Wake_Well Abandonment_20240318 (7)

WELL ABANDONMENT RECORD For lnurmlVwONLY
This forty,call be usell for siln:le of multiple++ells
1.Well Contractor Infi-r•Iaatian: WELL ABANDONMENT DF11All.5
Scott Hunt, Jr 71t.Number of Mc9b being abandom4l: 1
Wol UntlacuW Name for i- .mOirVA ,.n;eah-1 10 ,n..r--,a1:•.
nr-.nn,,n.,a,Ja-mi,w+rtryn.1„41 taw vi-MIN.rk,ir-r^
4561-A
NC%CII CnNr.K1nrC,;Mirr�;l ianNoxibcT 7b.Appnr%imate+nluine of H rter remaining in well(s): igal.I
SAIMCCO FOR 1SATERSI%PPI.i'%F.LI%Oi11.1:
Coatpatt>Name 7c.T)pe of disiniettant used:
L We"Construction Permit N:, _ __
h,,#di: A-,vhl.et:';>•,nrW a ah. 44e.t iwhme Ggta9ron elt.,if Lervv
7J.-lmount of disinl'cctanl uacd:.
3.Uelf use(check++ell user
U atcr StrpplY Aell: 7e.Scaling materials used(check:all that apply):
❑Agtxuhutat DMurwctrAMTubhc 1B Ncat Ccmutt Orout rl HC1110nitc Chas ur POICts
❑Ci othcrmrl(Heating;+['oohng StrWyj ❑Rmidemial Water Supply isingic) ❑ Sand Cernem Gmut ❑ Dn Clin
❑htdusrnd:('tsmtwcrcial ❑R;-tdctawl Water Suppt+ (shared) ❑ C'om-rete Gruel ❑ Chill Cultinp
i itti aqua ❑ Speciahh Groin ❑brine!
Non-dater Suppil,N'cil: f.l Wniontte Slum I-i Cliber u%plato undCI 7r,1
�hlotulunu(: ❑ktxu+rn
ajar Linn C : If,Fur each n1aR•I i:d w!r eta d ahnrr.lnu%idr amount of maleriak il.rd:
❑Aqutfcr Recharge ❑Cinxinclu:acr RentediAten Neat Cem.:94lbslb ,Wtr:5gal. Sand Cem.:lb ,Wtr:gal.
❑Aymtetmutaee and Re:rncn ❑Salnuty Hamer --
Bentonite.:511b ,Wtr:gal. type 2 portlaad Amount c ll gal
❑Aquilet Teat ❑Skrumater Manuel:
DExpennicnial I ochnrlue.% ❑Subsidence Conemli Ty Pruvidc a brief description of title abandonment priwed ue:
00cothemial(Closed L oop► (Tracer
Tremie grout well from bottom to tops no well tag with into
00coftrowl Mca(in gCoolin Retnrnl C-ICRWT(ex lo ,�in under , I
on Drell was found Z �-
4.Bale+1clll-oahsm6rnrd: 2-29-24 - --ry --
�a.Nell Incation:
North White Street Landfill
! .:Pr. �h•. .1`�.�•r. Fxil+h 1Ddltfappli-;Ibtct
1226 N. White St, Wake Forest, NC 27587 ,� _1 3/3/2024
PM sical hddmm.Cori.and Zip .s sc a!' a>:r/'.M N''C1I t'01110Wkn Of WCn 01%Mr parr
wake __ _ BY rtgning dui Jiwm, 1 hrreh}'rrrhA-that the wellpo wax iweret ahaurk-ned ur
L"'ilgnh Pxccl l L-idilA.th,tl N, ;t'It r M(-CMTltxx-r wdh 1 i 1 VC.-IC 0 1'.11100 ar 2C 0-NO Well C onctrvrhem Srrnu4)rJ.x
emd#Nit a er"Q1 this rrrf-rd lure betvr prrn 4vii 1.T llti-well owner.
