Haywood_Well Abandonment_20231006

• .
i !
WELL ABANDONMENT RECORD ‘.),\ Far Inienial iLls ONLY;
This farm can be u;sed for single'or multipl 1e wells
, .
. .
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott Hunt, Jr .. . •. . 7 .Numb&of nulls being•abandaned: •••
. Weildaitactoit4amefor ii§lIrniirr peep:tit:shy altanioning Wclion;iisittr prepeny) For widapie. bilertion or nontLwitter 4tigily. 'Was..-ONLY with ilie .seme.
o'riiivtruefiwildimil(ewicith)rw cicurbatharitkiiiefiirm,
4561-A • -76.Appro*rate yolnme of watm.itentairring in-welka)? .6;314
W.WeliCommetor iCCitiliotion•NuntiCi- - ' 1: • - • •
• . .SAEDACCO FOR WATERS.UPPL W Y ELLS ONLY:.
Compaq Name- . 7e.Type lir disibfectuof tiotit . .
' • .
• " • .
2:Well cUustruction Permit tit. , • • • - • ! •
Litfall iipplifthble.wellpirithiy i Criergy,,SIA Iiirlarrce.bh`e4,14*11(Mum;
7d
iAmount of disinfectant: used
.,.....
3.Well use(elinkivell'use): . . -
Water Supply Welk- •
' . . 7.0,.Sealing Matelia/S used(clic‘alfthat apply):
• ElAgricultura I. pMtiniCipa Wu* - • tD•Neat Cement-GU:mt. : CI Bentonita-Chips or Pellets
1:10Fotherinal(HcatingiCaolitig-Suppl)). Calcsidetabil Water-Supply(singie) • O.Saud.Cenient Otout CI'Dry Cho: - '
blpliii461/6ipii!tocfal• • Elliesietaial Witter Supply(aliattti) . ci,'am-ctule 01141g,. -( - ; - • ;El Drill.COlitl)
ClIttiwirtitin - . . . . ., El Specialty Grout CI Gravel
-
Non:Water SupplyWell:- •CI Bentonite Slum. 1- CI•Gther(explain ander 7g)
P9MuMtoring• - . 1:Recovery . •
Injection Weft:, - • . 71.For each imiterial selected ubO .ye;ptovidelititotint of Materials tteil.:
• • ElAquifeiltecluuti,v 1:10Muutinmei Re:Tian:a* Neat aem.:4 71b.,Wtr:3gal. Sand Cem..:lb ,Wtr:gal..
ElAquiferStonme and-Berm:et); - ..13S'alinity Barrier
DAiptifer Test EIS tonnwater Mai-Mtge - • ,
. . . . ,
• •
. . - .
• Eityperinieinal Technology pSubsidetreContall
7g.-Fri.:yid!!a,briefsfecriptioir 4the.alrandunmentprocedurm-
• OGeothennal(Closed Loop)• Caracer •
. , oil in well we well was sucked out and then tremie grouted
ClCeotberthal aleating/Cadling Return) 1:20fitplain ander 7 )-
.from bottom to top I . • ,
4.Ditto weR(Oalnaidoned; 9-1-23 • . Ext(,..,:i.:11 v itfi ,) •
• • • •
. .. .5a.Well.tuesijon: • . . . • ; OCT0 G 2023 •
. .
. .
Pactiv Evergreen Canton Mill . .
Fac
8.Certification: ' Inf6rm.7.41.T.T+Pr.-.v...-*7.4..•!-.,g Ur ilityiewoir Nine • • • Facillt,$*WO(iftipplioble.) •
DANCOOG . . .
34 Park St. Canton,. NC 28716. . . . . • .50491ALt- .- 9/4/2023
Physical-Address.City:Aka Zip ' Signitire of Ceuilied Well Coin for°Moll Owner Dam • .
• Haywood • . • •ify 4:Jo/kg 4/4iffarni, 1 4emb.o.cOlifriliat ill'E we/l(s)was.(were)aimi;doned.in.
Coady Riad hientificatIon Nu;(PIN) o0ookinec wish-/-5.4 AVile f12d.010.nr2r.#200 Will ConsIntrtiori.3.1atateds
. . .
. 'and that.a.cArbr,of'illiv-recard..ficts been;-piovidO.tpilre it'ell iiiner.
Skil-Mitotic:Intl longitude in degreesIndrintos/scconds or decitualldemes:
(ifweil aetd;oilelariltiagisiMarittie,ta) -9.'Site diagrunvoradditionalwell deral0:
You tan);use the back of tbiS page,to:ptoside additional well site details-or.Well
( • - N . .
. . - 'W „abandonotenidemiLs. You Ind aliaattath additional pages if necessary:
CONSTRIttilON.DETAILS OF WELLtS)BEING ABANDONED .--J1.1111VIITTAI.iNsTRutrrioNs •
- ilith-41 well.ounitriia.iith recf.will4i itovailithie.:.Iiir millpple thierthr th-tion.-iwiter ylipply . .
I
ire/1,1.0AI with the Oifielvicstrektullealieura.mimaxiva cau mdinit hot e firmi. 104:.For All V.Vells: Submit ili&!,form*hide.30 days:of completion of well
6b.
'Abandon:tient lb the'follOWitig •
:. 1
Well ID/hPZ-16 .
. .. Division uf'Water Resuureisdnformatinti,Processingliniti
• •Total well 6li depth 19 1617 Illaii§erviee,CMiter,Raleigh,NC 27699-1617
. , :. (ft.) . . .
• . 10h.for Infection-Wells: In.addition.to sending the form to the additsiin 10a
above.-also submit one aipy,of this'form Wahl 36days of completion of Well
6c.--florehole diameter:1 (kW , . abandonment tudie felloWing: I '
:Division Of Water Itpources,-Puthitgruyud htjectiou Control Program.
611.WaterlevcIsiclow,ground surface: 10 (ft.)
1636 Mail Schicelitefiter,Raleigh,N(.7:27699-163 6
t '
. 10e.For Watellinniv 4:.Inkethin Welk: In addition-to sending the form to
6e:Outer edsittg.length.(if known): (fp the.address(es) above. also submit-one cops of tins form within 10 days of
'completion-of Well ahandranoent ti the whiny health department of the county
wficre ataugloned. •
6f.lottery:Ong/tubing leniair(if tannin): -(ft.,
. •
6g.Screen length(if known): . - (ft.)
• .
Fonu GiV7:10 fiorth Carolina bcpauriterk of Environment arsiNatural Resources-Division of Waterkekarees itaiscel Atowt 20 t3