Mecklenburg_Well Abandonment_ (16)

WELL ABANDONMENT RECORD F„r lncrml UM ONLY:
Plus fort can be used for snide or mdltple wells
1.W ell('nnVarn r Information: %'F.H.ABANDONMENT DETAII S
Brian Ewing I&Number of wells her"ahandorved: l
Wdl('toitmim Name is,wdl ow nr pt ,Wh uhmlMmng%etl o,his ter ptapct%r h.. mulnpi, ONLY wdk do writ
„n+mn do gaxburmmi „.uaih•. , ... .., .,
4240-B
NU well Coanmm Cenlfralinn Naisbe, 7b.Apprsimate nllulgeatwafrr remelting iu weY(ek Igal.)
SAEDACCO Inc FOR WATER SUPPLY WELL S ONIA•:
eae pwm.Name 7e.Type of diJMectam used:
L Wdl C"MesseYirn Per>•It ir:70003075, ,
la.i dhy,/Aa u66-wfl rr.ma,".. r wars..tiwe.lenww.d/waac ea.r r/timrrn 7d. 1n%runl A Ji.tnfertaat used:
1.Well use(think well use):
Water Supph Kill: 7a Scaling ntamrials used Irheek all that apply):
r'1 Aericnhtu:d OMmsicINII Pithlc 0 Nar(-cmcut Gmw ❑ Bcrtonnc Chips of Pc lm
❑(imihemnl IUcanng('aging Ssgipl\1 OReademml N'aler SIIPph Vanities O Sand(urwnl(,rout ❑ Dn Clay
::hduemd.Iommcrccd ORadennal Water Sllpph Ishmed) 0Colicrcte Gout ❑ Drill Cuttings
.q_pk„„ ❑ Sphieh) (land ❑ Gratel
Nun-N stet 4upph Nell: ❑ Beraonrlc Slum I I (hhe,tcrpLnn nrdn Lei
%%',,n,m.� ORecmen
Inp,tion 111s4'Il: 7P,Fer stanch material selected alm\t'.IIIVHhIP ai mew of nwlcrial,u%•J:
❑Agadir Recharp O(Imun&%sier Rco"imion Melt Cam.:471b ,Wtr;3gal. Sand Cem. :lb ,Wtr:gal.
❑Aglr&r Sionsw and Reco.m ❑Saluun parer
❑AqW kr Tat ❑Stommala Draucsee --
OEtpenwasualTechmbl(t ❑Stbsidncc('onml
'L Pre\ids'a briel'Jexrtptinn of the aban&nuncsl Pnn rdu n:
OGeI dmnn l 447lowd loop) OTlacer
OGeothcmml 4Menin 'Coohn Return) 00shert"plain under7 ) tremi from the bottom to surface
r
J.Date wePubl abandoned: 11-1-22 "^' - '•- ^ ,_+-
Sa.AAcO lucatbie:
Rorfolk Southern Intemodal Yard
Fartliq.0wner Wmie Facile.IT).vf'MI';ibI0 N,(eni/ieatirm: ��aiQi•,S
333 Parkwood Ave, Charlotte, BC 28206 Brian Ewing _ 11/11/2022
PMsca1 Address,CH,.mid Zip Sealehae nfCenifcd W,:II('ommcla, ..:110wcr Dart
Mecklenburg 08301126 Bi Weing fhss Airm. /bamehf,rr,,A rAra the wel/fv was,fweret.diandased in
featly Pn:,ilJmna:asrn No.4PINl wtowilastre.111,114.W..0,0Y',WIN)or;(' 0.11101(el!(inrJracnon.V�mrAirdr
aml flog a<v/rt a/Ihr..nrurd lmv 1r.•.n lrnmu/nlla Jhe well sinner
Ms.latbude and Inn;itssdc in,bytrrrslmiwwrw•nmAt Itr decimal rimester:
Idwen r.-Id .",his h•r,,r..onr:.m. 7.Site diagram nr addltimal well details:
ou run use the back of this page to pm\de addiharal%ell sire details or well
N W' ab:wahntnrcrtl Details 5"sm isle\ also:tllach:alJrtmltal paErs If ItctieSsan
cOmSTRu no% DFTAILS OF WtMS)BEING ABANDONED SI'BMITTAI.INSTRUCT10N5
.Iraxr, .. nh"Ik' l..v mulnplo nuts nnrr w rv•n-x.u.> m(7.1., _
.ea,o\IA ...... 10a. Fire .All Web: Slbimt this form witWn 30 elms of comprison of wit
ba.Nell I Ilg:
TMW-3 .ibmid minicm to(be folios int
lMtWae of Water Reselurca,Infurmattun Prr evng suit,
66. I nlal nrll Ar111h: 18 (fLl 1617 Mail Seniec(enter,Raleigh.N('276nn-1617
Olb. For Itkciloa AAdls: lu aM1ldrou to scrdnk¢dw form to tlic:ddrrss it lira
IN.B,whop' iatnrrCC 1 lin.l abu\s• also eubntil ow pop\ of this fort wslhul :u da,,\J on,pirion,of%ell
:Ibaldemtmlr to the lolloe m_
Ditlim n n of Waste Resources,I ndrrymad Injection(ounil Program.
bd.N9ter It'd helrrw ernmi.l wrfarc: tfi.l 1636 Mail%cnim Center.Italei2h.NU 176"_1(s16
a m life- For Water Sutlt & Inierti n W elic In addition to sending the form so
trc.fluter using length lA Lion nr: drl dw Adtcwesl absnc. Aw .obnm ,tw cops of Ihu form wnhns sn clrts of
conlpieuon of well ab:utdmawnt to the cmmn heahh depannleta or Ilse coltm
w lerc.thaMorcd
6(.lesser osinLt%ping R•n_ah of knneni: 6 ritr
6%.5cnrn length 1 if l.nnst n r 10
i..,,."A- ^ Nonh C'mohm lhputncm of Em lmmtaa air Nmrnl Rcw%cn DI\aton of K'awr R�ariw.+ 011