ib.Latitudtr artd bngitade in or dMmal degmrs:
It t+Cli I'Idd Oni ttr:lnta'N Itil]IC7it%: 9,Site diagram or additional well details;
You ilia+ tee dw bad,of this page to prc++itlr additional%%ell site details or++ell
Tt �' abaudalnuent detaib. You ma+ also ataeh aaWitiutwl pages it wctssan
CONS"fRUf"I'lON DETAIL N OF WFLUS)REM;ABANDONED SUBMiTTAL iNSTLItUCTIONS
irhh is ea'i;'TPaVIrNc-1aAI nnv f•.;r7 varn„d.tr. ;•v wldopir nyrarxur ur am-wucer VIf7`Ij
tic il.U.41.t'x,ril t1x wa+r<..x.r ew<mal Oha-kk,avv.rrr.t•w rare m!•vr-t wiry N,rm 10a. For All 11eU.: Suhinil this forth within 30 days of completion of well
ba.1\ell ILIA -gyp ahandotmretu to the fallnwto;!
Di0win of%ater Remputm,Information Processing I.nit.
66.Total well depth: 78
1617 Mail Scm ice Center,Raleirb.NC 27699-161'
111.1
IOtt. Fur Injection% Aa: In addition to vending tht:form to the address in ltla
chute_ also milnitit one .opt 0this fawn Mithin 4)days of corttpletiun of Moll
Ire,Tiln•clwllc dlatlwtCr;2 lia.) ;Amnlut ulclu to the rolionukc
MWori of 1Fater Rc uun:es,l nderylnlund injection Control Program.
bd.1later tm-cl ticlnw ground.wirNee: 13 lft.Y 1636%tail Senive Center,Raleigh,NC 27699-1636
unknown 10c.For Water -hagi?l+ h lajittiiin WeNs: Li addi(ipn to satding(ttc form to
t.e.Outer casing Len nh lit'hilmi itt: Ift.l the addtessltsl Axo v. also submit vme Cupp of this fonts M i(hin Ill (lays of
:ongAdwn of Ncil ahandcttm-Aznt to the cowVN Iseahh depanutcta of tlic:aunty
unknown where.-am ichined
:a. Inner tasin�tuhin�temnh(it I;nuuu?: (ft.)
1+ •ticrccn Ien�lh of I no++ni;unknown
r r 'a-: N,:it,C'arohtn f3.)ianrrtclx o1 Em Iroiurirsn and Na[ural R.snw;c5-f31s tswn o1'Wartir]tcsonats Rt:,ised anva 20l t

WELL ABANDON-NIENT RECORD For lrserrrtlI-so MIX
This furnr.a►r br us4d fc,r Sins;k Ot multipie%%Ols
I.Well Contractor Information: WELL ABANDONMENT DFTAII S
Scott Hunt, Jr 7a.Number of wells being alwndoned: 1
N'l•!i(M11412LILN Mile 101 tiello"iti l Ivri lou,1di:t711tliatl;;%,A-in ILLS"Ile t Propene l 11W ,ffldorq, rrt;e+hr.,r .M rp.r)-NYete� .�I,tti•Jl .� 11.1L1 ..ril: tht .,. .
'vVI'Mm().*#.At..iw.'tr.NPhN,r/r,N lYl4+NtV,1i!!.Mk'JrIPlN
4561-A
'h. 1ppruaimate•%nluroc,if t%mer remaining in weBlsl: %gal.!
NC V('01 Cmdr.wint-Cc"MQ-dinn i+uvttcr
SABDACCO MIR 11 kIERSITPLY It'll L1.1.S()Nl.%'!
