Wake_Well Abandonment_20231204

NVELL ABANDONMENT RECORD ` „ For ldcmdUw.ONLY:
-This foini can bti uszl.foi Ogte:or nnaO0fe}cells
_ e.VYctE"Cantractoi fnfiitmatitina � jV1:LL ABANDltiNMEN'F DEfAtt-S
Scott Hunt,_ Jr ` U Number of o-vils being;ahaadancd:.1
1,Ve1f6ut&rNa Fcir rr+trlople. P A,_ettwt or rij?Ai tdr .mrpph, wells- .ONLY will.; 11w \;mite
. - cx�tastrrrefit��ar7nhtitrlrriri++«tt.")rit+crursr+ty++ltaiefirrn,
4561-A '
NC Well CdtaragorCcitiftcatfo+rNdnabcr
?tl.Ahntnzimate crilntne of fiat inerniiinirk"in
SAEDACCO FOR AATER.SF)PPi.YNVELLSONT V:
Cottrgam.Namc. •
. 7�Type of dlsin(Mant u3ed: �.
2.Well Qnsttuction Permit d,: ,
Id3farll.[,#p Mblt.a ll jteemetr(,e. irr rr;v Srrn°e.L°arlhmce.lirJrrtlurr.nlr!1f rUwrt 7d. tf14ttgQ.Uf.dlSillfCCtatlt ltSL41:r1
3.�V.dH use:(cLetd:h elI uxr}:
Water Suppir Welh, ?c;Scaling inptciiats used(gtecl5 all that aiipiy):
(] grim�irlfural AMitnicp�li('uiilic 'W•N6tCenicliCGi6tt. 13 Scrdpnitc:ChitarprPcileCc,
t7Cn glhcrmtl(ilcatinglCgpliirg;Supply) pitc5idwiat Water Siipply.(siriglc) L!'Solid Ceinerit Oitiitt. i]brp
Llbidastrial/Comnicicial ORWdenttatlVatcr buppl}(slt ,d) ❑..Con tn`Grout I 1]"Drill Culdn
Ofidetiou Specibhp Grout Grdv l
Naa tVatce Suliply.�dctl; CI Bentonite slurry 1��0iher(espiain under 7w
�141ctuilonit�e-_ �Fteeoteiv_ •, "
fnjccti n�V'cltg X For each material selected above,provide amountaf:materiais used:
T3A'4nifc[ReciW�rge OGrtittndtyaler Remcdla66if Neat Cem.•471b, Wtr 3ga1. Sand Cem.:lb ,Wtr•gal.
DAgnii�i Sfotitgc and S�very ClSaliiiity©arr➢ar �; -
❑rlgnifei Test l7Sioimwvler t7nefnirgd _ '
;
13F-\peiinienial TkintoIngy i7Subsir ehvi Cdi9rnl
?g.Prar'idla Iiftl'f tii'�Cr[pttanaf.fdlCall$adpnlllCnt(lr(ICIYIUtt:-
Meet mrtl(Closed Loop) CltmCer. �
Tremie grouted from bottom to ground surface
Meothennat(HeltlrtttlCooliu Return) 0011wr(cx 15inunderLg)
6.Datc.nctl(s).aharodoroetT; 10-6-23
Apex CSD,Waste Landfill _J - L
faciltryiokcrNmtas Facility IDN(9Capolimbici li:�crtlllrat➢oitc ;n,,,^.."' •„
! ^-C,a..::,:./',```a"•���1,F
5940 Old Smithfield Rd. Apex, NC 27539 10/13/2023
�s��S t'".imot'° •;Welt i wartttor or Well rn r U ne
Physical'Addtos:City;and Zip Sh
I
Wake IA.-,siphit�tltls flirr+2,.J Iremby certify,dwr dw wallf's)t+?s ncere}u5tenao2terl i+e
Caw), 1xzrc7lAni3t�tiioait'No.(PIN) "cre0filataccttilJtl�t:4C�ICO2Q;D1Qd:urn( 02Qp"fGe11C'orislrt1r11unStiinikmis
rmd 1Jrdt a copj pgfif ii remrd lrpsbeett pier=idcfdaa 1he.t#e1J rnri+er.
5b.:J..dWdcand Qoag%tudc in.cH carmtmuteslscennds or deciival d ices
(it vcll Cant,u+ 4itllo�t;: itlrieici�) 7.8.6 diagram or additlanat well detaUs:
7Cou.ivay.use the back-of this.page to p[q,ide adtlitiotlal ti ll.silo ds mils:ai scell
hT �� abandoutnetti details You iva}also;�l�elL acWitioiiaC�a� s if iteccssary_
CONSTQti1C'VlQ)Y.DSS'1'ATL5()it WELDS' BEING AIIANDONED 4UBhiT Ci AL il11STIRlTt"H[d�TS
:Aunt!;w I CY/lahwC11412 mrwd(s),if airo@ JL l'rit•-prultiple irlfa'ttleue,rv�rmnamn2ar sup !,
wells ONLI iildr 11w wife earsiruer2n2c�a aurrh�tx:,M2t.��ru run;;Lira!wre funn. 10a: Fnr All %VcILs: Submit flris farnt.xritidn 30 da}'s of completion of well
nbandontncnt tb'thd folioivibg:
6a:Weil®€t:Pzw-i !
Div➢tiit n of Waier lb sq arcis,inio"tirin Pruct sing Unity
6b.f atal tccll depth: 62 (ft.) [617 AT iii Service Raleigh,hC 27699-1617
tall.:Fur Tit➢ecttatt Rr db: In addition to seadior;the f0cm to the:a;lldtess in d0a
:above.also subutil aae eopy ofllb," fowl e19ttiGi'36'days of completion tff well
fie:Batcltole dLluictet:l (io.) ubiia 6 nneat to the fo11oIV41'.
Division,'f%Vater 116burccs;Vndergruund Lijectlou Coturul Ml rite,
6d.Water[eFcLbc➢rl<e'gr otintl curfaec.12 (ft.) tG36e tli:ril Service CQnter,Ralcig<b;ll C 27699-1636
Gc,.Qutcrc tying icn„^th.(if Imnrrn); (fw) loc.,rnr Witter Stmniv atr_$n)tR tlon Welly: 1n addition to rending the fonn to
tha.Adrzss(es)-ab6vii. also svlimit.6a6 copy of this fomi Miliin 30 days of
comptotian of well ntiandomn•rit to ttie cottnty heWth-dcpitcuncid of the county
6L.Cnett:scasinwAnbsng;tenob(iftnrowni:52 ft1t.).
ti herc almndoncd,
6g,Screen length.(if Imoli n):10
FOmt MV-10 Nonli Carolina Deparlimca of Pndronment aril Naluml Resawres--D s istanof Water Resowros Revised Auguu 2013