Mecklenburg_Well Abandonment_ (19)

WELL ABANDONMENT RECORD Forlrleltrl Us ONLY
This form an be used for sitglk of mtthipk Wells
1.Well f'wntra n r trrfnrmation: WELL ABANDONMENT DETAILS
Brian Ewing 7a.Number of well,bring shandooed: 1
Wdl Ciuwaeror Nan.mtwcllti ipry i.ulh aL.u,anmvg wA an hn4.r prupeml rw mxlnrk ,n/n nmr .r w.v-xarer r.NA .des ONLY m)d) IAm awr
.x,•mra mr,.A.a.nL,nau•rn.n.x r,W whmrt ix,r 6nn
4240-B
W Well C."Wor Cemfolw•Nox6a 7b.Appruximah,oho n ,d w Ater rrnwinine In W clot,1:_I gal.)
FOR WATER SUPPLY K F.I.IS 0%1,N:
SAEDACCO Inc
ConpaX, Namc 7c.T)pe of disinfectant lined:
L Wdi Coma ttaclMa FvnR IP70003075,
ro.a/.xr•n,anrr.rn/.•.,oar o.r.c'..nm..vw.•.i amok.•.fry.Xnan rxi.,llfArr.n
'd, tm,wmt of Ji.,in(atant uvd:_
L Wdi oar(chrda W cB Rack
Water Supph Well: 'C.Stvlof material,u,ed uireck all that apph I:
DA(pcultuml Elmunripal:Public W \,,I(Coi(inwt I I Bcraomte Chips or Pellets
OGeothcmud 1Hcanncl oohng Sign h I ORMIdciatal 1ii Sttp(rh Isrnglei O Sand(cui(ituut ❑ Lin CIa>
❑bdustnalA onum=wl OR,adcmd Water Supph ishavdi D Cowidc Gtout ❑ Drill Cuthngs
111madmon ❑ Spwabs (iruul ❑ Carari
Wr-Waller Supph Well: D Beuonnc Slam I I (_flier mylln„i wldrt 7g)
0 ORecosm
711.For each material rirctrd AIMo C.pin.i,h'Aui of materials owd:
DAgmfer Recharge DGroudualer Renredialion teat Cm.:471b ,Wtr:3ga.L. Sand Ceri ,Wtr:gal.
OAgtafer Storage and Ranm m Motown Banter
DAquda lem OSmruvi DrAumi
OEtpasmemal Irclaii OSubsidetce C'ontol 7g.Prouldr a brief dcscriptaw u(thc ahand nnoomit pretrtYlrms
OGwidwri nl 4Clowd I. fu OTsxer
tremi from the bottom to surface
OGemhemW(Heatt -Cooling Return) UOlbett under7 l —
A Date Wvlllst abandoned: 11-1-22 `— ter ITS
ti Well locAti...I — N
Norfolk Southern Intermocial Yard I
I( f--^ �:T.� (1n�
Facile.+Clwar c.��. I-cdv. li)x of XDDlYamal N.f.'rtiNcatintr. 1{�PiI:a.IrV'?
✓.:17., 3C
-
333 Packwood Ave, Charlotte, NC 28206 Brian Ewing 11/11/2022
Pausal Add,ss.Cm.ad Lr Mmururc al CcmfN Wbn Chum>ci .;IIOWats Dale
Mecklenburg Ift vig7urgf thug firm. !hi ,. -i Ad the ire ifai war(Were)tasaxi ied ui
Coen Iarcc111mncnlx)"No MINI txa<odron'roilhlf.fST.#(•(IY',uN/(tor:(' 02001fell invi.....C'tto,jo,h
noel Ih.a a[nlri a7 this rrcarJ lei.6.•,rr pmru6i!to!Ir<urlf aw nee
5b.latitude and kinifitti in drjfrrrvminutcuwavmd,or decimal do-greets:
1Jwal1 hId :ei W L.X.r..i Omen 9.Site dig(ram or additional well 1hialk:
1 Or ouw use the bass#of this page to pro)We adJuroiul well sme details or well
N K' abardouneitr details }ou it., also:ntaa'h aWiti o al pages if rrccr n
CONSTRU(TlO% DE TAILS OF K FI JaSi BFI NG \B\N 110%F1) SUBMITTAL INSTRUCTIONS
vrin MI r 10a For .AR WcLL.: Sdrnut this form W'uhm -,ii d:ns of.:anysktron of ucll
oa.Kell 111x-TM31-6
:,badennwra to the following
Di,Won of AAter Rcwmrii Information Pmmaing limit.
nor FotAl"ell,kptle 15 lit l(W Mail Senice(enter,Raleigh.N( 27n99-1617
Inb. Fur Infection Kaih: hi .61 to scdwg de loml tD the Address lit lua
M'.& abo,c. At. s,d?mil cne cop, of Ilus Tenn Inlhlll :u elms of Completion w of ell
,rrMde Aia nw•n•e 1 _.bw.l
ab:ntlennlem la dre hdlu„uic
De,Isuul'If%%Ater Ra,rmrrav,l ndc,gr„u nd InlnYiun Comlml Program.
bd.Klh r ley d holnw _round wr(acr: (ft. 1634,Nlail See,ice(enter.Raleigh.N('27699-1636
no.Outercming Irogih tlt I:now m: Ih.l Inc- For%i%urwl, A In4rth,n W'cll.: In addiucio to wiling the form to
Ile addrvss,cs, atw,C. A,. eoboui ore cupn of this lomt within In dns of
conipkunn of well ab:ud,mnrin to the :oimn heahh derymni of the cairn
w of.Inorr rasinL'�tuhng lrncth lil'Isnnwnl: 5 (h.l here ahadoned
6r.Scorn length lit to ib%ir 0 0I.1
r.,, I:u-- Nnnh('amhm Dcpsnneu of En,oo ncrwail Narursllreo a [h,uron of W'ncr Raowati's lre ixtl Augun Y,It