Wake_Well Abandonment_20240318 (12)

«'ELL ABANDONMENT RECORD For frurmll.-soONLY
Thin foon"lei be used for siiiek of multiple%%gills
1.Well Coatractar Information: W'FLL ABANDON NIEN-f DETAIIS
Scott Hunt, Jr 7a.Nonber of nelb being abanduncd: 1
WCII0NIdi ctof Name tot lie propem i f.d .• .n.n-Ns<•- ••,tkpp 1 t.elfs OtiLY , •.
,'Ml:ryry.:fhNt erA,l,PrA,JiI+kY.f.1,*Co4,-NArtllf-OW OWJN
4561-A
NC W'01CowactorCcdit'rc.NianNtraixi 7b.ApprnYinwtestdutnruf Natty remaining on xrll+.t: tp,Al.)
SABDACCO FOR W ATER SIJPPI.Y N Y'I.I.S O Ni.V:
Colivan±Name 7e.'i'yyx of di infectant ward:
L Well Coontrrction Pennk 0:.
l...,,t.,41 wpixa4i,uti:;hrxu.,,...+'tb,rtf.Maw.+..mare llgwhwr.Aral ifkrw,va
7d.-\mount td di.infcrtant uxd:
3.Wdl eve(checkwelf use):
1>,a0.r Su(+Ir1T Well: 7e.Sealisy;ntatetial.uN•d felled,All that altpl�):
DAgncuhuavt ❑hittrdciy>vtlfRltstk m NCC11 Ccmuu ORM11 Ft Rctionitc Olip or Mk is
❑Geothermal tlicatitioz"Cooling lmi*yi ORccidetdial\Vales Snpph isitLlei ❑ Sand Cetrient Garin ❑ Dn Clay
Dlndustri rl-Conmictcoal ❑Rewd::rMIA Wader Strpph 10amd? ❑Concrete 4,tout ❑ Drill Cidtrrps
Ohti uutt ❑ Specralh Grout ❑Gra%el
Non-Water�-oplih "cil: f I Rcntotmc Shorn 1-1(wham(c\plaur toliki�gl
Mhloralontis ❑Rccod en
TAjntinn Well: if.For each insTrital wleeted Awte.l+t'a%idt'attiouni of nvatcriak v%od:
❑ ipidcr Recharge ❑Grotindu.acr Rcittedr:dton Neat Cen.:94lbslb ,Wtr:5gal. Sand Cem.:lb ,Wtr:gal.
❑Agwlcr storaecined ltmo%en ❑Salmit-, Hamer
[]Aquifer lest ❑SlornraatcrUrurrf= Bentotnite.:5%lb ,Wtr:gal. type 2 portland Amount:4 gall
❑Expenuu ntal Tcxhnt+log� OSttbsodenec Corirul 7g.Pntride a brief(kxriptirin of the abandonment procedure:
00cotherntal447iosed Loopi ;_]Tracer
Tremie grout well from bottom to top; no well tag with info
flGeothzrrttal(Heaton •Coolin Return) f.1Ch1w(explain under^ i
on well was found
a.DittewrNtslabantMned� 2-28-24 `'f V E]•"�
Sa.Well location: 8 2014
North White Street Landfill
F;>titl,n tltdrt4rV tmr Tilih IT)e tif 8.CelflfllaliWl:
avMic,bky
1226 N. White St, Wake Forest, NC 27587 3/3/2024
Ph+sical Addmss.Cib.sled Zip >i .,far a!' onf*%A Well Canrm*n or Well OAr►r Wale
Wake Is► Isgn um t/tu jorrn, I hereby terhty lolow the wellfil wad ]were/ ahawkwed in
t=.ncef)l-ajfrcaaalkt 4PI%i ufrrxdivice it ilk f5A V(.-I(*lJYA/00or'f- 0.t?X)Well tixi.wrrrfYirrr Velar&+rri.+
Cmd th of fi twpl ell tht.r rn-fwd hixe bren pt•rnwkd to i*v wrll ootner.
