Johnston_Well Abandonment_20221208

WELL ABANDONMENT RECORD Fair KdenudUsdONLY:
This form can be usedfor single or muliip[o.vvells
I.Well Contractor information: WELL ARAINil MNIENT DETMUS
Stefan Smith 7a.Number ofyvolisbeim abandoned;:.
5VeltCouttaisorNnotc(4r�tirllout> PetSandly'als�sr[flsiln;^�wtl.outiistltcrprapcstyl fw• rrrulnple vVeeddir ur roa-,iatcr sup1m), wells ONLY will) the same,
Mnsfnrcfirxr�mborYlrxm��ru,,rnu cm sriMnll atiajFirhr•
35
3576A ( +WellConlWgor Ccitificaliou Narrbcr 7b.Aplitni ift aie Ynitiiue of ysafit x4aainik iu Vell(s�i {real.)
14CFOR V4'ATF.R SUPPi,V WELLS ONTY.
SAEDACCO Inc
Company Narnc' le.Type of disinfutani n3eil:None
2.�'V4ErCansttuctimr Penalt 4:,- — - --_-- —-- !
Lf3ralr.tr/ilr<lrableueflµrntiLti(i:iCVLraV Srrt$.lwrarKx.lirJrcifua,rrrfffGruwu X.Nmoutitof.dlinfectantttsed:
i
3.IVell pae(check r;'ell use}: I
Watei'supply Well: 7d:Scaling tnateti�tlstrsc+l(clicci;all tii;vt aliplvj:
❑eilgri ulftt>yt Mfunicipall Iiiblic- Gl.Nmt Cciactit.Gmirt ! 6d 13cr4oriitc Chips or Pellets;.
❑ckolhcrmat(Hcati.100olitig supply)' Q, .I'dentipl Water�`trFPl}'(sint;lc) El S3rul;Ca ttiml Grout ❑Dty Clay
17buinstriallContmcn ial OResidetttiat Water Supp4,Ishated) ❑.Concrete'Grout 17 Drill Culfiggs
❑ini fion ❑Speciirhy Grtatri E3 Gravel
Nua-W;ttcr.$upplv.�Vell:r C1 Beofo[dteSlurry C1 0t6er(c,�-plainunder?g)
®14lonhoaiug_ pRecomy,
injution Well: 7f.Foreach uiaterial-selected ab4vc,provide amotmtaf:ntaterials used:
❑Aquifer$ec[targa ❑Grtiundviater Remed[alian
o quifer Sionrga:uld Reibvcry ❑Saliaily Dardec
❑AilaifeiTea pSi6iinwoterDnillkw Bentonite.:101b ,Wtr:gal.
❑Ertperiuteutal Ttxhuo[o� 7Spbside:Coinpl lyiptini ieducPeovlc afbeabiudnnmcnt lr
7Geothermal(Closed Loop) CJTracer
Pour
<°IGeotkxtual(Headtty 6L)l Retum) ®0thcrOxplaia under 7R)
4.Uttc 'V L,L',
5:L LVell location:
Berry Global ln,omn,-iun fir; .�Unli
Facility/0imir Nrume Fxility 01)(iNpplkablcl
S..Ccrel[Ictitlou:. I ;�;G gGG
1203 'Chic22ee Rd.-Benson, NC :27504 11/28/2022
Phy.skal Address;City.and Zip. 5 ali+te;.CcitMcd Well Comwttoibr Well CA%'rLr
Johnston Ifu xi�rring this form, I heMbV certify-dW 11re u•etlfs)yr.as(here)aharrdoned in
t aeiuiy f'StreI ldettlitlt tbJL NO.(PlNj at;CvArtrre refOr 1 SA NC`k 626"i 0100.or 3C.0200 TGe1l Ci uslmcfivri Standards
adtnt g _ ra ell orrer.d , t
5b d,ati6ideand lougitiidc:in ticgrtcetilRiiuirtcs(sceonds ordcchuid dyes:
(if..411 rwu,n+u:liNluna j55Jifflcart) 9.Site di,•tgranl or adilldouat welt.t1etalls:
Ydu.may e'tlie back of US page to provide addifi nal ud silo,details:oi vteil
35.3646212 )t* 78.5541528 W :tGaudorwtcatdetails I'outtulyalso;u4�chasidi[iorialpigesiflrecessun'.
