Forsyth_Well Abandonment_20240514 (3)

WELL ABANDONMENT PERMIT FILE# 403692 s
FORSYTH COUNTY DEPT.OF PUBLIC HEALTH F pIN# 6843-043831,
DIVISION OF ENVIRONMENTAL HEALTH LOT: 31,32 I BILOCK: 2737
799 NORTH HIGHLAND AVENUE
WINSTON SALEM NC 27102
336-703-3225 WELL: 1 I OF 1
OWNER/APPLICANT:"" WILLOW BUILDERS, LLC
SITEADDRESS: 1 W 0 MARTA DR WINSTON SALEM 27107
Well Coordinates:- N: 36.038128 W: 80.216435
WELL TYPE: DRILLED WELL DIAMETER: 6 (inches)TOTAL DEPTH: 115 (feet)
Static Water Level: 7�7 s! Csf(feet)
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PERMIT CONDITIONS: G
© Plumbing present in well to be removed before abandonment
O Water in large diameter wells shall be pumped out prior to abandonment
REMOVE ANY PLUMBING THAT MAYBE IN WELL, EXTEND TRIMMY PIPE INTO WELL, FILL
WELL WITH WELL MIX CONCRETE,OR PUMP FULL OF APPROVED GROUT FROM THE —
BOTTOM TO THE TOP OF THE WELL DISPLACING ALL WATER OUT OF THE WELL.
EHS: MIKE MERRELL II REHS ISSUED DATE: 12/21/2023
'CERTIFIED WELL DRILLER REQUIRED TO BE ONSITE FOR WELL ABANDONMENT,WELL SHALL BE ABANDONED PER THE
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15A NCAC 02C.0100 RULES,SEE CONDITIONS ABOVE FOR SPECIFIC ABANDONMENT REQUIREMENTS.
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