Stanly_Well Abandonment_20231229 (2)

NITLL iBtll\llONMr`l`4.1: RECORD l '
faiWgm,nlldsi<ONLY: i
'ibis foini eaii tie ttseit.for.siiigta;ar tnuliipf�.rr�elis � i
0gtr4me worm,406ui WELL AIMMI 1Nh1EW D ffA[t_19
Brian Ewing 7.►.Number of wdfs being;abond'nm 1
<Yc1[�oucanurh`�ars,toer4�ltuttic�rp�no:c�tly:tta�nfinsiine:tiill.dcfliigllttr'pruicny) Ftv indnnle._ Prifecifrur .dr -M IA44fa 'OPPA walls--.ONLY with ihi wane
• .. twn'stritcftrxi'm"raxPr�h,t,�1,3ritacaursafvallfinvaafern�, -
4240 B '
- �71t,Appmxitnsitcinituitterafrt•tit I•attttratlQim�imN'ell(s}i `(auk:)
NC'4Vd1'CoalragorCofliCucntaou�Nnu�cr � ,
SAEDACCO 6fiti'1b�A11:g SUPPLY WELLS
Cenvany.Nhnw 7c;1}`& ►f iliikgfi`etant w'ieo: f
2:Weu Coustruet(ou:Perutit M:
ir3tr�Vlrr�f:J1i'�krtuelr�arretpt,.°CwutfY•i'r�v;+ iu��a��..firJriflnr..rt�llfkemura .
7sB<stcnotint.uf:dlsirifi�ctani used"
:,lVdi ust,ched.rt elluneji
`Valet sttpptt Welk: 7c:Soahrog i4itcrt:}ts used(cbor fall th it a0pty).
l7rbgrtCitlturil G11Ltiuiictp�I1Pu41ic i Nciii Cc[nent;GEvut i cl q3 wgAd chilis or mlcts,
arkoli c mll(F1C7d!tr�' 40 t4a Supply) t3 tesid.- aICr S)vo}'o-igtc) ❑ S.iti>j Cement Ciroiit LI'Ury Ctav:
t7 butitstiiaL�Coumten ial: [311, &ndat%tcr Supply(Sh,,t ) ❑Coucid;d Grotu :17,Unll trillitigs
17Lti� tioti a7-Spe'ciaily'Gioul: i3;Gratel
1�'Q4 tYatCC.$plT(lld'`F"CEI Ci�ellt0[11E�$�ttt7ff` i�,�klCf�yC\p1tl.UtldCr
Mdidtoring:. _ dRecovety,,
lnjccttop�Vctkg. � � ." - '71P Foe�cit inatcrlal sciecttcd abaF•c,pra�•ide atitoant'aP.tnatcriats tiscek:
nAtiulfer[tccG.ir'�e b66t ndiiw6-kentedii ait ii_"
Neat Cem.:471b. ,Wtr:34al. Sand'Cem.:1b ,Wtr:gal.
DAgmfer$ioniyeaid>;2a:tavery ]jSultitilvL3atrtec ;..
d7Atluif&Teri. L1Stoamwater C7nitawgp -_._ -- _-- ---
Eepei uieniai Ti liuolea�K L7Subsldetic�t oilltiul- 7 Fegtide a brief dfimgdotion of(thdAi adnnmant pitWcd0iei
C1Gept6arnnl(Clo.edLoop) 'Mincer.