GOMTRUCTIO'V.lJETAil.5 OF WELDS),BEING ABAND6NED SUmti rm tNSTRLTCTiOMIS
:lttrreti url)cwrigrruetiwt-h!nuriflsJ'f arrillaLte. lour multiple irletiiule,rir'raon•rrurer suppfj• - I'
nerdsDr<�GK1i711rtl�edarnsronttraenn:drrf+artfri�rnrent tyucpnstrbittirartjynrr 10% For All ♦Vctk: Sithmil iliEs fatal•uithin 30 da}'S of completion of iyrll
6a.W511[DO•Tt4W-1 ;ibani)oitmcitr to tlta fotlOwing;
Division of Water Ftesoi[rcm.Information.Prircecsing Unit;
17 1611 tlLiilS'nicCl�edterlialeil;fynC 2?699-1617
6b•Total well depth: (fl.)
101t.ror Inleetlon well3: In odditioa to sending the fomn to the address in[Oa
fe:_Bov,kole diameter:l �u,), abopt,also submit one copy{of this:form vvitLin'30 days'of completion of.neli
albtindomneW to'tlie folI.Wlag
fid.Water[cv¢lbcloiF otindsurfacc� 15 {ft,) DlvislgntifWatorltcsouries;..i7ndergruuadLrject[on,6utrulPrdgrap,
1636 trim(Scniccl'61 nter,Raleigh,NC 27699-1636
Gc..dntcrcasing Icnptlr(iflmnyvu): 7 (fi) 10c.,rnr water Stmnh.F.iafcctlnn JXP g: In addition to sending the form to
tl}e`addrt:ss(es)'above. also suG[nil:one copy of this torn %vilbin 30 days of
colupletian of yveh abitndamn.-nt to tfic county lucnttk depauintcttt of the Courtly.
yvlure abatxiotvcit, � �
Gr:-rnnir casinoubinj,l hifigh(if known): (ft)
I
6g..Si:reen length(If kuolta):10 06)
Farm G%V-30 Nonh.CaroUna Dcponmcm of EnclrOnurcat aiai Natural Rcsoumcs-D)rision of Watcr�Ite Ouces Revised Aagug 2ot3.
4 ' .

a
NT ELL ABAtt11TIlQNl1llIEN.T RECORD FarMemilUsdONLY: �
This foim' in tie ttseil.foe ON'T of muWpk vvdls `
1.Well ContraM r Tnfoemution: WELL ABANIJONIVIENT DEfAffS
Stefan Smith. 7sLNinnUerufrv4llsUein);uUinJoned:.2
5}r!]tCatyracsprh`�uM'(s►riatiltoureipet sully-alllul9nla;e►LJl.dn}iiallfsrprupc>Ayl �w', nllrin�lJro Pnfiettae or rwn,yitit r su,)kh+ winds ONLY wPdb U!e 4wite.
fir trrccflcn'tl batdlrnr mart.you amr milmi`t wI-0 rin .
3576A I�t
7b.Apprn rimate►nlrimc of trattu•rein,dninfi in lidl(NO1 (;al.)
NC Well ConlwclorCoitiftealiw:Nnmbd I
SAEDACCO Inc FOR.NVATERSUPPLY WELLS ONLY:
C ).N>ms 7e,Type of disitlfixtant rised.None
2.Well Comtruction:Pevmlt B. i.
I;
trll npfiJhwkde u fl.farlir r.Y(r.r C;x,rlh:Sr�t�.l°r,�iuY�.l frcilur�,arti Pfklruwn 7&Atnottnt of.d6infectant used
3.welt ulrr(lreCk: ell.irie):
j�
Water Supply Wc1L• 7c.Scaling iroa(6dals used;(chcclrall alit itppiy):. .
ggari illfntal phtiim C1pall/Ptlb[ic 13.Ncat CCntcilt Grant w hcirtonitc Chars or Pcllcts s
CJfl therm tl�[icatigr Corrlitta 5trjsply) pliesidgntita[Water Supply(single) ❑Sanr[Cetttent Grant 17.Dry iC
❑haTuSlriallt otnntcrciaf ❑Iiesidentbil Wiatcr Suppi'F(sh O ated) �Canctc,(e Groul ❑'Drill Cuttings
13Tni •tiou Specialty Giout 17 6rat:1
4�irn-Watee;fiitpptvWcll: 0 Bentonite-Shirtg ®Other( ilainunder7g)
CAlonilodng. I7Rtx ot'eiy
injectinPt Wctl• 7f.For eacli material sdgcted al Ave,pint'ide:tueotttoCaf_teeateriats ltsed:
❑Aquifer[tccbarF;e: l7Crpuird}} le Tteuiedl!lion
O.4quiH�e Stonrge irtxl ltxibtrixv •,' l7Siiliriih�®arrlas + .
