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HomeMy WebLinkAboutGuilford_Well Abandonment_20240617 (3) WELL ABANDONMENT RECORD L. ..l,unw!UseONLY This formn li ,at uxd for single of multiple%sells 1.Well C'ontrarpir Infionnation: %%F'IT let ANDO1iMENT DCTAIIS Scott Hunt, Jr 7a Number❑f%%ells being abandoned: 1 wol l•,,tstact i h.utc fist well oNixi per.-till,"Wotuug%c:J oii ha lwi ptcv.:m t F'w i •� r.-trrrrr uj(Ji , 1k 0M.1 write A' UA%e 4561 7b.Apprutimate solumv of water remaining in rcll(%1O (gal.) NC%Yell C'ntar onr(i diftcnlinq NNtttrcr BARDACCD FOR W 4TER SUFPI.l•W'ELI 4 ONI.I: C'orrtpum N attic 7C.T'k pr of disiskttaat used: 2.Wdl Cetsuructxni Permit 9:, l r.r<,11:4rf,Lt abi. ura •:r , t.,zr%.%&Ne.I aruivir larrarxwr,eh.,if Amo,sr 7d.Amount of dWofectant sled: J.Well OK(Cbm-k Nell u%cl: W Ater Swpph Well: 7e.Sealing material%toted(check all that appl%): I-Agmuftur.,l ❑Mimicgsal Aihlw 111 Nc11 Cenictit Own t-I lkenionite Chips or Pellets QCxofhcMLIl(Heath g'(boh1w S•WPb 1 011mdennal Walcr Saupph isinglel ❑ Saud CCnXM Gruut ❑ Dn C'ln 01ndus4mil Coninwicral ❑Raiideraial Water Supph tsharod) ❑CCovwfm Ciro% ❑ DWI Cutnnp Olfrizaton ❑ Spaaaht Ciroun ❑Gra%tl Non-W ater Supph Well: I'J Ileftolltle Slum U Otlitf(eiiplain undef'g) ®htutalonne ❑RCzo%cn njrction Well. 71.For each material vk•cfrd aMr',e.prrr%itk Anit.wnt ref material.nwil: ❑AyutlrtRcchargc ❑Ci2RitdgJiefRcnicdoation Beat Cem. :941b ,Wtr:5gal. Sand Cem. :lb ,Wtr:gal. ❑Aipnfef Storage aid Rccm to ❑Salnun B.,trtet 0.44µukr'I'es1 ❑StornmalerDranlagc ----- -- ----..___� ❑Expenniental Ie hnolop ❑Subsidctict Conttttl 7g,Prin itk A brief dcscripttun tit the Abandunincnt pn%CCYlure: UGeotl►erntal(Closed I dope liTracer triamy grouted well from bottom to top; removed cover and IlGeotheritial 4 Hewing,,CoofiP4 Remml Oc4buftexplain utldef 7 f cut Pvc below surface 1.Date aetlb)afrandnnrd: 5-16-24 `• -'v L-i �A.%%c11 h a Atiton: High Point C&D Landfill ►Wisflp 4ra'!?efx,AawT LW r.ttilm ri,,,><,V.itic � et iifapplu:Abrer II.Ccrtifksdnr: VI 5830 Riverdale Dr., Jamestown, NC 27282 '+ �' f`t" 5/17/2024 Phs skal.Addrew Cn,.end Zip "r.M d!c. :r,d W C 9 Ca ain near wr4 cM tier DW Guilford fat•opunst flies Itarwt. 1 herir4 i erh/v tAw My %riles. wait rwerey rsNwaWfi d in CowW% Pmelklcirtf"11"No4PI%I Iw4wrthink-raith A(,1Cq?I'.t0100er:C... 0:1MR'vllConstrue1kin, mAw4v ttwd thtw o crypt o1 this mead hav hear prr nvA-d to the w ell ou nar. Sb,lAritutle and langitutle in tkVredmimstcWwc@Ml or decimal degtrcl: lt/wcl:la W tw !i I ,-,.+alit_,,ta; 9.Site diagram or additional well detalls: You nra% tat the back of this page to profile additional Nell sat de inh or sell - -_- -- N W' abaldounicta detaib You nrA% also mt:i Ii aiWuional pages it rs ctssan CON*�TRI l 110-, M I AILS OF W'EIJASI BEING AHANDQN F SUBMITTAL INSTRUCTIONS mueop4r rmat(j,w.r rxKr wsUrr .,.;7•�r .. f I r,rx irk .xf..titr r.we Hrr%t lox. For .411 Wells: Subunit flit% fomi aulun 30 dais of completion of Wdl ru.N ell 11)=:PZ-5D handenmCrn to the follownkC Dist%iira of W Ater Rrw.urer%.Information Pntce%%ing Unit. bb. lutAl nclt depth: 41 161'MA11 Scnice(enter.Raleigh.M'27699-1611 (ft.l 10b. Fur Iniect(on Ndls; In add"t to sending the form to UK addtess in Wa ahw%c. also sutinm rftr cM of this fort arthin In tins of cCnttpktioo of sell be.%in•hale diAnieler:2 Iln.l ---- abaidoniitrnl to tilt Iollowuis: Di%o.bn of%%ater Ila.,turee%,t ntkrgnaund Injection(oninrl Pntt;ram. bd.W Ater kwel hehtw Lgviand%uirfare: 15 (D) I636%fail Sa•nitr(enter.Raleigh.NC 27WM-l", lac.Foy W aicr.}goal% A Initrrinn!Fell%: In addition to seating the form to 6C.UutcrCA%in;,;lcn-_nh itl kin%%nt: (R•1 tfic addre%yc i abut. alit wbnai oiw .-i,p% of this farm within III ias of compk-tiun of%veil ab.indonni;nt t.• ffie .antni% ticafth dcpannicia of the counts %%h;te.,h..nrloik�tt of•Inner taNin-_,rohin Icn.Rh tit Lnn%n): Ift.l t,g,Iiivvn Icn;ph of Li m%%ni: form GW-lit Nutt Catutim Mp nit►n!of Ein irutwictd aid Natutsl(icagtttct% Dit awtn of WAct kewitt ta% ki xd Au#ust 24it 4