Mi. 1 arint+lc•and Irrllgitiode is decimal dtxrery
tJ nd}ft W nlic fit.beg n.,ul]k> Ix: 9.Site diagram or additional vit If details:
You ntad wr die back of this page to pert idle adtl hoiral%%ell soic details or nall
A W abandwuttetn details. You rnad also attach atWNWllal lxgws If riecessan
(*02.NSTRC'U1IQN DF7AILN OF Wta_IASI BEING ABANDONED S('BA/iTTAI.RN,STRUCTiONS
.1(4ki: ari;a..raCntdr..rr rrr.v,f',,{7 u,urlmhk ;.,r.tr1/;i5ti( ta,: L•..v.A.ran-».uc, •n;'}•i,
.se-th ONLY with ibr m~C,vnirwrnm IhJkk-%"rrcr.t w rem,kAsnt ever au..• 111a. For All betty Submit this fonn nuhm ;f) dads of completion of ueil
6a 1T,'cll ID#t B -3$ abandoinucia to the fnllnnind;
Dhisisn of Water Remourve%.Information Prscrsring bait,
1617 Mail Sersice Center,Raleigh,NC 27699-1617
htt.'I'otal"ell depth: 30 4iI.)
fill). Fur(rokylion%,sd : In addition to sendnig live fun t to the address ill H)•a
atxne. also suhutit ogle upof this fornr nti ,ithi)days of carnpletion of cell
(�.Btlrelwile dianxter:2 tia.1 ;ibanlorniteru to the fAJonraG
Division of Water Rvwerces,l ndctimound Injectitrn Contrul Prutlrarn.
ittt.\tinter It trl betas L�rttund.wirfaer_ 3 tft.) 1636:Nail S-er ice Center,Raleigh,iN('27699-1636
unknown list, Fur W>A(Ct- bgppls A Iooketio �'ells: Tot tidditiwi to xtitding(tic form to
oc.()utercasiay Ifnsth{iflmortn): {ft-! the addresstesy abate. also submit cow copy of this famt within %it da}s of
completion of uctl abandotuneni to the coved} health clepanmcta of the carvtrl}
unknown W'here ationdonod
bt.tenet ra.in=,ituhrng R•rrgth{if"lawns): A)
dig.Scrtti-n length(if knonn):unknown (ft.)
Fade(AV-itt Nanh Catoben Dclitirlimm of Ent ironnietil and vattmal Rcsowes-Dn ownl of W'atcr Resoltays tie,6cd lagust 201 d

WELL ABANDO-NNIENT RECORD For lnknelVWONLY
This form ran be us.d for shiek at multiple%ells
I.i%'ell Contractor Information: WELL ABANDONhiENIF DF.TAII S
Scott Hunt, Jr 7x.Number of sells being-Abandoned; 1
]felt(Y•tflaolN1 Nd,tte tail Nell on fie PLWOHAl atMakftatt•4'%,31 1 propeat t r.v .rnc4rr�, ;nta,r•r.., ...._.,. .• . Q%J.t vPl, '..� .
r,,r•,(i11L 1)•k,.A�••IN.J,JiMw.•1 .. „ ... .. ,..
4561-A
v( 1%iI1('nxlrtemrCctaifta:dint:Nxatert 7b.Approxbeatritakawrof%atei rentainingniudllsl:
SABDACCO FOR WATERSi,'PPI.I' UNLY:
r•�„�;::n, K.Ptq' 7c.hN lte of diNnfectant usrd:_
2.�1 t,•Il C'uttsiructwn Yrrmit M;,
Lwratluwxvbir Uer.•prrnru..1,.:.a'taah.We&.I,tro.ue a 1"Y10xt.rk.I ifkncwrr 'd, %mount of di.infcclant wwd:
3.Well use(Check;in ell use),
Waiter Sepplc Wed: 7s.Wing materials used(check all that altph):
DAgtecuhural OMutuctFtil Public 0 Neat Celrnenu Grout fl RCIAORAC Chips or Pellets
06cothermai(Hodiny"Coolu SIVO)► ORmidcm A%letter 5upph isinvie 1 0 Sand Ceirent C;ruttl ❑ Dn CU%
01ndustrul•Corturic :ial OReskkniml Walcr SufTl►'isliumi ❑Concrete Gtout ❑ Drill Cutuugs
01"wation 0 Slxti-Ialty Grout ❑Grastl
\on-Water Sup{th Well: 0 Wise- is Slum I I Older(e%plaul undo Tyr
SRJotakmns ❑Riro+en
Injntinn Well: 7f.For rich ularcriat w Ic cur d ahm r.pr+.+ide aornurtl of mairriak rased.
OrlgautcrRedwrtc OCiratttdu;rareRctnediahen Neat Cem.:94lbslb ,Wtr:5gal. Sand Cem.:lb ,Wtr:gal.
