Durham_Well Abandonment_20240617 (2)

WELL ABANDONMENT RECORD Fotlrscrnal Use ONIX
IN This form can be used for single of multiple wells i \C-
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1.Well('antr•actor laformatior: � R'ELL ABANDONMENT DETAILS
Scott Hunt, Jr 7A.Number of"ells being Abandoned: 1
Well Coutricior Name(of Nell o%trr perwiWis ahsn&mng Nell on hti ter propcm s F.m mnlnplc oilta rirvr .rr ar.u-water strtyrh rills ONLI r,rh rMr
"wit—low rm.WAMOf OW form
4561
NC Well
lb.Approxhrrste volurne of"atrr•remaining in"cll(s): (gel.)
SAEDACCO FOR WATER SUPPLY WELLS ON 1.i:
Compans Nwic 7c.•f7 fir ofdisinfectant used:_
2.Well Constrectisn Permit k:
h%r.dl"i1ht blr well prrmax n.e.('weft.Shoe.Panama hyethon,etr.i rt karrwe
7d. amount nl disinfectant u%cd:
3.WdI use(check"ell usel:
Water Suppl} Well: 7e.Sealing materials usnl(check all that apply):
OAgmulturtl ❑INtmtcrp:tl Public 12 Ned Comeau Grt"it Ft Rcttonitc Chips or Pellets
DCr otheuml(Hcaugtt Coohng.SuMl't ❑Resu&nn:d Water Supph tsmcici ❑ Sand C'emew Grout ❑ Un Cia%
❑ItdusinaKontnicroal ❑Resrdcnwil Water Supph islwred! ❑ Concrete Grout ❑ [rill Cultings
❑Ini •Uon ❑ Specnalq Grout ❑ Gra%el
Nos-Water Supple Well: U Bentonite Slum I 1 Other(expiam Under 7g)
Sklwwonne ❑Rocosen
Injection Well: X For each material selected above.prin ide amount of materials,used:
❑Aquifer Recharge ❑Gtound"ater Rcutedt:aton Neat Cem. :941b ,Wtr:5gal. Sand Cem. :lb ,Wtr:gal.
❑Aquifer Storage and Reco,,m ❑Sateen% Barer
❑Aquifer Teal ❑Stomr"aler Drainage
OExpetimenial Technology []Subsidence Con itul 7g.Prnvich A brief c1mriptinn of the Ahandonmeut pn►cedure:
DGeothemral(Closed Loop ❑Tracer
❑Geothermal(Heafin 'Coolie Return) DOdrer Iexplain under 7 the well was mangled there was an asphalt company that_
damaged well and got tar inside the well we went as far as
4.Date sre/(s)abandoned: 5-3-24 we could and abandoned the well all the way to surface
Is.Well location: V Ij
H&S Cleaners
FacilnlONnctName Facility lDr(ifapplirablel 8.Cerdras": JUN 17 2024
105 W. H 54 Durham NC 27713 5/11/2024
wY Ifi0t7f 11iNlit°rl�'t.1�-e 1
Ph%sisal Address.City,and Zip -14swieo1 Welt(iwatpeeor Dote
Durham fiv ngfung this jb m, I hereby cer*that the wells) was(Ferri abandoned in
('omn.� Pagel Identification No.(PINT ec<orrhmce with 114.CAC 02C,0100 or X.O200 Well Construction skmdtmis
and trot a cnpY of dun record has been provided to the itwil owner.
5b.I.a Inn titic and longitude in tic gurcuntimttcsrsccundN nr decimal degm-c
;il nclSlal.l ant l:n t:w 11.,nu¢sCIY{ 9.Site diagram or additional w'eli details:
You nun use the batik of(his page to prm•ide additwutal well site details or txell
N W abatdonnterm details. YOu ma% also ailach addtlmnal pages If necessan
CONSTRII(-TION DETAILS OF WELDS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
.Inw:h*dl curtrlruc9me n'cr)r11&1 0 01 whtWv. 1•cv malnplr oyes near cv mm-ttato iipph
welkONLY wvrh rhr.rum twcsorrnwuabronkrmrrrrc 1<w cite sui5,wh wrrl(unN 102. For .411 Wdin Submit flits form within 30 days of completion of%-ell
ties Well IDa:NW-1
ab,udemucni In the following
Division of Water Re:amrcm.Information ProcesWng foil,
61),Total well depth: 24
1617 Mail Senice("cater,Raleiy:h.N('2 7699-1 6 1 7
(ft.)
10b.For Il iediler Wells: In addition to sending the forni to the:ddiess its lua
above_ also submit one cope of this form within In lass of completion of"ell
be.Borelwdc diameter:1 (in.) abardonntem to the folloµing
�, unknown Division of Water Resources,Cnderl,,notnd In rction CoaUvl Program.
6d Water"chit bile" round wrfan: (ft.l 1636 Mail Scnice Center,Ralcigh,N('276"-1636
10c.For Water Sunoh & Injection Wells: In addition to sending the fon"to
6c.fluter casing length of kao"nl: W) the address(es1 above. also submit one cop} of this form within 3n daNs of
completion of"ell abandonment to the counh health department of the cotrm
6f. Inncrcasin-_,-'tulrinL kn:,Kh(if'I:nn"n►: 14 tvlrcrc Amndoncd
(fly)
6g.Screen length(if knit"n C 10 A)
Forth GW-In NorthCamluu DLItannam ofEmnonmem and Natml Resomest-Di%isionof Water Resources Re%iscd August 4)13