COawvt Name ".. I%pr of ilmnirctant u.ed:--
L Well Comtr uctiiin Pemi4t
/su rent;qnly•,••, ' „xnfr..k,Xr.1.lnuwre InleatuM:.eh.i�f kr.,..n -d• %inounl of disinfeclant used:
3.Welt esr(check%a cH uset:
fate r•Srpg)Iy N•cll: -c.Scaling materials used(cheek all that apply):
DAgmubnn+l DMalwcipd:i'tltilc 2 !Neal CCrr1C11((jrtiltt F) Rthxon,lc(.'hip^to Prtk•r,
❑(icvnhctnul(Heating+C'oohn 'supplyI DRccidcnntal Waicr Supple'f.vnglci D Sand('etttertl Conlon ❑ Dty Clay
Dludustnal:Comntcrrtal ❑Remd:tnnal\►'alcr Supple (shard: IJ Concrete Grout ❑ Drill C ttlill s
7ittigatiuii ❑ Spec-salt Groui ❑Grit,eI
Neon-\\aa•r Supph Well: I I Wr Omne Slum I-1 Cklkr tespinto UO&I"g!
Mhieta!onne ORttcmen
Injection r•non ell. 7f,ft each utan•rial w•leca•d alit tsC.pro%ide Amount of materiak aced:
❑Aquikr Recharge 0Gymnd+%:ner Rcuiedudian Neat Cem.:94lbslb ,Wtr:5gal. Sand Cem.:lb ,Wtr:gal.
OAqunter tituraecaid Recrncn ❑Balmily Tuner --
❑Aquiter rest ❑Sk+nnwaterMunrge Bentonite.:5%lb ,Wtr:gal. type 2 portland Amount:4 gallc
OExWni tctual I cchnolog) OSubsideirc tonlrui
ix,Prin•irk a brief da•uriptutn of rchr:rbanllonintnt prntttilunr:
riGro(liernnl%Closed LOOP) IJTracer
Trenie grout well from bottom to top; no well tag with info
C]Geothertrtirl McatingCooling Rehorn) LlOtller(e>; in under?g I an well was found
4.Date weBis►atblimlont d: 2-29-24 + ,l
Sa.Well location:
iV1AK � g ,20-24,
North White Street Landfill
Facilih(n%mv NAM Fx-i►N,lnriifa0tdi;ziEk•.t R•Certification: P :.,t.
1226 N. White St, Wake Forest, NC 27587 3/3/2024
Ph,sical Addaw.Cih.and Zip i•..c:at a!'S a+::1'v!W'cll('atu tm nr W'rtl(ha ra r Dale
)take lit•vgnaig diti frwnt. 1 htr h►'terntr thw the wellfci wa:c iwere, crhouckwed in
i'awN1 P,ncaId vilw.dwoN ;111\1 ucrarrltaxe1r1thLi.-1�7:i<'Q3 .Nlt+tl,orZr owin-11(iin.rlrvrtwuGi,naGmix
earth!hear ti trirl o1 this reccwd ihiv het-it prrmnkellti tit'well owner.
. 1_Arinidir and bingitude in dtVrt•vtminutri'sccnadz or decimal ftir c
<tt t%d,I'xtd,gale ke.kmy N,ttlJicxtx: 9.Site diagram or addidoeal well details.
You I a% ear elk bacl,of this pate to prole iik addshoiral well mu tkiails of%sell
N �' abandotmneig details. You Ilia%alw allach additional iriyrs it necessary
CONSTRUCTION DETAiLN OF%VELUS)BEING ABANDONED SUBMiTTAI.[NSTRIICTIONS
xei;ows!'NO'..,,,••.1.v;N..•it Ln n1te'•fc. t',v.wu1Lj..tc rlyeLho..x,wn-wuar <a;•yit
Nt i7K OM Y stidt Ox•,om.L.•:r..trwrnet akiluk,mbterrl.t,t+t.tt:"hw o'k-re hsrw 10a. For All Submit this loirn within 0 dais of compklion of Weil
oa,t1-ell IUs•
Met-7S :lbandenmew In the fallowing
DiOmon of\later K"ourcm.Information Promssing Unit.
