Wake_Well Abandonment_20240318

WELL ABANDONMENT RECORD n/ For law" IUSCONLY
This forrr.c'an be ukk'd fit sunk 01 ntdltiple"ells 1
1.Well Unntractor Information: WELL ABANDONMENT DETAILS
Scott Hunt, Jr \ 7a.!Number of ntits bcint:abanduatd: 1
N 01 Cotut:k7W Naox nui tell uair'1 PLMIIul)%:rtxud.uang weg oa lMUlt lxopcnt 1 h-ia W"i0fti, mjt-o. , .M' +Nvr-a.t C• •.6% UV1,►' �•''• �' ✓
<nn.•wNt MA 1A4,10"ANnr.W..k+,a(01,aNigr,rt. ,.
4561-A
NC A'01ComuclnrCcniric.ilionNaniur 7b.Approdruste iolurrte(of"istor remaining in tsclVtil:
SAEDACCO FOR WATER SUPPIN W FIJ c MIN.-
Con:paan Kant' lc.Trpe of dWatcc•lant towd:
L Wdi ComAruction Permit 0:r _
l• r„�l r,::1:.�a;, ..ofl;.r n a Y,,. .t 1w.Ji.ShNr.l irwwc't l/gaviruct r/e.i!l lnuvn 7d.Ao*onl of di.I f kc l d nl u.tti:
S. 1`w cl l u.e(l•IICCIt n ell use): —
11 an r`vryipl� \hc II: 7c.Sealie>t materi:d I u,ed i nct-(I,all fir.it allpl�):
OAgttcultuad DMunicgx&Pubhc fa NrA Ceakna Grout ff Rcnlonite Chipa or Pelkis
O(innhctnul tHc:urntie f'nolm,Suptils i CiRmicicraial W'alcr`upp4 isu>rle1 O Sand Co nrnl Grout ❑ Dn CU%
OtrdustnatConmiercul ORccui.mul Waicr'-*,upph nshar d? ❑Concrete Grout ❑Drill Collings
Dhti r mull ❑ SM-ialq Groin ❑Grates
Non-Water Strplll') Well: f i Ekratrnnle Slum_ 1-.1 C)ilner(CN11hon un dcr"gi
sklomtonng ORccu%en
Injn'tinn Well: 7C For each mATirriat%elcmd shove.protide onwoM of matcriale u.rd:
OAtµufet Recharge 0Gnxttxl"atcr Renimh im Neat Cem.:94lbslb ,Wtr:5gal. Sand Cem.:lb ,Wtr:gal.
❑Atlader Stotaee and Rctio%en ❑Salnutt Hamer --
Bentonite.:5%lb ,Wtr:gal. type 2 portland Amount:3.5 ga
OAquitrr Test OSk�rmaalcr VnurH:c --
OExperrtnctual loclivolog) OSntbbickme C•oldrul Prrns'ide a brief descrilstutn of the ahando ninent l►rneedrre:
rJGmtliermal(C)osed Loops t_tTracer
Tremie grout well from bottom to top; no well twig with info
flGcotbermal(Neating,Coolin Returns f-1001er(cx in 119&t 7 ) on well was found
2-28-24
4.Date WtlWS)shain(Ir.liet
Sa.Well location; MAN 1 8 2024
North White Street Landfill yy
8.Cenifiration: 1nL;;;�..:; �r^,.Aal.:a- �iFT.
I.a tl•n fht+tr�i:orc 1'.N ileh lTtd•tf;tplrli;:•blc5 • ;' � �:'+�,"j•J{= .r
1226 N. White St, Wake Forest, NC 27587 ,� `> i'I 3/3/2024
Ph.ocal addaxs.Cm.and Zip Kr•:rr sr o!"�rz::l'd wa1 Cvrat tc•r of w•Ca(►"n:t Dade
Wake sir•xtkn ing Nus!iwm. I hereby,.ernA shut the udhf!+r wnx tuerer dhanrkrnrd in
l'uuutt Vxcul Wniakmikin N.- 4PINe ereror.huxc wllh hi.l ll ICOY'.Ulftl rsr'f' o-,1 0 If ids t ixi.cAyrlx�rt Sfin,rtitrcic
cmd Char o c.rf?t of this rerfwd texts hh•eu pr.nwked ru hhc-"vil nntrer.
>h. 1 iriauf. and ltunLitude in decimal degrees:
•rl %011'aitt cow k9,ksca:i•,idhcv•x: 9.Site diagram or additional sell dtKaila:
You pert usr 11K bm*of this pate to prok i&arddilloird tall 54e detads or"ell
K W abantdetinncnt details. You niat also attach AWitiunal wipes of ikcessan.
