Cumberland_Well Abandonment_20230905 (2)

WELL ABANDONMENT RECORD For WunwtUWONM I ;
z'iltis foitn`�iii 1ae ttseil.for.si�tz or muliiptei4eUs I
I,well Goutetietor information: 3&FLL ABANDONMENT D Tll MN
Brian Ewing 7a.Number of ivOls belug alian ri I cd: 1
�Ve1t'C7ot crurKante'.(gr'+ticllu'stirterp t3gnalJ4.:alxair[asdtte�tiill.oeiliisflt;rprdlienyl Frir rwilt!j!lr. In;arttat or rx!!!4t irrr ,�uPpA' cullts ONLY wuh fah+ vome
ebra€trrrct'ow ra'a��rtdtiivni�rt,}ne itipe xrafun�r ww"irvn,
4240-B EEt
NC Wetl Coraliaaor G:itllicdiuu Nni�t!ei
7b.Aliliro imete%tlumc of st�at`.i eri iiwn�in dell{rj: {RaL)
sAEDAcco FOR WATER.SUPPLY WELTS ONLY:
>'Name• 7c,Tyne of disinkviont pied:
2:Well C6ustructlenTennit#:
Lttr�r{l rrlyd'!N.rirtrfe-a�illar!iriL+r(i:e!"Cw,r!�,Spirt.durarux�.Ir�iurt;e7i:!j&etuwrr 7d.�ltnoutit.ofd]Sitifcctslit`t9SCd:.
3.�Vcll wk(ebe&iVc➢u,'ie):
Watei Suplily Well: Zc.Seatilig h*.M;ids us0d(t!wlr all that apPlt)r'
I7,'gri�ulfrtr i6 pbiiuiicipal)l'rtti�ic tR',Ncai Ccntcti(,Crtoa[. - M 86e 0ititc Ctii{s:or Pellets
17t",rntleem d(HeatinglCoolin4 StrpP1}'J Oltcsidgntiat%ter-S7tl�pl}[siri ale) ❑S*�rarii:nt amid. 13 My'
Clay
L1lruinsttiallCpmntsrcial L7 Wdendal Water Supply'(Gharcd) O Convre[a'GMIA _>?rill Cuttings
t38rti Eion 17 spe' iWty'Giuut 13. l
Noq-Watcr.S(rpply Vol: 13 EentgniteShi y 13;Odter(c,Nplainunder7g)
®hfautltidrrg. OReeal�ri', '
Trajection-Welt• 7f:For.each material sciccfe&atiovej provide amount af-materials ttsed:
OAgrriferitegh rre. OGru"triidt►;llei Remedirtin�i Neat Cem.•471b. ,Wtr•3gal., Sand Cem.:lb ,Wtr•gal.
Orlquil r Ston►ge rind Rceo�'ery 175aliirily Binier
OAgarifer Test bSfoinnv.ttrr Unitrctgc
[]E+ r ueteutul P�ti lttu►IoK}' I7Sutasideuc`Girttivl 7g,Pr&lde a brief discriptiari af.tlrc al►audnpment l►rtrdyluree
bccothcin"nal(ElosedLoop) 13Tmcer
TREMI GROUT FROM THE BOTTOM TO SURFACE
13Gmthemtat(Heittiuitri'Cooliu&Retum) t:lOtlaertesxplaiuunder 70.).
y( LJ
4.Datewetl(s);ibandoncd 8-1-23
U2
$n.Nyell location: r
Cumberland County Commercial Site (t+ VCYBOG
Facf Vi(hvmrNmiw Facil'ttvl?id(3fappUmble} Rcrli�(ticatlUll: . ��/ „
3960 Ramsey St. Fayetteville,. NC-28311 V I I� EYY I 1 8/13/2023
PhPiral Address;Chy,•and Zip 7f Gci4rt�tr+r .fl fhen r 17 ge
Cumberland fit?xi},quri�lJ4Ls rrrm,.,f hemby,c6rdA,,Ihai the ueN(:s) n'rrs(tnerO 001idmied in
Cbtiuty iarecl lit.n131^i Jla;t No.(PIN ncrunfaucc Ikir!.S#.h�IC I720;j,0Id0 ur 2C.-M001kell Cmist itcuoTi 5wn(&irds
anrf rlrut::a cnjo��of"tlris r err!rd 7rm'bEe+r,oini ifed IQ7ire.0 elJ ou iier.-
5b;,lAltitud�mid[ougitpilc:itt:eli%r+ccsIWautes/gc'onds.4r6oismil der k
(ilueld C4k1 ora 19tt<ugg;c j�ltt*m) 9..Site dingram_or additibuat woTdctatls:
You.tuay a tlae bar3:bf Us pdge to ptavicle additii iml uvll.sits d0mils'oitell
N JV rtbaudutuneui al'elails:-You ruuy a190 attrtch additional pages if nece sAty_
r(miRIIcriamfi"'t'AiLS OVNyELt.(S`t BEING ABANDONED SURNWr'A1,1i IBUCTtOYS
,tNi)n't uedJ cinirruclrnr!n?cwert3J'1jai�rzl7dife. J'cv'pnrfriltlr rRJc�ctialz rrr rstin.netr�.�t� I!
+tti(da©!VLY:+rtrltrl.�avurccrrmsirrncrdr}n•',z+�ntnloimril i�u crrn�irLirei iurrjorm ll]A:Iror Aii 1Vcllsr; $tt?atntt il_iss•Corm tiit[vu 30 13ayS of completion of titiell
6n 1Vcll w;¢.Ma-2
abandcinmcittta'tbc follo�vin :
DA'islun of'Wnier itesouiNcs,Lrformdtiou Prucrosind Uniti
iG17117jiitSrnicc;Ceritier;.12a1cidti,hC 6l'J-1617
Gb.Total i►rea dcotb: 213 (ftj
10b._tof_r_tnklion Welk:,bi adaitibu.to sending di> form.to the addm�s is 10a,
Uc.Boneltole.dIanictcr:2 abow.also,subfidt-oue copy.of Ibis:form mitfiiit'3O days of cornptetion of►ball
a biitidonmmd to the,Callowing:
,Divislori:ajf Water Res�urces;.i[Tudcrgttitund Injectttan Coutrot E'ragrr;m,
+!el.Watert cl below'tyvounrl stirfaccF (Ct,) 1G3G 111aiI Scn�cC C on-icr•,H rlcklv,11C'276159-IG36
loc.,For Water 5rmnly let:irifc>�Frin�Yella: In addition W SCIA tg the f0mt,to
6e..fiutcrcrsingten th('iElmo�vn); (fG) tha 5ddress(es).'aboge, also mbinit.one copy of this fotm lviebin 30,days of
completion of m-eft 3bando•unentl to the cou iy health depuinicru er the county
GL Lrncr crsin� tnliing 1611#h(if known): (ft) tvlicrc abaridor►cd,
i
Gg..Screen length(if known):10 (ft.)
Am G1W40 Nonli LaiDUba DzpaLmrw of Emiromncrit and Natural Rcsomces-Di+•istan of Watcr kesou ccs Rev sed.tugus1:013.
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