Wake_Well Abandonment_20240903 (16)

WELL ABANDONMENT RECORD For lgemI Use ONLY
This form can be used for single or mdtiple Wells
1.Well Cestraelor Irnforimatfoa: NMENT DCTAIIS
Scott Hunt, Jr 7s.Number of wells behgf sbsarlaacd• 1
Well Coumesor Nana lof%WII o„ni persolulh;thaadntnug well on hrs,lat propem I Fiv mulrirk- wrp'chrwn W 111w-Mfuee sgrph weita ONLY whip Me
cwi sow,(k,m ahawA,wn eW.tr,a l cur wAu1014W JGn7w
4561A
NC Well CotdrionrCcrtificalinn Nnn+hcr 7b.Approximate vrrlamc of%atcr rrntaininz im wrll(%tO Isul.)
SAEDACCO FOR WATER SIIPPI.V WELI.SONI.1:
fonjram Notre 7c.'fipe of disinfectant used:
2.W dl Construction Permit N , ( C P
ri ;4:gy+/re,rh.r welllrrmdx me i t.SAde.)arlW a lnjeowrm err ,1 Am,wu J C
7d.Armwnt of disinfMIlAnt used:J.Weil use(cheek well use): il.l
Water Supph Well; 7e.Sealing nlak•rial,u%c'd(ehrck all that Apply)- D a c
❑Agricultural ❑hlltnncipalPublic ® Neat Cement Grout fl Hentonex Chips orPo:lkts
O(icothemtalIHcatgG+CoolingSuppl}I ❑Rmidcrntml%PaterSntpph Icmglcl ❑ Sated Cement Grant ❑ UnClay
OlidustnaUConinicmial ❑Residential tk'ater Supph rclmrcd ❑Concrele Grout ❑ Doll Cutltngs
Olm^two ❑ Spmialt%Grotnl ❑Csta%el
Non-Water Supph Well: 11 Bentontte Slurn t 1 Other le\plam unda 7g)
R hiontlonnL ❑Rumen
Injettinn Well: 7f.For each material selected show.prrnide ahrwwat of materials"";
[]Aquifer Recharge ❑GrourduaierRentedtattom Neat Cem.:941b ,Wtr:7gal. Sand Cem.:lb ,Wtr:gal.
OAqurfer Storage and Recm en OSaltrnh batter
❑Aquifer lest OStonm%:aer Drunage -
OExpenntetual lechnology ❑Subshdcrtce C•orrnA Pno idt, I brief description of the ahandmunrat pntcrdure:
OGeolhemral 4Closed I oopl ❑Tracer
location was over drilled and pvc was removed from boring;
❑Geothermal Meatin 'Coolin Return) ❑Oth r tc\piain under 7 ►
tremie grout location from bottom to top
4.Date WVWS)abandoned: 8-5-24
Sa.Will kwation:
Brownfield Road Landfill
I I i. •:i,. ,i'..,i„ I . I II+ ni.i,rd,J-I, k.f�It itiK Atinu;
2600 Brownfield Rd. Raleigh, NC 27610 �fr. 8/7/2024
Ph,saal Address.CNN,and Zip zt ae o!' %ac fsd Wed CumSrctor ar Well Amer Dote
Wake Iiv.rrgmiw this form. I hereby cernA that the weU(r) was twerei sibmid red nr
Cows. Patrol ldesunc tba No.MINI acrordam-c with/J.4 XCAC 02C.0100 or 2C 0200 Well Conclntdton S?imckirds
and rhur d crrhr of this rerard hat bear prof+m Wto dre well owner
5b.Latitude and longitude in dMves/minmtWittronds or dttiimal de rrry
(ifaell field ore•W kwg n,ulfcwty 1 9.Site diagram or additional well details:
You ma% use live back of this page to pao%ide additional-Atli site details or Well
N W abardomtarnt details. You mas Aw attach Adnknul pages if netixssan
CONSTRUCTION DETAILS OF WCLLASI BEING ABANDONED StTHNIITTAl.INSTRUCTIONS
.aa,*well cwavhwc'livm mcwrdlsl{7,ntollaFk. For nrulopk•rnjechmr wr n,w1-»wire agyft'
MnilrONLYMrrhrhrwmrcwrsoenrwrta�amA+mnrnLvrecanuhmNruteNnm IUa. For All Wrtk: Sohn:u Ihl, lane •ohm �V dais of completion of%cell
6a.Well ID#:PZ-9S abandonment to the fhllnnmc
Di%isian of Water Rmrturce,.Information Procrosirrs Unit.
6h,Total well depth; so m.►
1617 Mail Service Centre.RBIrigh.M 276"-1617
lllb. For lnleclion Wells: In addilkxi lu sending due fort[to the address in l0a
alw%e.also submit one copy of this form mthint ;n dins of completion of Well
(.c.Rkrrelwtc dianider:2 (in.l ahandounwill to the folloumg
pi%ision Witter Remourres,Cnder'grrwnd Injection(omtrol Program.
bd.W aR r kcl I helow y.trtund goring c: 10 (ft.) tof W6J1i Mail%entice Center,Rakish.NC 276"46J6
lilt.for Water Sum)h & lniection Wells: In additrcut to xndrntg the fort to
t,r.OutrrcasinslensthIifimuwnl: 00 the addfess!esn Akne. also submit one cop} of this foml unhm zit days of
coutpletson of udl abandonmsnt to the counts health dcpannrcrtr of the:ourA%
6&lnnercasin:,,'tubin>;k-n)Kh(if knnunl: Ilk)
n Iwrc:Ihandoncd
6f,Scrcrn Irntth(if knll-Anl: flt.l
Farm GW-10 Nonh Cxwhm Dcpcsnnwrr of En,Iro o ew end Natural Resoumes-DI%tsron of Water Resources Re,bed August 2N)1 A