Onslow_Well Abandonment_20240624 (2)

WELLABAIVD.ONMENT RECORD rarlrnemalUkONLY:
' 7'tiis foini cafi be.used far si"la dr tuullipte~ells'
I,WcFE.Ccinttactuc Infncmadt}n: NVLL ARAND6NI<1RNT DETAILS
Stefan Smith 7st,Nuniher of wells being altandun ld: 1
15'e1t'+Ltd,cforNar>a+•(orxtilloieaicr rS�natly:ali5an(aninga.�nonitistir;r'prupcsty)' For routnple lgjerdosr to; rmn-naar�r I supla} gels ONLY wtdh the sass
coaufrrrcur�ta totrdrtnmrRat,trrn&r.yubj t efirm,
3576A - !I
AiG WO ContrttlorCvntitaitioir Ntiubcr 7b.Apinnsiinate v61uhm of viater retttidning in ti-eil(3):
SAEDiCCO FOR WATER SUPPLY WEL S ONLY:,
Canpanvhanfr 7c.T)*nf,disinfkctrutused:"% calcium hypchlorite
2;:4ittConstruction Permit A:
Lf31 id1 iryipfkvble u elllmrmldr(i.e_CrnGrtl}:State.Ytrr�ifrnce.Ldrdioa�rtr.!IJttrumrt 7(LAmouut of dlalnfeetattit used:3•oZ
3,Wdl use(chhcd:Well use):
Water Supply Well: 7e.Scaling matedids uied(clrccl;afl Mitt apply):
pASricul(ifat! Mitinici Pellets
OGcathcmral(HgatinralE Doling Suppl}) ®ttcsidentiat Watcr.Sul?pl)'(single) a Saud Centa)u Gniut ❑'qiy Clay
❑lndnstriallCammcreial ORcsidentfid Nvatcr Supply(shoed) 13 Concrete Grout ❑Drill tlitlin
❑Ini tiou O SpeciaityGrout. 134i:tt+ct
Nog Water.Supply�VcH; C)Bentoai(e.5lurW ®Other(explain under 7g)
I7M0tiltorfne. ❑Rec:ot•en _ -
Injcetion Well. 7f.For.each material selected above,provide antanntof materials etude
❑Agrdfer[tcchane Renteiiiiltian Neat Cem.:1881b ,Witr.:15gil.. Sand Cem.:lb ,Wtr:gal.
MAquit'ec-Stotage atxt Rekot'erV M$a iittty Darner
❑A iuifer.T,st C1SlamryvgterD'nrinu�n-
Otxpetirktual Techttoto v C1Subside)�e CarHral 7^ prnvidc a.bricFil criptiain of the altaudnnmcnt pelreCdun:
DGeodiennal(Closed.LooO MTricer j
OGeothemtat(Head Cooliux Retum) DOther.(M lain under jr,) Grout- abandoned via tremie
d.°I)atctect[(s).abandoned: 5/15/29
Si,Well tucaiiton: JUN 9 [: 2024
Richard Patane (frdt'i:7C,i: iHZ ^r-n e.4 ,,
racilit°l4rtiiavNait c racili c JDM(10 limbic) 8:Corvllicaitiair 11F
215 Diane Drive; Jacksonville 28540 _ 5/27/2024
Plowsica)Address,City,-and Zip fts -
Onslow, B)e.6S)lag 1hts j&zir, F lze"y cea•t,fy-that'llre Seel!{s)was!acre}ahandotwd in
Caeiuiy. PM-Cl Idaaatirki0aait No:tPlN) rtrxVitdance a ffh 1114 1Czle 02C,010n Or 2C.0200 Krell GUai.,inlr.aw slagihzrcls
- - nrxlllratgcdp��oflhisrcicarcl�etzsbecla;nrotivilerl.(v!!ra_trellatrrrer.• '
5b.I.ttitude and lon�ltattain.d�nriccslnrir<utcslsceorids ar dccimal degt'acr:
(ifncll f::41,oars Iiu1ou +sxplficiersl) 9.Sito diagr,mi:or additioimlvtell iletaEls:-
34.767855 * 77.491576 You-atay.tise tlie,bacle`of thus page'ta pio>idz adflitiofutltr4ll Ate.detuils or,hill
lr �4 :tlianaotwteru details Yau luny also,Aack ail&ioual pages if necesm-
CONO.TRUCPIONDFTAiLSOFW I,U.%BEINt:ABANDONEb CIIRRII7"IAi.i11iFTRL1CTIONS
.roach N ell 6mi,•lrttclfurt r&'YMI s)1j.avW[OL For rrri ftj?&H,1ea4Vu'(jr rmil-iatitir xupplp
u,eltgOVLYai•Ifhlltewuta c�usirbmfi.wrr tyre 101; Far All tlVcllc:. Submit iliEs+fatttt siithin 30 days af.caiuptctian of arll
Gsi Wen IN; abaudourtunt to'the rallotving,
I.
Division of Water Rrs6nrct5,Infurmati6n Processing Vnit.
161711Iai1 Scnicc Ccntcr;Raleigh.NC 27699-1617
Gbr2'otatnrlldcuilr: 139 (ft. � � .
10b;Fzir inl tlon Wells: bt additiau to sefxiia�Ute;fQtnt to t[fe addt�ssitt t0a
t of�ciiolc diameter:4 abatti;also subinit oiae topy�6C this form uillii t 30 days.of completion of Well
fM (10.) abanriogmeW to tiu:•fallptving; I,
Gtt.Water level held*grouritl surfaeci 18 owDivision of Water Resuurces,'Undergrouna Injett(uir Control Brd q=,
ifi"mail Seit•iw Ccnier.Raleigh.kiC 27699-1G35
Ge.Outer casing length(if lmown): (ft) 10c Formter 1j1niv&T11fSgFan1V0l1q: M addition to sending the font to
the addacss(es) above. also submit one-copy of this toim within'30 day3.of
conlptetiou of tvrll abando m cut to t'he county Inc rEtk depruimertt 0611c couWy
Gf:inner easinwtubiag tength(if6•nawn): (ft.) tibcrc abandortctt,
Gg.Screen length(if kuoun): (ft)
Faint GW-30 NanliCarolim Detnnn&A afPnrlroamem aril Mifufol Resomces—Divisionof WaterR.oiun.s Peened August 20t3