Wake_Well Abandonment_ (17)

WELL ABANDONMENT RECORD
This form can be used f.�i s,mrk Pit muhiphe wells
1.Well('ostrartor Information: WELL.ABANDONMENT DETAILS
Stefan Smith 7s.Number of wells being abandoned: 1
Well Cotatacici Name ilktMMlcl%it"pmitioulIs dxtmtomngimMonM two ptci,wn)r f.v H+rr:ort< rnlrtn<w, .0, tMN•M<I(<'r rw;.;,.
,v)rtarW((HNe'k,LQhOpirw,wiv(.ur.Muir(r,me kwo,
3576A
NC Wcll Cogt*ncterCcgi9cati+n Ntnnibcr 7b.Approximate inhamr of it aft-v motioning in Acll(%): Igal.l
SAEDACCO Inc FOR WATER SI�PPI.%'%FI.1.S ONLY:
Conpan+Name
7c Type of disinfta9Alit ux•d:
2.Well ConstryRlitu Permit 0:
1,,, Ittie'lifut elt i,t AMrrH
'd. \m(,"nl,,I di,inhvtanf used:
3.well use(check well use):
Water Supph Well: 74'.Scaling material%used is heel.all that spill'):
O•AFr►culnlral OMtmiclpal'Public ❑ Neat Cenicut Oronl a Bcrtonife Chips or Pellets
OCicothcrnul(Neautiptooling%an*%t aRcsidetaial Water Supph tsingic) D Sand Cement Grout ❑ Dq Cl%
0htidusinaUComtnctcrrl OResidcraiml Walct Supph mhared) ❑ Concrete Gutut O Dull Cuttings
❑Iris •lion O Spelaalq Grout O Gmateh
Non-Water Sapp)Well: C1 Benonile Slum Cl Other(explain under 7g)
Oklomtonne ORecu%en
injection well: 7f.For each material rciccteol abotc.protide anwwnt of materials card:
OAyuolcr Rechargic OCirottrdualcr Renicdianon
0Aquifer Ston ige and Rec(n cn OSalmtt) !lamer
OAquifet'i'mi DSfonimalcrDrainage 13entonite.:601b ,Wtr:gal.
Dhxpctimetaal Tmhtabg\ OSubsalence C•oldrul 7g.Prm•ide a brief description of the ahan(N,nmcni procedure:
OiZle tthemtal(Closed Loop1 UTracer
Temporary well; pulled and abandoned with hydrated bentonits
I IGeothemrhl tFieatd ''Coolie Return) I)Other(ex lain"rider'
chips
A.Date seli(sa abandonrd: 10/27/22 g'
Sa.%%'ellliwation: NOV 1 R 2n22
Future Murphy Express
8.Cr rNfkatitrn: In;,� ,,-i
F:Kihh <i,<•,r `:.��. Facilq�IthY{ifaDDlxahl<+ J
4501 Poole Rd. Raleigh, NC 27610 < 11/4/2022
PI.-.,,.i I '•deeds.('it,.and Zip alt(rr ('cgel'rld Well Contractor of Well O%ncr Lhk
Wake Br.signitiq this farm. 1 hernht rertifv thrrf the NeNrs, was naere, oAtuith,tied tit
Counh Warccl ldcirhfialau No (PIS, act41nittlore wills 15:I XC..i!'1)"('./l jl7l)or?(• 02(K)it*ell('curttrucnon.S?un(A)rdw
and that a col!)q/this re rtwd hac Aeon prr,ruied to fire ell ore Pier.
5h.Latitude and Inngitu(k•in(k'l!n•csanirutcv1.wmnds or decimal titxrct-c
ui %d:ieclJ ,,tx Lit k,u_i,.uni.%Lt s 9.Sitr diagram or additional well details:
You nut) the the bacl,of this page Ill pro\ttk:additional Nell Site details of well
N W abaldonatera dctat6 You tua% also attach additional pages if rw;:08an
CONSTRI C•f1ON DETAILS OF WELLISI BEING ABANDONED SUBMiTTA1.INSTRUCTIONS
.i(W<ir w. rurtVruUr:w,n•[v,r�l.,.:,;s(,u1,rv`•1a'. �'.v wwt.wi[ mecvn4,w rP.n
(e•tr.u.xt.f .,IIr/Ih'.MNFC t rNt�/7M fHNt,ih YIeAwH»,•.,r �.v(.tn aMn,r rwr k,.rrc Ills. For All WrUs• Submit dus firm within +0 dads of completion of well
ihandonnlel"to this following;
ba.Well IDtt:Tl
Dhtiwon of Water Remourcm.Information Processing Unit.
i,lr.7ufal.+ell depth: 20 (ft,/ 1617%fail Service Center.Raleigh.NC I7699-1617
1Db.For Wcction Nell: tit addiiiam to seeding the form to the address in 10a
abme. ale,std>nu( otw cop.\ of this form within 10 da}s of ttmiplction of well
i,c.Fkrrcfude diameter.1 (in.) abatdonnutir to Ilk tollowtug
Di s i>io n„f Water Resource+,Underground injection Contrail Program.
aid.\N ater kt d beh,w Lrouod%urfacc: (h.l 1636 Mail Service Center,Raleigfi.N('27699-I636
10c. for Water Supoh & Infection N ell.: in addition to sent irift the form to
be.Outer casinzIcnzhtifknoani: (ft.l the addresses) abote, alw submit one cup% of this form within Ill aims of
:ontpknion of well ab:udonnicnt to the cotmtl health deparniets of the:mom
6f.Inner casin,;itufrin.,Icn�Kh,if Millie: 10� {fl~1 w here atntdootcd
i-a.Ccrccn Icnoto(if Mow at 1:10, 1f1.1
Form GW-3n Nogh Camttttl t>Lpann�n of Em ironnnctn artt N Utmat R.wumis Dts nsion of 14':ncr Rsstwnxs Re,ised Augur-41t3