TREMIE GROUT FROM BOTTOM Tp.S[IRFACE:__ -.�•
000thenviat(HwO55l'Coo6u`lietunt)� bt7tl QF Nxplain under Lo.. . `
- — . -- -. . .L: i i
J;Datc11t0447akriud8ncc6; 12-1-23 DEC 2 9 2023
{u.}weii rucatbitn: tn�ot�t'.a.+�si.at:; rg i�i
Residential Property
raoiltty China Nmw [:tc_ility IDN(krappliobld), �.Cerdifieretian:`
28384 NC-73'Albemarle, NC 280.01 �_ 'am,E ��1..�1 12/7/2023
Pitiskal'Adilmm.Ctiy;aitid zig SEu irui of Ceititied tiVelt t nutr,rpot v ,ii f}ir Dim
Sternly By visntrtt�ti lhts fn�rn, f lieitby ced�trfy iltarllr,a xeltls)erns(tcere ahmdwied in
Cniinty. ( trei ld,,wilYeatlnri Nn..tPlNj riccbi7JFrncc n rllr'1511 wC`r1C old bj#o r 8G.0209 It e1l'[�tititratcfdun Sltu tints
vnid�kmtacropadvflfaisrc�rordlrusb�eitFinit�ctkldllte,t't�liiiuiier.
Sh..Ji4tudeaod 14n1#1y.dc lti;dcgmlc sliii tiut /sceimdsot°d a:aun�Qd mcc i I.
(if'd•ell Cxtiw,otn G1t11ot,;35�ttTic�t�} 9.$ita di.�rritii aer adtiictoaat well ilctails; .
You.tiwy,ttse cite ba6}.of this pad;to proride'additiQnat ist ll.site;dacatls:or`rcell
* {� :�G�ttiiotuueitl d fails Yon ntoy:tlisii.utach adili6atiat pa e3 if nesessa _ '
i
()N,.q"Rtlftit1Y.Dr,,rAiLq(y weLt(Sb'BEtNr.AB'iNDONED UBAtr(TAL INSTRUCTIONS i'
:tare td�11 cyuLyJ,•arctimi ncrr�'!si'tf.nvcllvLF�. I'rrrt{ufnrh nr�r:fttin ar'r�n.tvcttrr.'aurnyh a
>.Vik t?,N k li-A ilm s5uii eizrrstivumon) +iapryb,trncrtt,wo cpn suhi.wl u re'A_n,m •Harr111 �'Velt<• Submit:IhLs� Catni tiiQrin 3Q.;dt1}s of cutultletiun of rrmll•
Ga,`VcH M#:MW-2. 161ndonmcirt to ikio follatviti
Dtvi Aun.of Water it¢�pw rrti,[aformoi im Prnccccine unit;
40 t6i7 1♦9 iit'Seedica Cmt+zcl;t381cilli.AC 2GJ9-p617
Gb.Tacit bell depth:
doh..F-nr fnle 04"WeIIa:-hi additibu to sertdiitb Elk f6mi to the pddtess lu'IN
Cie:florekiote diameter 2 fin;). abort`,a(su subndt one '.cif lliis torui rrti1lriit 30'.d tys of coiiiptetiou of.irt lJ
vibiiniiatnneut to cite fallotr•ing
glitiaitltu;aft'Vut4rRi�sanitct�;.idudlec,�rannd I<liji•e�tiou�aiitetvk Frabrvtu,
f,4i.watGe EGvcl.hcran ground aiefaec 1636 tltail Sccvict:d rater;ltateigh,-XC 27619-1636
Gc:.Outcr c isin ICn e6lvnrt�:- goe,ror m1gr Stm11WI&inrt.�stinn Wolls- In adtliEian to scuding fiv fomi.to
g �ih:(' ) (ft.l the 5ddi�ss{es}'abate. also sulinut_que copy of Etta Fomt %A11kty 30.days of
e4lnptetton a1 nbxit'nliaidai rient ea the county heir kdeparintent of tho coum,
Gf.inter essin;Vtubtag tciigth(if latwwn): fL) iidirro abandoned.
6M Sctvn Icalgllt(if kuot�ti)c20 (t>f.)
Fat,GR'-3o Nonit tmoUba,Dcpanto m of EnUionatcot and Natural Rcsoincs:Qlcistan of R'atcr ltcsoutns Rev'Sni Anp!u 2011