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HomeMy WebLinkAboutMecklenburg_Well Abandonment_ (17) WELL ABANDONMENT RECORD For lnenel UW ONLY This tram can he used for single or multiple wells I.Well Cnntractnr Information: WFM ABANDONMENT DFTARS Brian Ewing 7a.Nunibrr of wella brine abandoned: 1 N',nl nlaiYel01 NJi1\IUI M2If UM RY pCfSOIYBt almdaNa�C wCll Ull ha'ILf PrUpfn)1 Fv mWnpk .rile.hmr '4 cam-+<nrr vuplJr .4h; ONLY afd /hr raaw r .'M tNN uhJMIrMNYXr I.rM tlN WhmlI rYK hm 4240-B 7h.Appmdmatr rnlunw of w atrr rrmaiofee h peWak 1841.1 NC Well convenor,Ceilificalion Hallakr FOR WATER SUPPIA MF.IA SONLY: SAEDACCO Inc Coapoa,Name 7c.Tspe of dirnfecWm used: L Well CamttanYhm Pervall N:70003075, bard? Ti—A, +. .. —:' war. Vwe.I,vmmr I,nr,m,r, .a J1....r 'd. Amount of Jisinfirtanl used: J.Well aar(chndt veil Vert: WNer SUPPb Weil: 7e.Sealing material\uavl(chcek all that ApPI!,1: ❑Agrcoburd 0Manx;gML1h"x M Near(cement Grrnn Cl Derlondc Chips or Peliets IXkcalicmeJ IHcmag I iudnnht Supph I ORcsdcmml Wmcr Siryph Isnngle) O Sand(Clar t Ganl ❑ On('la, ❑hdusm:ll:('ommerewl OResderstal Water Slrpph Isharodl O corktrir Gmul ❑ Doll Cultuip AIM bo, ❑ Spocialn Grout ❑ Grind Nan-Motor Wpph Well: O Bemmule Slum I (hlic te\pLnl.uliden 'gi xl,lonunnuc ❑Rwo%en Injrtlisn Well: 7f.For each niawrial selected abate_pmttdr aminmt mf malcio rind: ❑Agatcr RcLh,agc O(innond%ma Reniedlatiovl Neat Cem. :4711i ,Wtr:3gal. Sand Cem. :lb ,Wtr;gal. OAgmfer Sa)ragr and Root m ❑Sahmn Damer OAqulfer la ❑Slonlmakt Drainage OEryennlenml Tahrobg2 ❑Subwcklcc Control 7L Pmi id<•a brut drseription of the abaVihrnlnwet pniarAtRz OGeoltvmctl tclosed I.00pI ❑Tracer OOwihential McounglCoofing Rehm) ❑0ther jc%pfalrourderi I treei from the bottom to surface l Dele aix8(xl aMedtltltelk 11-1-22 - ..-. e VEP 5 .is.We86pVtllte: Norfolk Southern Internodal Yard ln(Oflp i-" Pr-;,weo ;g Urn Facdin'0avcr Nnmc Past,me afapplrcaht R.f rrtinratinn: DV 3rJG iQ1 333 Parkwood Ave, Charlotte, NC 26206 Brian Ewing 11/11/2022 PM seal Addreu.Can.and Zip _awns of('am 11.d%a ramn.l I "A Oann Dow Neeklenburq 08301126 /it tilinaW Met jirm. I herehi i r r,;i thaor like wells) was Meru abandoned in ("an, I'mul I&M4eAI,No 4PI%1 o(rardane with 15dVC4CO2 ',0100 or:Y'.021010 Well C'tmrim,I.....VamFrr/t rmd that a e'tprt of Ibis record hat been prol-ided ro the cell,caner Sh,lawitade and lanpttnde in dtVvrvmimnrn:,awade ar dermal degree: If sell veld ne,Lot bop n.alrakvi 9.Site diagram or additional well 4k-tA41%: N ou wrn ID('Ilk back of this page to pen de addraoual%ell ear details or sell N _._ M abaldc arrcm details You ItIm alw:avail aklltalell pages if necessan CONSTBUCYION DF IF LS OF ME I.I ai ail I N I, tB\S DON 1:1) SCBMITTAI.INSTRUCTION .Itmafi +rn.2N.) .riser N.o-- Ma. For .40 M'db: Subaul Ill. loan vittbm 10 lots of conipletou of "ell ai M'rll ID,TMW'4 ahaidoamcm to the fohlotung llh,Wom of W ater Resisters.Infaraunhiw Pmct'.ung I nit. rib, Imlal nrll delnh: 15 It i 1617 Mail Scot lee(eager,Raleigh. ,( 2-IM-I617 lob. For Lnieclloe Well : III mltfltwa IU rld"w Ilk Iona to Ilk:ddkr cal IUa Iin.i abu,e also sulontu our cup) of this form %nhlu to Jars of completion of%ell In.Bur\'IMJe'd1111%'ICY:1 ab:uahmnanl it,Ilk IiJluw rile Dhuinn nr Maler Resources,I.nJcrgnand Injection Cultural Pnmrain, (,it.\1 Ater k'rd brinw ground wrfarc: dl.l 16J4i Mail Senior('enter.Raleigh.N( 2709-1636 Ilk. For Water Sunelr& Inurlion M'rlls: In addhao to carding the font to I,Outer caring length lJ know no: Ift.) the :ddwsslvsl abuts also whom oak cop, of this form within III des of coarpMmn at„ill aKi donircm Io the :aunt hcahh dcp:mnkm of the canton „Ikrc.tMlidnlad e/.Inert tasiny''tnbiag length ail'Mown): 5 Iltl tot,Screen length(if Mow n c 10 111M 1 .,., r.:A-- NonhCamiro Dcprl ofEmlmmncead Nml iResoaacs - Dnulonof wave N.uwms Re.aeal Aipa-N)It