HomeMy WebLinkAboutIredell_Well Abandonment_20230626 (7) WELL ABANDONMENT RECORD I lAc ONLY:
TIOS fohif.caft be used fdr.sjngle,.or multiple wells
1.Well Contracror Information: WFLL ABANDONMENT DETAMS
1
Stefan Smith 7.a.Number of wells being a1liandune& 6
Fw, tradople 0!1�efio)
Well 6DUract,r Nb�,(01 vw r w; ima-ii-cirr stippti, .elfs ONLI' wah dee? .Vne
It propepy) ?,v"j
3576A
�71P.Approximate wilunic of)iattx remaining in well(s)i L)
NC%V01 t6wftj dor 6rl leicilitiP 13 Kltlilb CT
SAEDACCO Inc FOR WATFR SUPPLY WELLS ONLY.
CORIPamy Nainc 7t.Ty it iddisinfecian'used:
2.,'tVel[Cdasta-dctioti Permit#,.I WM03012801
sdAut tlstA:
7d;Amount of ilh.infL
3.Wel I use(0jeck".efluse).
I&Sealing fpat�kia`], that apply).
Water supply Well:
.IM.(in.icipal/Riblic" El Neat CcM.M.Grmit tia Bcnjo1ni(c Chips orPellets
bOLpthcruial(Hci(inWC.riolingSiipply)' OResidenlial Water Snppbt(single) 13 Sand.Cciiteiti.Grout 0 Dry Cla.v
EllndustriaVCornnicrcial, OResidential AVater 8iipph-_,(sliarcd) E3 c0lciete CrOql o Drill Cniti tip
11 spedafty Groilt, EI.Gravel
Non-Water%PP!.•AVVC116 1:1 BeffloniteShim, 11,10(her(explaifyu*der 7g)
aMwillorim! E I Recovery
if.For each material selected abovi-,prosidc arnount:of nuiterials used:
Ij Aq'uii'e i PcOMMIC
;J&Aiiritir Barrier
CAijuifeia t6st ElStori. nwaier r Bentonite.:251b Wtr:gal.
7 `f-d' "'Mp loutICA'Aiatid inuen lipleedurr"t 0 a t
DGeolitennal(Closed Loop} btracer.
Ram) M0(Wr(c.x01airfu"ei72)
pour
(9-ab5indnimi: 4/26/2023 4 V q—:..0
Via.`Nell hiealioo: JUN ,) C-
Ferti Technologies In -jc-n prc- A.-A. Uhl
P,
111 McNess Rd. Statesville, NC 28677 .5/9/2023
AM
Zip M119
Ireciell I h,6;i-ebjt rer4fP,tfiaz ft-wellry)was 6vore):ahwidoiked,hr
lblliil ld.fdifi6t d L N13 I -iw�(PINj
wnd'ihair ac'op'y qj'jids rcl�ordh',js to firz111 owhcr.
FIC nuteq wcondsordo�"ci6iii'dcLre-�ii -
&
(if,,vu nw,vs.Litilaii g i5 -Site di ilgri"
' i, 6 1 H
�ou 11.1�1 I addiflonal4e
9
35.758011 80.79491 abatid( lit ije additional pngts if neossan.
('6NMUCTION DRTATUS OF WFIAIS)BFiNle,AB_�NQO' NED UBMTTTAT.FN.-%TRM.TFq
thk farnit *ithin 30 days-of-coffipIction of hellHa: For.411'Welk: Subinit
Owing;
ab,,indoniii6itto thc,foli'
OiL We u Iw:TMw_5
Division.tif Water Rty6iircLs,lnformati(in,Prticessin,!Unit,
1617.Mah"ick' R-Acigli,SC 2769,94617
6k.Wal wiifi detitil: 33 (ft.)
forat to tlie-Wdni§�"M 10(a-lob.F!or 1"IM116"MeIN, In addition to,kiidigg the
abovc.�also subudl 6ve top�l of 6i it -4 S Co P efloil of'Well
CPCA Mtolc' diameter I _q�6�u�Nvitli n.50&Y of" in I
atb;[ndountent to the fnllotitiiug:
Divisiotiof%ValerRestiumm;UllldMmutld hijectlon ConliA Pr(ioratu.
6(j.W.;jje_i le'vel,b-Clow Cc 'r,Raleigh,NC-2760.A634 MadSertice nte -1636
6e Outer carinig-len-th(if lmowrt): 23 10C.Form .510 ter' 111V&Injeofla"I Wells. Iti'addition Ad sending the form to
;
—00 the-address(es) aboie. alsd stibmit qn&)copy of f1lis'fotni withid 30 days of
cornplctiiin:4-,�-cll alfandoinne n�t:to the count)-health department of the conrtty
6f.Inner ct,siiiWtuhinjg ltnj-fh(if knolvii): why ibi'monca;
6g.Scr&-u length(if kntM n):10
Force CzlV-3tl Non 15 Cawliva V*turetyl of Env ironivent and Natural RcsonlcLs-0051011 of Micrkesdiaocs Pe%,Lsed Augu,4,2013.