Wake_Well Abandonment_20240318 (9)

NVE[_.1. ABANDONMENT RECORD 2urtra�rfal(scCltal.l
fills jurist k,ao be used for sitwll of frruttiple li+e1Is
1.Wen Coatractnr information: WELL ABANDON61ENT DETA/15
Scott Hunt, Jr 7i Number of nells bciur ahandum-4; 1
}:a nnlfur , Oi t'0t 4 .A .x.,!-.,: c. m,Pl41 wett5 ONLI' +A Nis' +Wnr
�Vc1l l'OIY13�rUt t aolt 1[Ft nett t».Irit t�siroratl�:1F:111lr,1tl11 NISI?L IILc'tlt(lr(aptR1+ r,Wj,(rlrtft,n„J,rK;ICJ$hY.r jo., ,(-t f-rAl
4561-A
7b.Appn►xuaatr nr►Inrtrr of w aa-r rrmainiag is ntrrlllsl: +4:a•t
NC it'-;It Conttldnr Ccrtifrc-Mote Nt,nt,.t
FOR W ATF:R SIIPPI.Y W RLI N ONLY:
SABDACCO
Caawx�Name 7cs 7\lw of fh.wfe taut nsetl:
L Wall Comitraction Permit 0;
j-•,y<r!rr.�l.•:d''k.,-c:',..•rn;!'..,.r.+.',w.ah SkNr.t-rrrwxrjxrvartru,trh.l:JAnr.-»n 7d.Amount ofdi#ilrfrflirtltust*
3.%4,01 ww(t•llCck 114 ell usel:
�1':rtCr Stgrph�4r11: 7r.Sealing nwtrritds used icheck all that apph 1:
❑itch- ioppl 7Mutwetpalri'tthlk ® Nca1(.-cuu-elt GFMII fl ner-donne Chip,or POILts
❑ Sand wtu Grout ❑ �C'l
❑Ckothemul tficatilse'(nohng S %I ❑Rmidui:el Water 5upph fsowkf ❑CrnnLrte frnt Li Drill Cut
nus
❑1tw&anall-4aler 5rrphShaed2❑itdtstna ( :nulrcrciat
twn ❑ Spenalh Grout ❑Gra%cI
❑leri01ttiefiatrr tiuirirl.♦1'clh Li Ekutcnuc Slum I-i i-Iliet(explain frldct p
MN1101ulonng
1nIt nitnn if.For each mart-6A WIrPh•d ahmv.l/r+>'idc$111110rlr c!f nlmrriaK p5ed:
OA[ltrifcrRccharge ❑Groorrdu:perRctucchateul Neat Cem.:94lbslb ,Wtr:'igal. Sand Cem.:lb ,Wtr:gal.
❑Atiu►Itr Storage ald RcNrn cn ❑Salim% flamer
Hentoaite.:5%lb ,Wtr:gal. type 2 portland Bmount:3.5 c
❑Aquifer Ttst ❑Stormaatcr Drainage _ ------ -------_... --
❑EXPanetwutul Tccllttrtlog) ❑Subsidence;Cinttrul 7lw Prtn-idr a hrief description.if the almndonmcnt pnlcedure:
i`JCreotliermal Wilosed Ltropt t-]Trace(
Tremie grout well from bottom to top; all well tag with life
06cofhernwl(Hcau!&+Coolh!a Rchorm I 10ther(C\PJ8iF1 undo" t
on well was found
A.Date wclhsl abandonert: 2-29-29 K- , + ♦ `;"
Sy,Well Ifwatitn: MAR
North White Street Landfill
Fxilin If! ,.fa k.CrrlifkxHon:
F:titlitY 4lF,-ir�!amr PD1Kt11Jtr^. 1 • - f�'.:-,s U1R+f_
3/3/Z024
1226 N. White St, Wake Forest, NC 27567
Ph jd- :;cr.ar:a!'5 a etttid Wcll('unlerc;tnr ar Will(Tll lzr (lilt
r 1-�SN..�S��IiY�`s.CnY...Its�Itt
Wake Ily..gt�urrtY Nt+s yirrrre, 1 hrrtti t!. rnh thw Ike well+ci wax rweref ahaorkoned in
11}[ru1Y P.ncc2140-Wiflc:aurn N,,MINI atrrrrrhnlr'e•with l-i.-1 VC,_y'iJ 17l(r)or'(` fI 00 fCrll C tx�.drxr'fitnr�'r:+err mlc
rend this rl rnln al this rrrfwo' he ew prrmukil ter the well own r.
5b.I_atirutic And Il)ngltude In tk4,n`E-VminuIcG,WmHd!or dFdmol degrees:
+d ntli tkkl o,x t9.k:r:g r ,n171.x1x: 9.Site d agram or atiditimoilil ncll JC(Ailr,
N700 ntar tee the ball,of this papa to prol,ide adtlilioml hell SAC details or.+ell
ti W abatdotuuetu details. You niall, also Alach AWitiutral jxIgc$If rteccssan
('(11" 'fRl'I'TIO1 DETA11 S(►F WFLIAS)RFIN(:ABANDONED St1111111TT.Al.M TRUCTIOWS
-t-.0�: .,r,f i•-ra'rt-�la,-,r�a r t'. ::V,whelfa i
,c-ity().41.V-rem the rrwnr< .e.rrrx rr-tee rah.>rr4-wr4l,ol +w r r i.nl-w,t rurr Nrtnr loa. For .kil Wrtlt. S11hinit this fortis althin-10 din-s of completion of %Vcll
ahandonnicnl In the felliclumg
64.Wen ID+a:NK-'A
Dilihiun of N'ater Rc%ources,lnfirrntati►n Pnrcrssitm knit,
1617:?lad Service('enter.Rtdcikb,NC 2 7699-16 1 7
66.Total sell depth: 23 (fl.}
Illb. For Iniettioe%-A fir addition to sending the form to the address in l0a
abo>,c. also milbutit One con, of this fond mithin .f)dms of ctmgalc'tion of hell
6r.Barebefe di 1t11rtfY;2 (iM.► abanlonnlcnl to the R410'a kg
Dia•iaton of Water Resources,fndcmnpund loin-titn Control Program.
60L Water In-el belmr ,round.%1, r_ 7 ftl 1636 Man Senice Center,Ralcilth.N('27699-1636
{tk, For Amer Suotrh�die luk'eti►n Wells: in addition to sitilding the form to
6c.(finercasin>,Icnwah!iflatortnl: unknown 00 the addrestw6i above. also stibnril Cale eop� Of this feml ltithin ell daNs of
compictton of nett abandourium to the coutdl health deparrtncut of the county
unknown wh re.dnraloncd
i.f.loner ta.in-�tubind fen�Kh(if I:n,n%nY• eft.)
42.Strew(le"Oh(if lawn n l:unknown
Fans 6W-41 Ni,nh t'arolrin J rnlncot of Esc trontrksd mtQ Nar[rral(ti5t?tlP C5-Dn 45W 110f 11'8G f RCSOURI s Rex red Anprst 2011