C(►NiTRUUTION DE'LAILS OF M VIA iSi BEING ABANDONED ILR111TTAt.t]NSTRUCTIONS
i((.0 is aril a.+rx:raclwv r:r:vd•+: K u..�lm'•tc 1-+.r•a.uL•frir u.fr�t:o..A.x.n-waur v.p+pit
ax(h0A.r with ik- Inca. For All Wells: Stibinil this lornn nrlhin 10 chns of connpidion of isrll
Oa.11 ell I9A:
PW-1 :ibandon"Ictn In ft folkiwitti;
Division of W'atc•r RiYuutcc'.Inlurtnation Procrssing Fnit,
6b.Total well depth: 25
L617 Mail Se•n ice k cuter.Raleigh.NC 2 7699-16 1 7
flt.l
[fib. Fur tpiedkm►-01a. In akWition to setduig Ilk Gitm to The address in lua
ahotc. also subintit une cop) of(ins form"ithin :t)days ofco nipltlion of"ell
(N.Rn1Y'FNYII'dia111eteY;2 tin.) :bandontncrn iu the Falloinn kg
Ditision of Water Rew. urges.t ndctxnnund Injeetiun Conlin Program.
ors.Water k-trl brinn Lt'ouad utrface: 3 (ft.) 1636:Nail Scnice('enter,Raleigh,NC 27699-1636
tile, Fits Water 5gop t A lokctkin Wells: low addition to aesding ibc fort"to
1K.Outer caungIenL4h!Ifl:nonni: unknown 1ft.! Ilia aMfMk,t� ) aa(rte. alSO sknbniii k4te ecVv of this fame %i(hin i[i da%s of
.ompl Lion of"ell ahandatuntni to the county health dC:panMetr of the toll(%
"'hctc:dxrrkdortcd
$f.lnncriavin�tuhin�temKh cif I:nustni: unknownrti.'•
4g—Screen length of Monn):unknown (ft.)
Fonn(rW'-ifi• Noah Carohnn fklnttotcnr at Firm n.onimm and Natural R.soancs Un tswn of%ater Rczoltkvs- Re,rscd 3i"u.44 t

WELL aBANDONNIENT RECORD For lawrmill-wONLY
This 1`01rr,-can be usi`d fat sio le o1 111ulti0e%%JIS
1.Well Contra mr Inforlaation: W'ELI.ABANDONMENT DFTAII S
Scott Hunt, Jr 7t.Number of ndh bcirlt:alrandoncil: 1
Well ibutac m Nalite ion+..HI cm I%:I p-TW It:il. iidairai�w.i)in]ir lee,Pleven), F— .nrrki�;, ill;,�i:...., .4• H,ai✓•• .$"IVA wells ONLI, 1400 My Wtw
' ,n,l,nn.,u„n„h•,Mrl,aiMuvlr +..a,nu,>,1•.lur.,•a•rrM,r
4561-A
NC Vic11CmttrtcinrCcrtirtcalinnNeittiCr 7b.Appnrximi to iolutarof"ater rcutainnit in ttdl;Nr igat.l
SAHDACCO FOR W'ATF.R SITPIA'W FLI S ONLY:
Cciavalo!Mania 7c,Ty pc tit flemn(tclant u.cd:
z.will ct�q,tt�M�q PtYrttit tr:. _ --
l.,u iff:q.r::„ '/a l m t:x•,.r.!"LayJt.Sru[r.i•inuarr lxfua♦una rh.l�f Annwn
7d.Amount of di.infcc►ml used:
3."'LAI use(check ae(I use):
Water supply Well: 7e.Wing materials used(check all that apply):
OAgricultural ClMu niciNtlTublic m twat("Cincut Orma n RCltonilc Chgi.of POICIS
OCinnhCMied(IlcalilljvCvohng Srtpl+l)( 011midentOl Walcr Supph isuirici ❑ Saki Cenica Giout ❑ Dn Con
❑ludustruLC'oninimi3l DRK1c1`nttal t\'aicr Supply tshamd} ❑C'oturete fiwut ❑ Drill C ultings
Oltti aeon ❑ SpCa211) Groat ❑QMCI
Non-W ater Supph MAI: I i-atonue Slum 1-1 Ckho(expkttil ulitk•I"gl
�hlolatanng ❑kccosen
grvion 7(,For rich ntarC•1•i:d%clected 9hlicr.pr o%i4k-artinual of nt Wrials used:
OA ltuti:r)Ccdiargc RCniedlAlon Neat Cem.:94lbslb ,Wtr:5gal. Sand Cm.:lb ,Wtr:gal.
