Wake_Well Abandonment_20221118

WELL ABANDONMENT RECORD Rlrinitrn-11UscONLY
This foma rat►be usW for single or mtihiple wells
1.Well('ontraetor Information: WELL.ABANDONMENT DETAIi i
Stefan Smith 7a.Namber of wells being abandoned: 1
Well Contractor pant lot sellawtwiprrsol►it)tatVod(aun;e.a kill hoeherprolwmI lttr a+l,t(Jptr cntr,lta,t n, ►leaf-Ma(Yr 11prJt .01i ONLa wah the to~
,v WrrF'(rMx,+AtirU((IIANl91f/1(lov taut-Uml)f tole h,rml
3576A
NC Well Coatmctor Certification Nuinbcr 7b.Apprmimate f ohimc of water reraaiaiag 4 weBls): (slat)
SAZDACCO Inc FOR WATER SIJPPIN WELI S ONLY:
Compwn Native 7c.Type of disinfectant aced:
2.Well Construttioa Permit 0:
Iltf adf trpt+(:. ,teo t•r,reds o e i vanit'..stiXe. I arh,+Kt• ho eabu,i elt.,to Am-ft,
'Id.Amount of disinfectant used:
3.Well tow it heck well use►:
R after Supph "vil: 7c.Sealing material us(•d u•heck All that apply):
❑Agrvcuhural Dbtimicillal!Puhlic f J Ncat Cement Groat M Betatron Chips or Pellets
❑Coeolhermal(1tcatrng,-'Cooling Supph I ORecidetaial Water Supph 1singleJ O Sand Cenicati Grout ❑ Dn Clan
❑irdusfnal:Commcrcral ❑kcsidedtal Water Supph (shared) ❑ Conciele Grout ❑ Droll Cuttings
❑Irri,•twm ❑ Speciaih Grout ❑ Gravel
Nov-Water%apply Well: ❑ Bentonite Slum CI Other(e\plain under 7g)
Oklon►lonne Okerovrn
Injection Weil: 7f.For each material selected ahme.provide amount of materials afford:
0.44uifrr Recharge ❑Groundu ater krnicdaation
❑Aquifer Storage and Rccrnrn ❑Saluun Hamer
❑Aquifer Test ❑Stonnnvatrr Draarnage Hentonite. :601b ,Wtr:gal_^
OE\pcnmemal Tcchnolop OSubsidetwe Control 7g.Provide a brief description of the aban(lirninent procedure:
C1Geothermal 4Closed Loopi lAracer
Temporary well; pulled well and abandoned borehole with
DGeeothernaalIHeafin •'Coolie Return) f)Otherte\ lain under' ► _
hydrated bentonite chips
4,Date wells)abandoned: 10/27/22
ta.Well location:
Future Murphy Express C1,`'1.
FAC iM >Lt (ht t r V;mtC1 Facilq.I rl:t 1C;1p�1. th t;l A.Certification:
4501 Poole Rd. Raleigh, NC 27610 <_rJ 11/4/2022
Ph.seal.addmss.CM.and Zip Aw1t;t�J('carlied Well('o>umum or Well Offing IJy1c
Wake Hi-slulnty this fivai, I heneAc certift Art the amyl/r_r, %its fuepri uhauukoned rn
l'ourgl Pared ldt;raa6canau No (PINI tk<<nticalxr w(dt 15.1 17'.W O."of".UIW or V 021K)H*et!(ini troichim.Sifmckmlr
and►hut n colt qJ this re(rtrd lam•hectic pmiwird to titre Y ell nwit(r.
Sh.latitude and ltngiturle in(let rrestminutcs:xeonds or d(vimal do"I've :
oaf ttc o(x w otte L loaf.n,ul)tca►: 9.Site diagram or additional well details:
You man me ilk bacl,of dus page to prof ide:additional well site details or well
N W abandonini details You nua% a6o attach adcsuronal pages of wt:cssan
CONSTRUCTION DETAILS OF WEIJAS1 BEING ABANDONED SUBMITTAL INSTRUCTIONS
.HGxir Writ r.,tzaructr+,for n•cnrd•.t:,t tnwhd,k•. Try raulaplr anjelUna ry n..n-aala9 wpt!h• - -
wrflr OALt *)IA the.vies twi,ou r!ort t✓atn.A.,mtcnf r,tot era alhmtt enter N,na 10s. For All Welh• Submit Ihts fornt wvithnn A0 da%s of completion of well
6a.WeBIDs:Pl
abandonnical to the following
Dicisian of Water Resources.Information Proceeding Unit.
6b.Total well depth: 20 (ft.) 1617 Mail Service('cater,Raleigh,N('I7699-1617
lob. For Imiccdom Wtiho: In addition to sending five form to the address in 10a
abuse. also submit one cop% of this foot naduu 10 da)s of conaplelion of well
ow.Iltn Iude diameter:1 lie.) abandonment to the following
Division of Water Resources,Usdcrgrvwad injection Coatrol Program.
WI.N Ater Ictel heblY );round sutiA(r: [ft.l 1630 Mail Scniee Center,Raleigh.NC 276"-1636
toe. For Water Saool & Injection Wells: In addition to sending the form to
(e.Outer casing length 1if knonnl: (ft 1 Ito address(esl abo%e. also submit one cop% of this foma within III Jars of
conipictuon of well att:andinumn► to the count) hcalth&Nrinicaa of the couaan
al,hcic attindancd
6f.Inner t:asin>rttubin�l•n�nh of kiu,wn): 10' (ft.l
1�crccn length of Wimi n r 10' A)
Fomw GW-Iti Noah Carolina lxpunnxir of Ein iraruneni at;d Natunt Rcwwccs Rc,tscd August!411 t