Alexander_Well Abandonment_20240212

PAfnE 7
WELL AB ANDONAZENT RECORD Test Inning
TieMCA
Y: — —---
Thar tom cos be met for single ex multiple wets
L Well Contractor laformation: WELL ABANTIONM NT DETAILS
*tC ('L l/,1 V( 7a.dumber of wells beftq abandoned:
iiC awA®el&setoomrrpeaomltramnioidivoallecbitflezmcpar) Far m::lttoir erection or non-omen {r lea. MIT reran Lae leer
( corcot rrraelalueuwoweaq you OM s derir000lom
`D(f�__(�''� G 7b.Appro un to volume of water remaining in scan(:): `e J 0 ,aL)
1 —— 'FOR WATER SUPPLY'R ELL S Ov3 Y: t((
Car Buse (I) n!� ,7e Type of disinfectant used: CADI —_.
2.Well Construction Permit b: -A
Lrro!oaphrmfdeseaPpina&paCOMO'AronPerimu't bglection IfiC.,Fr bitnall I Id_Amount ofdisiodactantused: ! 02-
S,1Tell use(check trel me):
tiCater Supply lF'e1L 7 ealbtE ma$erials used(sheet all that apply):
CtApoattttr al DLfami LPnbli Neat t emesr C-twt D Bmntnim Chips of Fellers
QCseuthrtsavl ',Y ooiiab Supply) �.eadentiai' art Supply(sack) 0 Ss D Cheered Gmwr ❑Dry(lay
nv. ,.e.:si tCtmtmetcial Ctesidetacal Water Supply(shared) D Cat Grout ❑Dull Coating
Qi>aCrtics O Specialty Gunn t7 Gavel
Non-Water Supply'Well: ❑Benmafre Shary ❑Oahe:(rvplen,ands 7d
cMemory
In — — -- 7t For each:mattetial selected above,provide and lint of materialsmaterialsmatt �,/�
C[Agti�a Rechttge CCtta tmiam // /
undire a& ad n 1 —(C0l i?�4�ayc Q f .c_Q�` Grw 1
CfAgtdfa Stump sad sscooary CSalinity Berrie
ClAquifer Test DStntsaaate Darmame -
Caspeximetnel Technology ❑Stdatideace Control 7g,Provide a brief disc iption of the abnndoumenc procedure:
ClGeotfie®al(Csnsed.Loopp) Clutter /� �'//
l7Geothemtal(Heating1CooEngRem) DDtba(explain raider7g) I �dsr%7 G(�/ .�nW" r�trQ
4�I ,. / ch IOtt A �P (sI 4e. c_eI�^�,G
4.Date scents)abandoned �t' G re f- f e Up N/�/.
it.Well lacafioa
yet- k 9-?/`) —
FacinpOwnerName haat af waxlike') 8.Certification:
1 1 C LA 0r
�-� z
Ph9�1 aan.Z� an �
Ale, ail � BJ,sianirtg Mt Arm I harebe cont'afar the welts)wra Qua e)abandoned in
Comet' Parcel 7 kid.(PIN) accordance With ZIANC4C tr3C.0100 or 2C.t7300 Walt Cb, tnitrfnn Stardar&
and that a cop;erhis record ha:boon provided 07 the wal!owner.
0b.Latitude and longtudeis degseesiminntestseconds or decimal degrees:
(i uellfield am laolcmgis atttficaa*) c. Si.Site diagram or eddtdonol well detail,-.
j1,? $- / 1 02 tr I/ Ton ay use the back of this pap to provide addinmal well site details or tell
T T� t _W abmdammam details. 'You may also attach on L peps if necessary.
CONSTRUCTION DTTAIIS OF WEI L&BEEN-ABANDONED SOICLEL'CAL IIVST2CtCITCM
Amid well cnnsutaates;mortd(u('asiailabic Far la linter btia=asa or ant-u®v sapy{t
we.t°WWI►deem rostatrman_t:tadonuarc 3n+,•cmailractouejbnn. I0a. Far All Wells: Submit this foam within 3C days ad compleion of well
abemdommmtt tc Yee following:
firs.WellID*:
Division of Water Resources,Infonne doe Processing Trait,
lib.Total wall depth: 4 lit) 1617 Simit Service Center,&ilei<:h,NC:276PP-1617
lob.For lniection Wells: la addition.m sending tad fain to the address tr.IC*
above,also submit one copy of this four within 30 days of completion of well
6c_Borehole diameter. _Iat.) iaaaderameac to the follaa :
Division of Water Eesources,Trndersnomad Injection Control Propan,
red.Water lerel beim ground surface: 3 r ft.) 1636)Soil Se-vice Center,Raleigh,NC 276a4-1636
2Os..For Water Snooks.d laiection Wells: In atldidm to sending the taro to
oi.Cturer cas1f le tli(if ltnoun):.—. _OE,/ the editre.s(es)whose, also sitt1110 ate copy of this tows within 30 days of
complexion of well ebandanmttat to tlx calory health deeps mu of the cranny
where abandoned. _
6f.inner casingit ibis,length Gf hoown): IL) _
. �C�E1V..
tij
6g.Screen length(tf hnoscu): 'ft.)
• s
F r.B 1 2 2024
ForaCalit-3D Mirth Cantina Dammam orEnt9mtwrnnfNa=a1Raroonan- ef Revise`Wrsc2013
tJ