Guilford_Well Abandonment_20240617 (2)

WELL ABANDONMENT RECORD >„rtrlkrn,tl rcONl l'
This form an be used fa singk of multiple wells
1.Well Contractor Information: I%IsIF%7 DIET AII ti
Scott Bunt, Jr 7a.Vnml)cr of M else tiring abandoned: 1
N'cll(•onuacrom Na1tlt:tot MclIo et►i ptwwdl,:tlunkuwty,M L on hts tics f>ropcm, f.e »n.:, a..•-a,n%r tvp(4) well; aVL) Iiah dw 4m*
:•nIffk(i'+•', ..,..: .. .! ,..1l.,Y:,Mf,Nlif lilt hNM1
4561
7h.Apprw,timste tolome of water rtm M aininL in rllie10
NC WcltCoamiorCcrlificatx>a'txrtfler Itlid.)
FOR WATT.R SUPPLY WELLS 0%1 N:
SAZDACCO
Convex"N•1''t 7c.Ts lie of disitdectam ratted•
2.Well Cun.uvetion Permit M:
v ,:men.Shoe.I artowe hreahrw.eh.:tfkm-vo
"d. \Iiatunt of di.infsxtant u.od:
3.Well me(check wen we):
Water Snpph Well: -r.Scaling material%unad(chcek all that apple):
DA.amnhural DhlimicipalPtblic x Nem Cement Gtrnp to Beato"C Chips.Of Pclktc
D(icoihcrnul 4 fimving'Cooh ng Supph! DRaidemial Watcf Supph tsingle) ❑ Sand Cemenni Gtwtt ❑Dn C•lat
❑lndosinal:Comnirnral DRcu&rvial%Vaw Supph ishared) ❑Concrete Grout ❑ Drill C'uturtp
131fn two ❑ Specialb Grout ❑Gratel
Non-WalerSuppl, Nell: tt Rita"1111i•Sluin II Ckhef(C%plan)utldet'.g)
INhtonilonng DReroten
Injection Wen: ( 1rat aA.h to Atet l.d V'It,h'1I Jhn1 c.111Wtlit,'AtlN NIIII.,f nlatt'r1al.I/V',l:
DAilutferRcchiamc DCinnudttateFRemediaon Neat Cem. :941b ,Wtr:5gal. Sand Cem. :lb ,Wtr:gal.
0Atpnfer Storage aid Rc%:onen DSaluun MUMC --
DAtlmfet Tem DStonnwalcf Drattwgc --- _ — -- —
❑Expennicnial Teclimlop 0Sullsidetce C'omnd 7g.Pnttide a brief description td the ahanth,nmen►procrilun•:
C1Cietittlteriilal(Closed Loop► l.tTraCer
(7C,eothiernl3l(Netti •Cook Rrtnrn) I10TherteN n urdCr 7 ► triaap grouted well from bottom to 1toop; removed cover and
s. t"'.ir R,M L l
cut pvc below surface %t�` e
4.Dole wetl(s)abandoned: 5-16-24 JUN l 7 2074
ca.%%A(neatkM. _ °f•� ]t-^rCi�;ry�t.t,_'
High Point CiD Landfill DYVQJCriii
' .rti.irttr Partin If)ettfappl+tabkt
x l,t utn,iti,ut:
5830 Riverdale Dr., Jaiitiestown NC 27282 '" i �� 5/17/2024
t tress.(1n.and Lip :•, .:air a!C e un d WC9('oattaetot re WC9()Mnrf-- flare --
Guilford lit rrgtmag)hit Jimm I herehy rernit Aw the welleu was(were,aliiNkho eed at
PUCe1 Idctrlf"Ve No 4Pl%1 urr<mk»x-e rtdt/S.1 AI("1('1)"( .()lip()or:(' 021K)If*ell(an.strw-ho"Uwkka,&
rmd fhrtr a vori O)Ih1T ri•C r,rd istrs heor frm7tled to Ilse Midi tw rk-r.
Sh.laritvde and Inngiitnde in dct w%1minutrslvernndc or decimal defftew
-d.,.!:tcU -tx La ten:n auttsant. 9.Site diagram or additional well details:
Neu urat the the baci,of dos palmy to pima nk aftivvo al well site details of well
W 3bamdeenucnt dctat6 You ma% also attach tdduioml pains if ntwessan
('OSSTRf(ll(ri llPT\ILA UP N\Fl l tit ttl'l�<: 4B\NDONEII SUBMITTAL INSTRUCTIONS
ri•n-»..lCl ryjY•ia
» r.(►.\l.l ».. .:.K,n» , ,w. ,..e,.,•.y,, .,rN,flr ,..'..,.: y.,,:.,,rr;..,. IOa. For !W VlWrns: Submit rhino form witlun 30 days of compklton of well
6a.Well ID4:
P8-3D Ibaixion"Icin In the folMutnit
Ditttion of\\Ater Rcalur tom,InImmAtinn Procriisisg limit.
61). Iotal Met,depth: 60 Ih.) It,I- N1ad'�t'ivice(enter,Ralrich.1( 2-649-16I7
hth. rur t i"twu\kiss: In addilioti to sending the form it)the addiess in lea
;botc. abo subrntt one ccT.% of thins fonts within 10 dins of voingiletimi of will
M'.Httrcholr dianM•ter:2 sin.) :ibatdomrww to the follouinu
Ditisioe of%,aler Rmwrive%.I.ruk-mruund Inketion Control Program.
od.N\Ater wet.1 hrinM �Ivnnut luilaer: _15 fft 1 1636 Mail%crier t enter.Raleigh.N('2761M)-I(j,16
su Wens:e.for Water Supolt A Injection In addition to sending the form to
bc.Outcrca.in•11cn�ahlHl.no�nC (hI fix. aldresstco aboite. also w1imit ow rapt of this form within III dms of
conq)ktwn of wdl aha wkions,nt to the,oum% hcahh dcparimcia of the;oura.%
w here ahuiidoikA
W.Inner ta+inYitahieg length lif{,wows): 010
6g.Scmvii lcnlMh of l.nottn): AI
t -;, 1 '.t. Nun IF C'woluu Mpmimrs of Ent itunml0l alma Natural R,:%oiwcs Do isiun of%Act Rcwtiaii itc,teed Augum 4tI t