ov ie•oon Styr(har fs emd dral za copy r_+J thfs recce ci lun pert►prtrr irl.ii ro Me tr ll olTne.r. Sb.t,•arimdc and tmr�ntude in ctctrr+cesftninutrsl5rcnntls or d�itnal dcgt�e,4; tt1 nett rxtd,nits l itilt!it rc ratr;csctai 9.Site diagram or additional well detalls: You twky me the back of this page to ptovide additional well Site d tails or well N W abarxlaur erd detaiV. You tuay also attach addititnull pdgg s if ry cessat4. CCINSTRIIC'nON Dt'rAlLN OF%V1rL1 .Sa BEiNG ABANDONED nLf ATiT A t,W-TRRCTiQYS ;#trod tr!'cr_mstra�£rnr.n.cvr•lrit tr'urvt4a�:i. l�u�tmrPtm a itdxsti:�r ry rrnnrvlrr xrl+lri: a eldr UVLi u arjr r e a,uta srtra..a_t urt al+untk+!;:arrtr qua cprt�rtbttrit ncrr ti me 10a. For All t%tclls: Subunit tlrit form tsitWu 0 days of eorttpletiun of vic11 6a.Well Ill9: MW-16 -ib tndountenl lu tie:foilntying: Division of%aatcr Resources,Information ProcLssin;t Unit, 1617 NW Senicc Center.Raleigh,NC 27699-1617 6b.T0talwctl dcptlt: 40' (.ft.) 106.itirr T is th4lt%arils; In addition to af'ndinge 1W fann to the addrm in [Oa above.also fAdintit one copy ©f"this form N%itlrihi A days of completion df%%ell (c.Borehole dlnnutcr;2" (in.l ab uulaunieru to the fallowirt4: Dlvisiortof%VaterRmurc6,Underground Ltjection Control Program. 6d.Water level below Found surface: tft.) 1636 Mail S¢nice Center,Raleigh.NC 2 7 69 9-1 636 30' Alit,`..Fnr Water.Satnn1v& role tfnn Wrelta: In addition la sr.ndin^die form to 6c Outer eosin.M Icngtlt of lat►tvnl: Fft 1 the addFess(es) above. also subn* .one COPY of this f0tni Uilbin 30 days of ccrupte(itin of wet!obandoitmem to the county lrcm[ttt deparintettr ot"the rautay iyh�re abin,�lar�d• 61.latter casin hubin„+teap'th(if lamAvn): Vw 6g.Screen leagtb(if Idtmr11):10 Fnnri G�V-air NOitty Caroline Depcsrnucm of ftwoiirnant m'd Aituml Resumes-Di+Lstin of�b'ute!r Ri uurces Re iced Atipus.200,