Randolph_Well Abandonment_20231006 (8)

WELL ABANDONMENT RECORD k
For Itticuwl l)sc ONLY:. f
This form can be used Ibr single or uuulliple rFt ils i ;
i ;
1.Well.Cantractur Informatign: )'FLLABAND!)111At1ENT DETAit 1
Rich Lemire '7a.Numlier of wells-being altandoned• 1
RrolldotLaictorNaute(arecltoicn narially;uli�lnkirih16%%Ql611la.IN-fp0pcny) Fm; witlople. 11#0N6m, 0 non-11d& injjp - uelh ONLY wth J,W sruJre
C/JIl4r7Pf6ttGYt;Qh:71Pi'�fN11JJCTJI,lY1PJ 4Y1R,47#rA'JIJf L4�d 1r?n.
2593A
'711.Apprarimate�'ieluiitc of vfutut rcmltining'in - 11(r,o (g,tLj
NC W411 ContradorCcttifadion Nionbcr i.
SAEDACCO FOR-WATER SUPPi:Y WF,IAS ONLY:.
Canytarty Namc
7c,Type oftliainfitiWttt.uscd:ct3LotiINE
2.Well'Coustruct€on Pemlt H:, 7607-MSWLF-2015,
LL31 iJ1l ejitJhrtlbl�trz!!la rmtr,,'p.r.Ccurttr',SJaitiJ:J'uhJiiati C.L;rciiolr.elel ffkim�r» 7d :tmourit Uf dlslnfcctatit used:2 OZ
3.Wdt use(�hcd:h'dl use): -
Water Supply Wen: 7c.Scaling the tc ialsascti(6-mic'all titat.apply).
❑AEri:ititumt l7Wimicipal tblic- FA Nett Cement• to qt ;r-', '-s^5 ' �.Gl,.l)cntonitc Chi(is of PLUcts
gCrrnthcmral(Hcatinrf C4vung'Snnpply)' ❑Itcsident4d WatcrSuppiy(single) Q Sand Cctitcnt drout ,p'I)iy C4�y
❑ledustriallcommercial 1312csidetuialVater Supply(shared) ❑Conetatt`Grout Q C j b ❑ Drill Cilttings
❑iiti •tiou l7'Speciulty.Graut o ZQ23 ❑Gravel
Non.Water Supply�Ycll; Cl BeJrtauite A r:<^1^1-1 ?'. �r;�.a. fOriher{explain undcr 7g)
®Motillorine � ❑Rct:uren' G:`vi "�:�iii
In jcction Well: X For cacti material selected above,provide amountof.tttaterials used:
❑Aquiferltecfta ac EIGriiundi%wer Renrcdiutian. Neat Cem.:241b ,Wtr•l44gal.` Sand Cem.•lb ,Wtr•gal.
❑Aquifer Stontgt and Recov'ery ❑Saliidtv Barrier
t Bentonite.:71b ,Wtr:gal.
❑Agnifer Ta:st ❑Stomneater Drainage,
❑E�perimenitil Ti liup€ogi pStibsideltt-;.Cpt9rol 7 Frniidc a brief iicvcr€ptian of the aft►andnomenaprrtcillure:
DGwihermal(Closed.Loop) UTracer
TREMIE GROUTED FROM BOTTOM ,TO TOP.
❑Gcothemtal fflca inldCoolin Return) 00tlickox lain under 7jo
4,Datcwcfl,0atbandoncat, 8-22-2023
5u.Well location.
GREAT OAKES LANDFILL PZ=71k
r1wility/fhcncrNainc rwilityIDV(Tfapplicabtc) 8•Ceti€il6tion:
3597 Old Cedar Falls.Rd, Randleman, 27317 _ �J'rnv-.tr, 9/6/2023
Physical Address.City,and Zip Sil_ltihim of t-• ili�yt�Vc1t t:crwrrtni ur vVc11,0?vn r U:nc
RANDLEMAN W.Vigning thisirrn, I here by cNrlijJ?that tka vrell(.q}M.sys(trere•)aMadoned hr
Coelnl)' Pateet ldaruirk.WauNo.(PIN) ,ketJlrl[i1Jrc 16110 I5ef WC-IC 0 C,(1100 or 247.6200 Moll Co ianicaolt Slawkirds
and Ilia,a lka well oe'ner.-
Sb.i.ttitadt and longitude.fit rtcgtccsrminutcsfsecotids or dccitii:il clegrccs:
(ifive,1101eld,One tntllong.lss iffJekl* 9.Site diagram or atfdltionalncll tict:iiLc9
You ntay use tl►e.biick of Oiis p�g8 tti liiovide_additional is' site:degiils or well
728800.74 �* 1777572.83 �V -*aadonntetit�le aui You tulip also auat lr ai aiiionJl pa•�:siCtieci%sa.m-
CONSTRUC'i I N t11 TAILS Ot;WELi-00 BFJNf:ABANU014E13 SL1BA11iTi Ai,i1VSTRLTCTTONS
Atlruh 11�41 0awUciiur1 ricvrdtsJ!j'u:wt'We- .nV,mr:ltiple ilriecdeifl 0r,mn-11y1&w Xupptr
6Y'!!S UNLY 11'JfJI!hB 6V/JM LSWii6=11Ult<tLP10r[h91ff1dil.JYJkv GYlfi S1IJ.urcit urrr na -IOa. For All Wells: Submit this form viithiti 30 days of compictian of well
Ga �Vetl m •Pz-7R aband4at»cnt to'thb f411ovving
Division of Water Resources,Information IPr6ev €ng.Qnit,
GbcTa tat nclldepth- 74 � (n.)
1fa17 Mail Service Ccnicri Ralcigli.Nib 21699-1617
Olt.roe Inleclion Wells; hu additiou'to sending din;War to the-address[it l0a
Ge.13oce1role diauiteten 8.25/6� above.atso submit one avpy or this fWa tr'illdit 30 dAy of comptetiori of well
(u,} abattiioutileut to tin:,f411oti,•ia�;
Gt1.WaterIcva`.bctovv Dfvision.of\'PaterResotir",U.!to, -gruitaditijL.LilonControlMigrant,
gtriund surfaeca (ft.) 1636 Aiail 46r icc Ccnte�,Raleigh,NC 27699-1636
Gc.Outer casing length(if lmnv,n): (ft.) Itle.l oP'yyatcl 5nnnh-.� iu€ectinn iVclly: In addition to sending the fomi.lo
the addresses) above. also submit one copy of this form within-30 days of
comptetiou of well abando'ninrnf to the count}•health departnicitt of the counh°
6c Inner easing1tubing length(if lwo n): (ft.) v'vherc abandoned.
6g.Semen lengtlt(if luiowu): - (fQ
Font W-AU Nonli Curollm Ueparimcrd of Erivironincnt and N:utual Rcso=cs-Dlvislanof Water Rwwn s;I Rcvk;cd August 2Dt3
it