Wake_Well Abandonment_20240318 (5)

WJLL ABANDONMENT RECORD For heernalVyaClNIX
This n=a be used for sim le at muttiplt%ells
1.Wed Confraconr Information: %'F.LL ABANDONNIEN•f OFTAII S
Scott Hunt, Jr 7a.Number of nAs bcinE abaedomd: i
%'ell Carylscux Nanx lot+.ell uot+.+p r.nril. Im bee p epp.-I+f P.- m+Jr,rn MrttJ na n +-a,pt•. �Nr'ier -vM ONLY trrdt the jaw
.nn•a+rcrJ.,v,J,.nwl..x+r►vrt +.u.<cNr.erM+rrr,.wK-kuJr
4561-A
NC W01Coaltrrtorl7cr1irrcalinnNwnftT 'b..►ppnrsimetr+nlunrc•d%:ucr rctoaimn�m aril �I: l�l,)
SASDACCO FOR%%ATF.R SUPPIA Nil 1 S ONL\:
Cawfpart+Name 'c. h 1w of than(eclant u.rd:
i vlWdl Construdien PenWt 0:.
14w,41 gtpbi 4-ue4lpvrwa.v'P.,%64,rii..14 re.+anowe hyetluxt eh.+itAJwwa -
7d• lnurunl u)di.inticl.fnl ua•d:
3.Wdlage(check,"CIT use),
Water cuppI%Well: 7c.Sealing materials uwd(check all that apply):
❑AgrreubmA ❑MattictpalrPublic m Ncerl Cetr"it(unit fl Retilonire Chills ter Pellets
06codicirimal(Hc tiros (hobo,SrrpQlt') Dilmdcalial Water Supph istnplei ❑ Salta C'crtxm GIVlrt ❑ Dn 03%
❑hcinstna):Conmuctt:ral ❑Rcucicuto:d 1Vwcr tittpph'i0uircd! ❑Cotwirte Grout ❑ [hill C•ullui,s
Dltu uulr ❑ Spcoain Grow ❑Grascl
Noo-1Natc•r tiupph Well: (I E"Ile Slum ft Ckher(,y:lalll undet"p
®Nlomionne Dkccuten
Injection Well: 7f.For each material sekctrd ah rse.pfv+cidc Amount of ntatcriak peed:
❑A&piikr RCCILdIt•C ❑Gnitind%:ncr Rcnuiltatteu Neat Cen.:94lbslb ,Wtr:Sgal. Sand Cem.:lb ,Wtr:gal.
❑Aflutter Stmec and Rcvosen ❑Saltnu> 1)arrief --
❑AyuitcrTest ❑Slornt%atcrDrum= Hentonite.:5%lb ,Wtr:gaa_— type 2 portland Amount:3.5 ga
❑ tp<mrtrtual Toclawh i7Sttbsrdescr Ct►rrtvl
i>Y Prnv'ide a brief drxriltturn of the at>andonttunt prnredaor:
OG othenrtal i0osW i ociii UTracer
Tretnie grout well from bottom to top; no well tag with info
f1Ckoduernkyl(1-1caun2-CoolingReturn) f1Ot)ktr(cx t)n 119*t 7g I an well was found
A.Date went abaminne+ 2-28-24
a.Well hrcatioon:
North White Street Landfill S
MAN t
Fxlist%Ch%i, r�.,i, r,ilfn Indodavplrcrblc+ $.Ccttillratif,tr: HN S 20Z4
1226 N. White St, Wake Forest, NC 27587 '.'.� Ift+t:�iTf l?"C•9iS�4:'.+�UM 3/3/2024
Ph+sical Ad&Lss.Crh.awd Zip -q,"at a!'i 0.0k3l Well Cawtrxkn t bare
Wake hr ugnow tim fivm, 1 hrrrhy rertiA-that the wellfs+ woe naerrr a han+k+ued in
them+ I&ivifw.•twrlu N•. ;11IN+ urrorrl+J,Jce with 15.1.W"ACI)Y'.Nlf/J)„r'(' 02WO hill f ixi.wvr6u#j Gt»uJirrrLc
cmd th+tt a evj?3 of this rerrrrwd lure hi etr pie ukd to 11ty Nell ow?wr.
th. I arintrf.•and Ianl!itude ill dr n+.;mifill tec:sc.nfills of decimal deglevs:
.+l ncl:1x1.1 ;ax tw.k:r_n.•ulirca,x: 9.Site diagram or additional well detaBy:
You nta% uur the b:x*of this page to proside addilioiral%ell sue do-tails of►tell
N abaidwiment details. You ntac also attach acWitiuttal pngxs of mcessar'.
(,ON sir RFUTIONDE•tAILNOFMFLIAS)BEIN 8iNDONF1) SUBMITTAL DSTtUCTiONS
rrurrd'.: . �.,.. •,;: ,
wrfkO.'47.V so ail dx•www t,r:., .., t.urr,o:re loa. For AB Wrlb., 4tibnttl lhts form %tlhin 34) days of corrgtkiton of well
6a.Wet IIWMK-3 abandonniem to the fr•Ilmcrn.2
Di0sitin of N dtc•r Resource.,information Pr"crssing t nit,
"ell depth: 25
1617 nail lwinicr Center,RaleiCb..N •2?6N9-1617
hb.'fatal If1.1
lob. Fur Ini4Stion Wefts: ht atWilioo to scttdntg the furot to life address ill Ma
atx+tc. elw stolnuit one cop% of ties ftxin%tlhm If)dais of aenpiction of sell
tie.Rrrrtlfttic dianxter:2 tie.) LbarniomrxW to the foUounkg
Division of Water Re�rces,Cndemnound Injection Control Progmun.
t+[I.��atef In'cI helrtM ;:rraraA utrfucr 3 Ot_) 1636 Mal Service Center,Raleigh,N('276"-1636
loc.For Water .giijj s A Iaketign lye IT*: To addition to 6ctldiog Ilx form to
t.c.Outer casing IrmRh+if Isom n1: unknown (fll-) lift' addressees) abc++Z. also .tibnlit otic kx4n of this form Rithin ill da%s of
.otnpletwn of%cil abatsdr+tttncro to the zounly beach tkpantncry of the mouth
unknown %here nhnnrloncd
+�t.Inncrcasin;�tuhint icn_Kh(it hnmtifrY: +fl.)
6R Screm lenob Of Mown):un)mown (ft.)
Fan"0W.-ill Noah Carohtn:kI+anrrciv it Ens troniffew and Natural Reswacs-Dn mwn of%awr Rescrahtis Re,used Ar"m 21,1 i