Randolph_Well Abandonment_20231006 (3)

WELL ABANDONMENT RECORD Far lmcroal Use ONLY:
This foi nt thn lie used foe sit le o r multipla ivells'
1.Well,Cantractor Inrornration: WELL ARANDONNIENT DETAIL S
Rich Lemire 7a.Number of ii'el s being al►indniied:,1
WeR 61ractorhaare for srcll ounu 1,erSorially abindan rin tell on hisi ter{ttupeny) Fa• rrnrinple Nlleafon, or r,Y,n-WeltfY wells ONLY with Av sane.
emutrrrcrrar�5n,riirxtrnt7rt,,IY+r+(yo?'Viow1+f r�'!L f lrAL
2593A
N6 WcI1 CoatractartAniliaitiau Nuu(icr 7b.Approximate Volume rtf rFatrr rempining in*cII(s)NoL (gaL)
!.
SAEDACCO
FOR WATER SUPPLY WFLI S ONLY:
Con4,an}.t+ante
7c,Type of disinfictatrt usegl:CHLORINE
.2,`Vct(Conatiuctiou Pt.,t'tnit d:, 7607-MSWLF-2015,
Id�f till r+,vplrei bla tsrtlimrrrridr lT.e-Crvi+ly,Srela•:1'artrirme,Lrjectlo, etc:!tf kirc,ts,+
7d.Amount of dlslttfcti[ant ttst4l:2 oz
3.'1V�l.use(eb"ccl.w�cll use}: ,
Water Supply Well: 70,Scaling dtatcriadsuscd(cWcl:all that apply),
❑Asriatlturat ❑NlanicipalrPttblic fed Nazi CcnicntQ1Q t u 2_: ;' ,a:'Z!', cruonitc Chiles or P;.Mts
❑(limitctmd(HcatineCooling Supply} C]ltc4ictentutl l4ater St�ppl}'tsin,le) GI Satin Centeitt Gvo tl Dry CLry�
❑lndustriallf ommcrcial 1711tcsidcntial Water Supply(shared) ❑Couctetc Grou[ OCT 0l . 13 2023 ❑ Drill Culling
Mitigation •O Specialt}Grottt ❑ Gravel
Bet
Non-Water Su h•�Fcll: 0douite IJ b'ttrer(explain under 7g)
Mmajillorine ORecovery
lujcction Well: X For.each material selected above,provide amount of materials used:
❑Aquifer Rccfiarac ❑Gtoundtyaler Rentedintian Neat Cem.-241b ,Wtr•144gal. Sand Cem.•1b ,Wtr•gal.
DALIk r Storage and Rtcbvery Malihitp Barrio
Bentonite.:71b ,Wtr:gal.
❑Aquifer Tasi I]Slomnvit[er U�ntinugc _
❑E\petintaadal-Tcxhtioloee. ❑Subsidertre Catuml 7^,Provide a brief description of the abaudnnment proecdun:
Motheriml(Closed Loop) OTrmer
00eathemraltF1r:itiWCoalinrtRentm} ®Othcc(erplain under 7g)
TREMIE GROUTED FROM BOTTOM TO TOP.
a.Date n'clt(s).abandnncgl: 8-29-2023
$a.Well location:
GREAT OAKES LANDFILL PZA-5
Facilit}'IQmnrNuins FaciliIVIDIV(1NPplic1b10 S.Cettifl+:ttlan: /7
3597 Old Cedar Falls Rd, Randleman, 27317 �"� . t {/ �/r�r�4 9/6/2023
Physical Address.City,and Zip 5ig;61nrc ott_. iliwl Neil Couirrinr or IVe11(1x•mr 1111C
RANDLEMAN Hie-signing this form, t hemby certify-that Orr iralll) li-ax there}irbandoned in
i'aunry P=Cl 1dd ff"D vinallo.(PIN) rr6conhi+tcc trdlh t 1t 11;CrIC 02C,0100 0r 2C.0200 ll•'ell Col istruc on S16rijbirejs
rind street a copy of dr(s record hosbecn prouiped to Oro.ieell oinmr.
5b,T�idtu de and longitude in dcgr ccslntinutcslsccnrids or tlCcim;d.cl�;r ccs:
(ifn•cu t',td,tim L161(ma ics i0'icietrr) 9.Sito diagram or addldonal well detallc:
You ruiv.use ilia back of this page to'piolide additional well site dirdils or well
729122.22 �* 1777883.65 �� abandonment detaits. You tray also attach additiotraf pages if twc�sary-
CONSTRUC-HON DWTAIL.S OF WELLS}BEING ABAN130NED SURNITTTAT,INSTRUCTTONI
Atfadr 11�-P cnas+recliun rrrnnils:+!j'avntlral,le. Fur"nn,leple by--riuir r,r iwin-uxriw-mpptr
14VIA-ONLY u•ulMW5tm,ervrcirrrxtiru:'argn,har++:tMtr.ldWYcm+submirairtuner. Ifs For All Wells: Submit this fortis within 30 dims of eempietion of ivel)
6a.Well lDg•PZA-5 abandoumcni to this following:
13irishm of Water-Remiurcts,dafirrmation Pr6ce-ming Unit,
6b.Total well depth: 44 (It,) 1617 ALail Senice Center,Raleigh.N'C 27699-1617
10b.rite Tnlr tigin Wells: In ariditiot}to sending the fRrai to ilia addtess[it i0a
e•25 above,also subudl Otte copy of this frin.w'ithiu 30 days df completion of well
6c.Rorckalc diameter. (ire.} abandonment to the-following:
6d.Water leFc!bclriw'grnand sttrfaco {fr.) Division of Water Resources,Underl round lei jectiou�Coutl;rl Mgram,
i0e,Nlail Scree Center,Raleigh.NiC 2769)1636
6c.Outer casing Icarth(Iflmow a): (ft.) 1tic,rnr &freesia r}};gilt': In addition to,sending the foma to
the address(es) abode. also submit one copy of this R)rni Within 30 days oP
completion of Wrll abandoumem to thc�eiiunty health department of the county
whcrc alaindoncd,
6f,Inner easinWtul►iog length(if lmotyn): (ft.)
I
6g.Screen length(if known): (ft.)
Fmnr QW-30 Nanh Camlim Naptli em of Pm•irounient aiA Naomi Resou ces-Divistoa of WarerR0;ourtis Revised Augusa 30 l3
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