Mo. l'n1a)Hell depth: 32
1617 Mail Scn ice Ccoter.RaleiKb.NC 27699-1617
1h.1
lah. For lnier;tion Naha: In:xklilion to wilding the fornt tO the address in Ma
fbirdwilediaoxier:2 iin.l aiti%r. atsii sidmtii otic copy of thu form within 111 days of ctirnpkiion of cell
A)ana crone t 10 the feilluaiine;
Divishm of tFater Resounc.,I odergnound Injrction Control Program.
od.\\arcr A rrl hchl++ �runnd cornier: 10-_.__ (ft.i 1636 Hail Scnice('enter,Raleigh,N('17699-1636
unknown Itic, For Water Sag oh LS InK-Vion Welk in addition to wvbdkn_e ille fo►in to
4w.Outcr ca.inF ern ah;if!mow ,,: (ft•> Ilre atldre5Sti5) at`Cae. alSO subotil C41C COP% Of iNS forth Norton ill da%i Of
wQrrlpk'tlon of well ab.ItdOIRIVI l to Ilse Catl1111, health depanauttl eK Ilu:bunts
unknown where alknidoncd
Lt. Inner trsin�tubin;;Ien_4h(it M,rwn'!: (ft.)
6 ,Scrten length of kromnl:unknown (ft.)
r, , V-;,� Nanh Carohtu Depattinox M Ent trormmoi and NaUtrrit R.saacecs-Dr.iston of Water Rcsotovv& Inc.zed•\ngust 2011

WELL ABANDONNIENT RECORD I'm Interim]t'sr ONLY
This tbnw can N ukd for sitrrte of multiple»ells
1.Well Contractor Inkinnation: WELT.ABANDONMENT DETA11 5
Scott Hunt, Jr 7a..Number of"t91s bcinr abandontd-. 1
Well Votaramar Nantc not+1'410%net 1X•n:ur11.:dc+:U.+fulls W M On lu;tier propem r Piw .m or t, ;1,tv.-r ..
rnn•rrd!u.,rt•d,a r R un,.v.r +�,w rare swaanar.atv h.rm
4561-A
7b. ►lgrru*;intrtctotunac„f' attv'rentainiaBin'*CN(sl:
N('1►'cn Crtrdrtctnr Ccnific:Minn Nuafttt
SAHDACCO FOR►► VIER 51'PPI.Y►►Rl.I2i 0NI.ti':
t,,nre;re�Narne -.. 1,pc of da.rnttrtant utted:_
2.Well Coastroction Permit 0:r _
r,.nLe�'•t; nn;•.,.. r'.wnt+.SJ,ate.1 bnwxt bgeatrunz rJr.l if kww-v
tli,in)'tct�n1 used:
J.Well 411(theCk Hell UW):
Water Salgtl�Well: 7c.Scaling material.uwd(check all that appl%):
DAgncukutal D%1unkclIx&PubI1c M I;C�d Cement n t Grout r l Rcrooauc Chips or Pcikts
06cothctmal(Heatill):l Ming-SlIPT6 r DR:cidcldisl Water Supph tsrntrlc1 ❑ Sand('=war Grout ❑ Dr%Con
❑bdmmnal-Conmictcial ClRr id1ccu nil Water Supph•ialrarcd? ❑Concrete Grout ❑ Drill Catnap
`.rrt:::eoonr ❑Spcti7alt. Grow Cl(ir%cl
�(ill AN titer Snpph Well: CJ Beldame Slum Ct Cltht r whplaur unk-1 7v
ahlonulomag Dkrwusen
Injn-tinn ell. M For each nivvi•iA a leered anti,e.l►nMile anuiant of ma aced:
CJAcltuierRedtarge ❑Cinxind":iterRcisediation Neat Cem.:94lbslb ,Wtr:5gal. Sand Cem.:lb ,Wtr:gal.