❑Atµrttet Storage ar><i RCCo+'en ❑Sahtttty liamrc --
Heatonite.:5%lb ,Wtr:gal. type 2 Portland Amouat:3.5 ga
❑Atµtilrr ftsl MicmmalerDiai m=e
❑Espenitri:tual iochnokV) ❑Substclence Control Pnrride a brief dascrilNinn of the ibandunmcnt procedure:
ClGeothernial tClosed Leap► !_)Tracer
Tremie grout well from bottom to top; no well tag with info
OCCO(hernwl(1-l"llimfooling Rehtml 1 10dkr(explain under?g I
on well was found _
4.Dole wra(s)obantbmM.. 2-29-24
Sa,well location: A K 1 S 2024
North White Street Landfill
Lim
FxdN ci> ,i r,runn, rt,meidappliciblcS $.Ceni(kaliun: DVIII ..gyp+,;
i C:rs
r�
1226 N. White St, Wake Forest, NC 27587 �,�"'? .`,� 3/ /
3 2024
I kddre.,.C m.std Zip .`1-il:::•rt ar:v>aa'.d Well(•OMM-•ICrr Of well(b+rer !late
Wake Rv ssgrtat* dies Jrrrnt, I herehy certify 1hw the wellfs'i was meret rrharadmied ill
n.r. 11u cl4L-idifkarraNu ;Pl%i inx-.,rdiviteustirli..117;It'Q:1f'.p/(,Nf.fir-f' O-UP Well Cixisfrur Ps Vunrkxr/.c
and Atit ar awpj nl dos rrcxird hies hens p►mnkel to die wrll ott,ler
>b. 1 ariault•yud{r,uLitudr in ak��rc•.�minllrrs:vrnnds nr de1•ima!d1•y;rtr.:
'.11 Welt t'>:Id ciw Bu.1:r:g t,•idlers:IX: 9.Site din rani or additional"0 detaft
You neat toe die back of this page to pre,ide additiianrat++ell site&tails or hell
i W' abatidolinteat details. You ma+ also attach:rWitional pages if itecessan.
(•ONF'rRl'C770V DE'IAILS OF W EI_IASI BEING %B kND0,%H) SUBMITTAL I[NSTRUCTIONS
,mk;i "ei.,tltti.,-_•1CIt..•:f.'..Y'.{'♦ 1,V.V!;t6'•:l' i•U•A 31:1.':•li _ •t".: : •1.•::l •:1;'iVi
octkONLYN,fn the aww c• rslehn•rirat:er.k•na,arr.iwa.ur.rf•a -:•:rm 10a. For All Wells- Submit this Corm within 30 d;ns of completwn of wilt
4wridonnictu In the followine
bal.Well IDO:NK-9
DiOsion of Water Reruurcm.Informatilm Promssinp Unit,
fb, Tntal++rtl depth: 24
1617 Mail%en ice('enter,Ralcich.NC 2 7699-16 1 7
ifl.)
111b.Fur ierlicn Well : In addition to sending ik-funu to the address in l0a
alxnc_ Aso subutit otw ropy 4this forni within 111 days of campleiton of well
/.c.fitrr•clnllc diMnn•trr:2 lia.) abandonnirrn Io the falloecnrg
bhWon eif W atcr Rowartc?i,I.nderttrnund laim6un Control P'rut;rarn.
ud.\\sire tenet bclnw @ruuad.wirfan_ 7 (ft.) 1636'Nail Senice Center,Raleigh,1('27699-1636
Ilk, Fur Water Stimoph .4 Inkectittn WOW ili Wilton to mending ttk farm to
i,r.(tun r casinl!Icn�ah!if!mow ni: unknown (ft.! Iile addressies) atxoti. also submii one Cut» of this fonts within ill days of
:onlpktion of%dl ab.i ndoruncnt tc the -.otuMN health depannunl of the south%
fit,Inner unknown Ift.l where atxan dancd
t:asin�aiti>int tcn;,�th(if u
Imlrroi:
t,�•srre n knzIh(if knm%ni:unknown Mill
Form(IIW-aft NoahCSmUan t eMaincaz of Encirommitt and Natural R.u),MCi-Ds%iswnof µawr RcwmLc Re.tied••\,i�atst Kit t