❑AijuikTo. ❑Sioimtti lterbhingtgo Bentonite.:101b ,Wtr gal.
en ' -- - f--: --
t7E eiiutenttii TkImplol jy OSitbsitieuee Ctil Anil 7_;;.Peuvide a hrief dii-w iptinn of,thc Wwitdoumcni pro&ylUrei-
170taotUenml(Closcd.Loop) . Mmcer
-T3Creothem%altiiead P.iCoo6nttRetum) ®0&,r(explain under7R) Pour
�:Oats n611(s).;tftandirncal: 11-10-22 C 'L e V C e..y+
s+.tdellCucatilit: �! DEC 0 8 2022
Berry Global <• C,r•, : :,
il:.Ca:riilliati�u:: Unit
Fstoilitg/{hvtterNairoe ridlily tn4 ffijpolicablo M`o
1263 Chicopee Rd'. Benson, NC .27504 _ c 11/28/2022
PL}.sicat Addrum❑ty;ai4 2j p iuu Ccracd Well Coo;or br WWI Drib
Johnston By sipj!ng t1io frirnl,.!lterLby,cea•t fy',f ffr I/'se u'FII(s)tags(tear!)a6midurted ne
Calms t".irccllde�ll[? iiiliitNn.tPIR7j rttcaiidtrdetvifleP� N fCO2C.,:CP1(JtJ.ur2G.U21d0i6e11t^t+Piti?i7Pctfyrl.Sfirrtiltlyds
arksl6l a cropjraf11ris record fam4.eeit provided to dre-ti+ell ou•iier.-
SU:I..•ltittideand IongitutTc tri cTeg�e�fitiinnteslsecnnlls.nt•diciin:ol cicimceFi
(ird•efl Wd,Ow l ttJlo,t3 s<r0*1-4) 9.Site diagr m.or-addltOuat wil.detalls:
tt Yov. w}..t�se!lie back bf M p�.t to p;6 ide additiottal w,11 sits,ddails.oi well
35.3646212 . �. 78.5541528' -. W abuuflotuueatdetnils. Ytia tma3,rlau�ltocttaclili6oualpii��eslfttecessary
CONSTRUCrION.bl'T'Ams OF WELLfSV BEING.A13,4NBONED .SURIV11 FAT,ii ISTRUCTiONS
!lNlaelt nrff ixllisfrltcliur!'rucvriPfs)'ijairiltrd�PL I'rir prufitple,its}�'[tlrili�nriatin.teurarstrppJJ� - '
11'elbOVLL`.iWill lbe 1711M¢YIIrSIYfIE(fG!!k)E��1H�171.'ICNI/,IWI Call 57rJ111tPf nllNftJ79ff. IQa:.File'All WCUS:; Submit ilicS Arrti tsithirt 30 days of cotupletian of tvcll
6g.WeGI[D •TMW'2 mbanddummut W thdfollowin-
Division of Rruicrllecoiircm,Intl iinationTrocMinu Uniti
F6
I7 DIuil ScrVice+Cedier,,Ra
6b.Total spot!depitu 18leigh,NC 27699-161-7
40b.Eir Trilccllatn Wells:-Its Idditfoa to senditlg WPnu,to-thi addroAs in E0a
rc.B,amliole diatuctcr:l kdve,idea sttbadt.bne ropy of ittis-roan miWii'30'days of conipteliou of well�u') iibdndomnenl to the follateiugi
f
6t1.�Vatec¢eicl:bcTmi trot!stiefaee�15 (ft;) 1f}lvisiQtt.6SYVntgrRasourccs;iluilerSriiund Ttiject[uu Conttiil Irrrjgr>itu,
t636 Mail Scn'icc('enter.Ralci2h,Lt6 27G99-1636
6e..Qntcrcasiagiere .(iflmlorvn): 8 (tQ.) loc i rlr Watet• aluu .co.Ttif,��ti In We11g: lit addition sending the form.to
the addresses) aboge. also kilimit.bne copy of this'fbm i0thin 30 days bP
comptattion of mdl abandorunenti:to ilie-county IwA tli'donruiterrt of the county
(f,dutiercltsim;;ltnUiti;;lrng$Ir(jf tnrutiti n): tfr.). witerc atrandowd.
6Msemmlength(if knots' 10 (er.)
Farm MV-30 Nonb Caroiltn Deponlu:m atEnvir000tcnt and i4numi I(eso=cs-Division of 1Vater k lomms Revised Aupua 200,