Buncombe_Well Abandonment_20230706 (3)

FELL ABANDONMENT RECORD For,reentn,13xt7NLY
This form cart be used for single or molliple wells
1.Well Contractnr Informstion: M'ELI.ABANOONINFN't DE'f�1
Stefan Smith 7a.Number of wells bein,;abandoned: 3
WC111•r19NOofName for-welt owocipetsortall%ahaiknuiL%ell anhisilicfpropeirsi For Wldupk 011rltvnl W' W0-90ffr ,4pful Ae$'k ONIA �rdl INS NMW
,wKvrmctpml IItIhUh1�WMfgr,I'm tYtn emirit INK hrral
3576A
N( %tcl!Camr.IctorCenificatinp Nan{Icr lb..Appmrimate tolume of p ater remaining in Adl(s1?1 4gal.)
SAEDACCO Inc FY 1R%%ATER SUPPLY WELLS ONLY:
Conlpaaf Name -� I�,x of dislttfrctam used:_
2.Well Cwtttietion Perak N:, ,
Ilia all appfk•uhlr well prrmitr me_CwM,Uwe.l iutarrne./xlecfiam ek.,if km,rw
d, %-,punt of duinfectntt uwd:
3.Mdl use(check well use): �" t`;
Water SupplIt Well: 7e.Sealing material..user)(check all that appl%):
❑AFn:ullurrl ,III ❑ Neat Ccincm Gros M Hervonite Chips of Pclkls
❑Geothermal("Caper Coolucg SAMph l ❑Rc%idcnuA Water Supph Isingllet)) ❑ Sand Cemertl Grout ❑ Un C'la}
❑hadustnaU('ommacial ❑R@iide tVa erSi ' l> teQ► ❑ Con micGrow ❑ Drill Cuttings
❑lire •tion ❑ Specialh Grout ❑ Cira%el
Non-W ater Supply Well: ❑ Berdonile Slung 11 Other teeplain under 7g)
®hlunuonue ❑Recu%cn
lojection Well: 7f,Foreach material w4ectcd abo%e,limtide ainount of materials uwd:
❑Aquifer Recharge ❑Grounduver Remedtation
❑Aqutfer Storage and Reco%en ❑SAinih Barnet
Bentonite.:21b ,Wtr:gal.
❑Ayutfer Test ❑Stonm%aler Drainage --
❑E.V rimeatal Toduwbg_% ❑Stibude-lice Control Pro%ide a brief description mr the abantbnnneut procedure:
❑Geothemtal(Closed Loopt uTracer
Pulled DPT tooling and backfilled boring wl hydrated
OC,eothetmal 1Heau oolin Rettinu t 1ptticr(cN air under , t
bentonite chips
i.Date welts)abandnorrll 12 June 23
5a.Mill location: •'' r —
j=J!_
r:lcllm(h%rl r Nan< Facility Wit(ifappliable) S.Ccrtifleation:
E?
I
144 Tunnel Rd. Asheville, NC 28805 A/h __ G1a+'.hnc.G 6/16/2023
PtnsicalNitif' , 1 :1+ ,.iK %i. �' We •.Cenificd Well(;ortuaetoror Wed(I*ver Dale
Buncombe li% signing thes fr)rni, 1 hereby crrrrfy/Am the wellfs'j iras twer+e, ahinofluned in
COntih I•❑. I I&imfwatim No.(PIN% rtcrankim-e wr*11.1 VCAC OX,0100 or 217.02V0 Well Cilnrhuc'hun.VancJiirrl%
and drat a cops•of this aerial Alas beery pro%ided to the well cur .rate.
Sb.Latitude and longitude in rkgrreslmimltrs,%aaands nr decimal dty rVI.4:
01w011116K olr LIL-lolls la wtfn:ktr) 9.Site diagram or additional well detaft
You ma%use the baci,of thus pale to prmide alddilioaal well site delaih or well
35.590819 h 82.529824 µ' abafldonotei t details Poll mj% also attach a lditwi al pages if necessan
CONSTRICTION DETAILS OF W MASI BEING ABANDON ED SUgN1 ITT Al.(NSTRUCTIOYS•
.Ifkxh well cnrirarllcntw racunitzi q wwlubk. Pi,r mufuplc n%«n,Ia ry rr.n "aler mpph
w,edrONLY with Me&mw cuttsvw(wn oAcoAnocenr.ivw clan rmhmil rure,Pin" 10m. For All Wcll%: Subiml this form %%ulun 30 dais of completion of %%cll
&L Wel IDr:TMW'2 Aandoonicm to the follomukg
Di%isian of%Ater Rcwrurcc%,Information Processing Unit.
iota.Total well depth: 13
1617 Mail Scr%icr Center,Raleigh.N('2 76911-1 6 1 7
(h.)
lob. Fur Iviettiou Wells: In addition to eimling the form to the address tit loa
arc.&rrelwdrdiameter 2.25 (ln•) albme. alw subtrul Otte copy of this form%%uhu% 10 dins of completion of cell
Ibatdomnicit to the k4lowute
Di%Won of Water Rcwaurces,Underground Injecdon Control Program.
bd.M titer Ic%d hello% ground%urfare: 00 1636 Mail Sen ice('enter,Raleigh.NU 27699-1636
Itic. For Muter Sumrh A Inkclwrn Wells: In addition to sending the form to
In•.Outercasiut;Ie•n,+nh tit Imoc%nr fh.! the atddress(esl abo%e. alsu subndl oiw cop of this form within 10 days of
completion of well sb ndonment to the.otnt% hcahh department of the county
6f.Inner casin44nbrng kn,,Kh Iif known): ([It.) %%licfc ahindoncd
6%.Scorn leri,Ith(if Ln4wni:4 (R.1
FatmGW-.V NonhCarohm Dept nimcA ofEn%ironmcm aid Natural Rewimcs Rc%iscd August 20t;