Wake_Well Abandonment_20240903 (15)

WELL ABANDONMENT RECORD Im too,YlIUtcONLY
this form can be used for single or n!ultiple wells
1.1%cll(Mrtractnr Itrfnrmatior: WELL ABANDONMENT DETAR S
Scott Runt, Jr 7iL'4omberoflodisbeini:abanduued; 1
�•uractin PanLL tar sell uumi perwucilh alun6rmng well on lit%Iwo piotwm i F'r rNN/npk rnlr%tarrr rwpph welts ONLY waft the ware
f MtAlf(IMMI r71ti�Lk1�,/IMH'rN.1.rrr r.ur.Y74,1 Jl,Nr.hrrlN
4561A
NC WclICommnorfcrlifiaa ion NxmbcT 71P.Appnrximate srdumenf water rrmainin_in u(•Ili.i� (�,)
SAEDACCO FOR%I A UFR SUPPLI W 1-1 1.�OV I:
Coif Name 7c.1.i pc of dimnftwtam nwd:
2.Will Construction Permit 0:, , d [
Lu:di r,,ni::„i 4 a. !;a rn,r:. ,wM.5t,ir.1�nwrcr Lryrctx,a etc:i(J lairs C !� ♦ 20J
"d. lrn ount of isinl'cctanl u%cd:
J.Will usr(check wmdl use):
Water Supph Well:
'r-.ScAliny matenal%uvd t.r•heek all that apply):
_.
ClAgnicultinal ❑hluntctpaLPmrblk X C•ucut('WAI f] Herionac'Chips orPellets
❑Gcothemt:d IHcannGK'oohng Supph! ❑Rcsidennal Water Supph ismElc ❑ S.lik!<cnmew(,rout ❑ Dn(la}
❑hdusnnal:Conmmcnctal ❑Rcmderaral Water Supph'isharvi ❑(on,rete Groin ❑ Droll('uutngs
❑Irti •trun ❑ Speaalh Gfoul ❑Gra%el
Noe-Water Suppl Well: I 1 Henlonnte Slurry I I Other(explain under 7g)
®hlom(onnt! ❑Raosets
Injection Well: 7f.For each nr.tt,-rial w4ected abuse,pm%ide ararwat of materials used:
❑AgmlerRccharge ❑CitoundwalerRemedmation Neat Cem. :941b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
❑Aquifer Storage aid Reco%en ❑SAinih Hamer
❑Aquifer lest ❑Stommalet Drainage -
❑EVettnrerwrl Techmlop ❑Subsidence Control
'p.Prrnirh•A brief description of tlfe abandinmcm prnarlun:
OGeothemial(Closed Loop! ❑Tracer
tremie grout location from bottom to top and cut below
OGeothemral(Neatin ,Coolin Return) r 10dieriex ain under 7 ) --
surface
4.Date w'eYfs)abandoned: 8-5-24
Sa.Wes location:
Brownfield Road Landfill
i ,Iht%IDw(ifattplicabkf
R,(crtiiicalinn:
2600 Brownfield Rd. Raleigh, NC 27610 - 8/7/2024
Plo sisal Address.(i,.aid Zip >:'•rn o!' rR�Ud WcllCootgcforor WCMOrrrkr Daft
Wake Bm %tXnn jX this form, 1 hereby cerfg8-Char the well(.rt was(were+abitini fined or
('aunt% Parcel IdciarMatsrn No.(PM) o((„n1tvx'r with 11 t MCAC O.C'.0100 or X 0.00 Well Conitim-tion.S6m(lmrds
and that o ty"r ojthis record hoes been proviared to the well owner.
Sb.Latitude and InnAitudc in doeMeslminutestsmunds or decimal defpres:
0f ucll frld air Lot k,iu r, nlhr ociv; 9.Site dinram or additional well details:
I"ou nia% tar the back of this page to pros de additional cell site retails or well
N W abatdonnuein details. You to a% Also attach:ddnxmal pates if mceman
('0NSTRU(-n0N DETAILS OF W'ELLISI BEING ABANDONED SUBMn-FAI,INSTRUCTIONS
.Imkh wr/1,.aorYoow rrrrrnt s+it u,iil ahk. Nrr mu/opie mlrcrren rw r -"der supply
"CIA 0M.1 wxh she•svmr crnr.Ntva bu,r r,+mr<knxnrrN.I'M car(whmi+rure A,rwr. IOa. For All WelLs: Stdrnut this fetnr %%tihm -,0 days of completion of %cell
6a.Well IDO•PZ-9D abandonment io the follo%%in¢
Di%isain of W ater Rewrumen..Inhwortation Pntcrssing Unit.
1617 Nail Senice Center.Ralei-h.M 276"4617
6b.Total well depth: 65 (ft.)
lob.Fur lalection Wells. In addi(ioa to sending five furor to the addiess in lua
abuse. also sibntt one cop% of this form wtUnn ,()dons of cumpletion of%%ell
6c.Mirelnrle diamrler:2 (In.) abardonmctm la the following
Di%Won of Water Resuurres,Cndereniund Injection Confnrl Program.
6d.Water lies ell below Zitirao(I wrian: 10 (ft. 1636 Mail Seaice Cater.Rakish.N('276"-11636
Irk. For Water Suutrl & Injection W'eRs: to addition to sailing the form to
6c.Outer casinglength afknownc (ft.) the addresste�i abuse_ also submit one cop} of (his form within All da}s of
.onipletion of%fell abandonment to the courAN health depanniera of the counn
ulurc.ihandnncd
6f.Inner ca%in-'tubim,li ngth(if kn,is%n): (ft.)
6s.screen Icngrth(if knouni: (ft.)
Fort GW-iii North Camhm lkpa nnrcn of En,rronnrera:nil Natwal Hewiuces Dn isioaof Wxwr Resouncs Re,ised August 201%