Rockingham_Well Abandonment_20230315

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WELL ARANDONNILENT RECORD ' Far Iniernal.UR".ONLY:',. .
Tlits,fortnr:cadir'liti:O*Ifoi;Ookti'roi-.1'ill.6.1titije.:irMis
I Well CrititrictOrInfOrniatinti:- AV Ell.ABAN B()N M ENT BETAIt.S
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Brian Ewing 7a.Nutnber id mai:being alianda tied: 1
:We Idlc.6064:10'.K.aate(or td..c.eldrOli.“,..er.r!i*raialt,,'ati.iii.lrining qcij"kilfitisti4pi;i0eiiy)- "If ir, i a qv te:- -6004iin 4r ,1),921Lii!•:ire,!. r-,•iii','14i': WeliS 4),NL V ..ii;;',/1 ..ili,,-..S,44.iie
.ordiscrric(toikqn:rit;itmeni,yfy,t•1tH.;,-;.,,,'.9.tift t.,,,k,1.0.,91..
4240-B I •
.. . .. ...... .. . .: .. . . 71),Aliiirttilm'ate.'itlu inc.of Water iernaining in)Vell(...)i• (gal.)
NC Arcil Cd ri.M•Cedicirceit igf,'AiDO;Nif(16,)6 .., ,
1---. •-•'... -=,, —,- FOR WATER:SUBBI.Y.:NirELIS ONE.Y:
SAEDACCO Inc
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—.•qe. fyite of-disinfectant used:.
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2.-‘Vel 1 Canstrnctiati:Peintild:', , . ..._ „ _ ..MAR • 5 202-3-
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M.:Anninn t''of'iliinfeCiarit iisCil••
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IVO'wise(rheckii.t..11usek ....,d,•Q1.2.01,.4
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water supply welt: 7.c,Sealing iiiatcriii4.t.004-(cIteelc'al 1',that a ititIO,--,•
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if)AgiVentittral; p MOnicipal/Puhlie, IX.N.o.it Cement:0ton; %fa Went OnieOtitis or Peili.rs-..:
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. • .. 7 d.7. 7. 7.... • . ...• 7. .• . . . ..7 7 . 7. 7....d•. d.d • ... .. .. .7.7 d
ijOctoltcomi,(HeatinOkroling:-Sup.ply'l bicsideniiiil.Water-Sitpiy•(singlc,),•, :la:Saivicetiterr.",'"(Ont '.Er Div Clay
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• ..., •. - •• .... .d.- ..-0 Indistraicotntiereal al•WrSu,ppk rec) 0. . b i-...re(e,Grout: :. „_•-
...o...—D...ur.t:t...„ii106
El lt tigatiOn.' :,EI,Si: ;:ialty:•Oiont ''..Ld0•tkace I
'Nott-%VatO ..0 pply:NV tilt:, '- 1:.I.tientotii(e.Sttoy-. -•f.:t'OtItc((eNplaitt_pteIer 7,g)
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',IXIManikitit . 0 lec-tice ti'.,
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Injection-Well:, •d .If.For carirtnairrial-okieted•;ibore;)*6iite aboiiitrorniateriaisii'sOlf
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pArittifer.Xi:Charge beirtiiiii';iit-aterl-terti(.di:iiiiiil Neat Cem.:471b ,Wtr:3gal. Sand Cem.:lb ,Wtr:gal.
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r.i.: ijuitlir'$tofaie:to:1:f.t..4:OVt ry.: OS:iliitiiy.tkitriet- •
p Ail ill fer•Tet. ElStornitc:tterLtraitrage•
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171perittlenta1 Tcchrkiiois 0 S itbSirle w.:4i IiMantl, • :7.4.-.P'Oil tle'w liriet.iltletijitirt ti n'f.the'al.raitilirintierit:Or-Seed-it-1r:-
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. 0Cleotherntal(cfosed.toopi QTroce rd.
.TREMI GROUT FROM THE BOTTOM TO SURFACE
OGoikrlai.(fictItiojtCoolitf^.Return', bOltrzr(eNliliiitro War 7,g) ,
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-1,-'•1)are'irell(i)-.,ribatitioned:••3-1-23
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5a.•*elltacLitinni
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Washington Mills . . ..
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Neitily/(livii:r.l•tinre- Ea:Ilid.in 0 ora005ibfc): .:.• •.. •
7801 NC-135 Mayodan, NC 27027 • .... Brian Ewing.-.' . 3/2/2023_
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Plisical'Adds&;,Civ,-and Zip :.'Sigittnee.er.retil6.4,WO.Co iltrir;:i6i*,w.'.:11 Ols I.4 ..P0,:.