❑Aquiler Stotageatd kccovcn ❑Salmi} tamer
❑Aquilrrl'eat ❑StorntaaterDruranic Bentonite.:5%lb ,Wtr:gal. type 2 portland Amount:4 gallc
❑Expmnic ttal I Mjnologt ❑Subsidence Conrtrul 7%•Pr in ide a brief dcseriluutn of the abanthetunent Irrrreedrrn:
UGootlrenual 4Ciosed Loop) !1Tracer
Tremie grout well from bottom to top; no well tag with info
11Geothesinwl(HeatingiCoolin Return) 1.10(ficir(cxpkvin tiwkr?g i on well was found
4. Datr+1rW:s Ah;utdwwd.. 2-29-24
5A.Nell location;
r 1,..
North White Street Landfill MAR 8 2024
rhdit,(-h%t<r Nair% r;vilft.IDr t if avplictbk.t If.CctYillcaliwr:
l V
1226 N. White St, Wake Forest, NC 27587 , fr Inn. ?,'::SC�L i > 3/2024
Ph.sicaI Adtht ss.Cih.and Zip fit'.::sY a!' c•z J%A 15v:11 Cantuartat or W4()atLr Dale
Wake As,egging daas Dorm• l hrrtby rertilt•Mai the wellfci was tberef erhaucktn2d at
('awah P.u.J kkislAw:chin N., ;VIN, MC(stl,+rxt'wcth 1 A VC-0,0.1'.1110)or Y' 0-10 Well OtIvVrvrhrrn Gwidorth
errid alert a cvaf!n of this recxrrd hwxv Milt pr cmwkd ao i4ir a rll ouster.
Sb. I arituelt•;aud Inngitude in i till nVi."A-ands or dn•imal th gret is
it]ttcl;I'xld ow to.kmz't.•ul7tcxtx: 9.Site diagram or additional ndl dtKAlls:
You ma+ aloe die bawl,of this page to prom&-additional will sne tletads or"ell
N N' abandonotent details. You nla+ also attach atWitmi al popes of neoe. sari
CON5fN1'('7ION DETAII S OF W[I.14ti)BEING ABANDONED SURMITT.AI.INSTRUC'TIONS
l-term; "ei;uus!zdo-•,r rrr.va4 e,vW_"W'k. 1-.v M100".1tc mlr:::or.a.mi-Nmirr m;Jt(j
.tx-17.r 0ALi'trrth rr.v t•,v can'vhw,;.arc Nance 10a. For AD Welly Submit this form within '•O days of completion of-.tell
ba.►loll IItx:14 i-5 aba ndenmcru In the fallowing
Dkkiun of\►titer Rtrttnrcm.li fortnateon ProtrssiUC Unit,
(VIP. I,rtnl++ell depth: 35
1617 Mad Sertice('calcr,Raleigh.NC 2 7 699-16 1 7
ill.?
111h. Feir Injection Wdls: In aMition to sending tlne fora to the address in Ma
thou_ also mki rit site copy of this forni",chin 1r)dais of campletion of"ell
tom.RetrclnrlJe diaetxtcr,? (ia.) abansionntenr to the follotitng
ttok\\arse level r!M bin �ruuart wrfstr 10 ln) Dhisicm o wa f Water Rearees xrn,U"derund Injection Control Program.
1636 Mad Service Center.Raleigh.N('27699-1636
foe. For Water Sudth'& Iak-okm Wei-it: in addition to-.coding the form to
oe.Uuhrcasing lcmah!if lnuwn): unknown 01L0 the addresstcsl abo+e. also submit one cop) of [his fort %ithin lit days of
congAdwn of Well ahandoluivni to the couni health&-pannier,, of Il[c colon\
unknown w here.ttxandontcd
teL Inner casin�tubin,tcn_>th i.it'hnossn): As
41.SCrt-en length of La401A111:"nImown (flJ
Form(1W.-tit Rey tsed %igmst:4,1 i