OAtituter Stutaec and Rc:cnen OSalnuh Banter --
OAquiiot felt OSWirmaterDratmec Bentonite.:5%lb ,Wtr:gal. type 2 portland Amount:3.5 ga
O@xpemrteutal ictiltnolog) DSttb:tdctxc Conirul
if,Provide a bit-irf da•xri{Nu,n of the abandumnent{u+ttccdrn:
CIG'othenrial(Closed f.aopl I.-]Tracer
Tretaie grout well from bottom to top; no well tag with info
rJCxothertnal(Heatin ,Coolin Rehm i,I(Alwr(ex hlin 11"Cler 7,g I —on well was found
L Datc n rlhat attatrahtned: 2-28-24
ell lucalion:
North White Street Landfill
VA 11`t, {r,1,F N.,r. Uns
— — rx itn.ins rda0plic<tbkS 8.Cenifkxliun: y
L,{ a
1226 N. White St, Wake Forest, NC 27587 .� :1C 3/3/2024
Pthsieal AddrQ�,.Cm.and Zip Kin:r st a!"i ondk d Welt(•aatrac.•tcrt in WC110nngr Date
(take 1b, ugning t/ui jnrm. I hrrehy rernlr river the wellpo wat merer ahutttkrued ur
Count 1':..d W-iddk•:asro N., ;P1\, inctorlrnxe•with lf.l.VC-IC!).tr' 111(ml or:'C Oyu)(►Well(ita.+YrwaYNio.Ganalrmfc
and(het v tnf!u Qj 1ha.r weird luxe he('lt prr)vkletllo!h r tre11 owiwr.
W 1-ariludr;end hingitode it dt(rrt slminuteR crcrtndx or decimal d grmv
I n:l;I't:It] c,w W.1:ter 1,,it171cx w: 9.Site(Nag.An or additional midi details:
You neat the fire bail,of this page lit pro(idr adtliliowl%ell sae details or►cell
S W abandonownt detaih.. You nta% also attach a lditionral p:tyxs If rtecessan.
('ON s-f-R11CTION DE'tAll OM V6'CUAS)BEING ABANDONED SUBMITTAL iNST tUCTIONS
.tak;; ,.ri!ayrr..,:n.arw,r r.-..v;h.;r:v,vrlmtilc ;•v.trxicr!lr vyrar:a,:,,r,wn-.ra,trr veiled(
mix A,UNLY Mrrh rhr&t~a'Wter c'rr!Nt rr<tiuxk.,n!arnl.1rw cnrr"'NW,r(„re N,rm• 10a. For U Wells• Stdttnu this Joint within A) days of completion of %rll
6a.Well IDO-W-4 aharrientnent to the fallow sug
Pit Won of%atcr Rextturco.fill.omation Procrssinu I.nit.
t+ill depth: 24 IfL) 1611 Mail Srnice('enter,Raleigh.NC 2 7699-16 1 7
aria %'rats%
lOh. Frlr Luiection Wdls; In atidilion to setdintg the fund to ilk:address in l0a
r.c,firucFtcylc diaotclrr;2
ahei m c. also miburit om cof;N of tins for %tthnn It)dens of crxttpletion of well
tip.►
--- .dtalalultotnt to 1f1C fdluntnG
Disit.ion of%rater Resoercn.t odctitrrrttrtd 11100iun Conlntl Pn12ram.
teal.%%atct beet Mina %r'tuud surface: 5 lft.) 1634 MAN%mice{'enter,Rakich,N('17b99-1636
itic•. For Ralcr �VLm?h & Its eti+rn %%•11s: lot addition to-wading the form to
4.e.Outer casing!lcn;.ah 61'Immi,,: unknown (ft.f the atldwssrei) at+c•+d. also submit otie C,)p of this fend %ithin %0 days of
:ornpL9ton of%ell aba ullontrictu to the;:ouar. health dcpannteutt of the coum
wn nkno
i.f. Inner casinVtubin:;icn;,Kh(it►;nliun�: u (ft.) wWre.ftrrdencd
4W,.Screen lertxth(if Itnuwnl:unknown (ft.)
Form OW-tl, Nonh t'arolt,o:hIotlimni of En,tronniew and Natural Roomes-Dn mwn of%%star Rcwatoa5 Rc,csW logos%201 t