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Rockingham . .' Sy signihrt.iiiisfirm,..1-herrbr renVi.-ii:at lire Ici,11114:14,a$.(it.'e?e:/..iii.lacieloned in
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l"...Teelldesrifie'in4a-,Mo.rt'lMi •!or*.c.ohltiriceivitii1:54,Nc/R.:....02(:":-..0.icy?.b.r.:....,,c;;021,10'111,',t1tIZ•eiii,qh101:15(1..Sifini-15wc1.
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d.".widiltnia-0-0y,:i?b.iii.i.rer•rriVIrrt;;ib.i.,i.vi.,nsiOdi.i116.41-411:6117ice.',
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.5ti:Latin'de.iino toigitOtio.41,(tegreesitoOgtFs1ceei.ilds:ai7,,tlecintitl d,qtrceti.:
ill' ell tield;•iiii,::•1.11:indei-i's'. .Olieterfkr -'' ' • -' ..'- . .:9.Stic tliatteimt o e:a iii.iiiiopatyfi-ei l'act al IS:,
.•,. .•..•_d On dniaY'.liisetrietracl:Of titisilkIgO,t(rproyrde.a4ditiOnatiicl1.;s4e...*tail§,1,uW'ell
'IC N'' filliatidointiettitletaik--YOu may ilo-attacittitlditioids.4fliaiieSititeCesat --
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C()Ni4T1i11(711()N.DET-rtlt.S111;.*ELL(SillEIN(;-ABAS•ai(iNE1)- :•S1.1111%1ITT;1/41-.-.IN'sTR(t.-TION .'
thi-"c"kli'ef(cl?1"2artk"liti ii..0.11;;P:9 if Oiliji401,,,,,.f:"iii.'iipit,6*iitje0iii:Ot.rip.0;i!i.i.ti.i.,.4:iiin:ti, • •
YFj4!C)Y1.-.)' '.0•!?.'''.;;!,"1".'ri-!1.',:•! ..(.:1.u-'il.,e.,!`i"4',!!!?,'.!‘'?".+.')I'il(......"'`"'"ilrl it . •lOa:•:Ftir-All-Well :•-'--Submit Ali'feint---Witliirr•10 dai Of.'cotitriletian Of well
abittdrinntelit.tOilied'follOWitrii- '
6a,Wed iiiiii:Tbnq-1
Division tilWatefitisititrees,intirrnatiOn:FineesSing-11nit.•
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,,1617:-Mail Scri'ice.,Center.Raleigh NC,276.9916 t 7'.
6bi'Tniiil Vrell'&4461:1-7 1(0
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• lobI F9 iXtliCki int7WcIl .In,l:itidiiroit to 66itlitti'lliti)foir to:tit tad i rOs in l0i
{abo‘e.-al$6'-stilittal,:otte..Opf,O.this.fortir'Withitri:0•..4i4Vii Of iio,111041 i6ii•ti f,.ivel I
6c,Bo Mt ale'd lametert,2.25 (in). aliatiticinineal.iti'lliOSO"Itiwing:
_,.... .,„ ......... : .. ......... ..., ...., DivisiittrOf WA tetReSOti tires;tiodetitilitii0.1Ojectioit coot eol 1).t.rigraiu,.
6d.Water level,liclair grnundstirfacc: 12 (ft) , . .• . .
. . .•_ - .1636.Al.ail'$iivicc:Cnto',Waleigh,-:SC17.699:-:1636
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10c,Fn i.Water.50011r iCi..-iitieetinii Well :-d.In'addition:td'scit-diht thc:form to
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6c.•Outer-rasing length' if lainn-rik -(It) the riddresd..aboe.,.tilo submit:One-'epiiy•of;,tIrg-.:fornt-within'1.1)'days of •
cottipletion'Of well ataricloninent to the•count)-hcaltlidifilianntent'Of the.counts
t•-•liete atiandriziedi
6f.Inner Casing/tithing letrgili Ai(lattiwn): 411(,)
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4g:S4iion.length Of iiiiiiiiiO4 0 am , •
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r.0.,.,Ciw1=36. :14miljtaulina De.Nrtinc.4.:it-gp$jsoni»ail uNdNattimt II !..atiNes-:NO.iionpiNai,:ilitic-A, ourros:. ttel'e;ed L'itiguii 21).'13-.
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