Wake_Well Abandonment_20240903 (6)

WELL ABANDONMENT RECORD ror Inknul Use ONIN
This font can be used for single or multiple wells
1.Well fonhectnr Infornution: N'FLI.ABANDONMENT DETAILS
Scott Hunt, Jr 7a.Number of wells being;abanduncd: 1
Well Commicior Name tot well ow ter perwiWIN alufahnwsg well on his l+el prown< I t r mntnph ollethun or moi-rarer swpfdi -elf, O.V1.1 teeth 1k, untr
•NI�fl ter INNI..i.i lrklrul Pl.'i+! I.iN .el♦Utxx ll•Nr. f.rxr
4561A
NC Wdl('aiilrtdnrfc1lffic:ihm+Nnnbet
'h.AppnninutC I plume tot"ales renuininX in%clltsP lgal l
SAF,DACCO FOR%%A*IVR SI PPI N M FIJ S ONLY: ,
Contpcm>Name C.1.lie•of dninfeetalit used:
2.Wdl Construction Perk N:
laadlupphcabkwril prrtwtr(i.e.Cw+wn.Msie.t,n,wrr lntrcixin etc.r ilAm,ru -rL �monnt of Ji.infcCtant uxd: •� 4
J.Will use(check well use):
Water Supply Well: 7r.Scaling materials used(check-all that opph): _
❑A ricultural ❑Mun icipal,Public 01 Nest Ccmcni Grout Cl Hcmonne Chips or Pellets
❑(icothcnretl(HcanikWCooling Supipl)I ❑Rrsitlenual Water Sttpph i-inglci ❑ Said Cement Grout ❑Un(U.,
❑Irdusinal'Comnicrcial ❑Restdemal Water IsupphIsliared) ❑ConcrcieGrout ❑DrillCuUtngs
❑Ind •bull ❑ Spccialn Grout ❑Gra%el
Non-Water Supplh Well: Ci Bervonite Slum' (I Other w plam under 7g)
iGbknufonng ❑Reco%en
Injectinn Well X For each material wicrted Attic.pan ide amount of material.u%Cd:
❑AgmtcfRecharge ❑(inwnduaterRemediation Neat Cem. :941b ,Wtr:7gal. Sand Cem. :lb ,Wtr:gal.
❑Agutler Storage and Reco%en ❑Sallrmn Banner
❑Aquifer less ❑Siorm%tiatcrOtainage -
❑H\pettmemal Technube) ❑Sdisrdetne Control 7g.Prn%ilk it brief tam-ription(if the abandonment pnwLtlure:
❑Geoiliemtal 40bsed l.00pi LITrad:er
I(Geothermal Meatin 'Coolie Return) ("hcf(c\plim under 7 ) location was over drilled and pvc was removed from
boring; tremie grout location from bottom to top
4.Date wells)ahandoned: 8-7-24
5a.Well location:
Brownfield Road Landfill
I'JObtl/00- of Numc Fame,n m(iraypiicabkl 8•CerWkallma:
2600 Brownfield Rd. Raleigh, NC 27610 j/ 8/7/2024
Ph.sisal Address.Ca.,and Zip
Well('nntrxiar ra INCH(odder Daft
Wake !3v.viy(» >A n this J6tm. 1 hereby crm/V tout the w[!1(r)was(w ere r frbevifk+uell iu
Comm PmtcI olrmrfkatiitn No.(PIN) urxxinktme with I XCAC 0.1C.0100 or X 0:00 Will Constmutum.4,tn(A;rrA
and that o Dopy,of this rrror+d hm been pruvukd to dAr weft owner.
Sh.Latitude and longftsdc in dry(rccsJmiiiwtrslsccdtnds or decimal defr en:
(ifwcll field,otr hit-long i,mwiftcwtft 9.Site diagram or additional well details:
You Ilia% List•the bact,of this page io pro ode addrncaml uell site details or%tell
N W abandotintem details. You Ilia% Aw attach additional pages if ncccssan
If NSTRCC I ION DE LULS OF«EI_IASi BEING ABANDONED SUBMITTAL INSTRUCTIONS
.:neai, x.i; ,.' for muihph oyethm ry ma-water wppfr
rrfl.v ONLY r ith the.wane tc noreitfstm rJrarnArtment i.m can submit owe•h ern Wa. Fur.All Weds: Submit item fort %rinhrn 1;0 da%s of completion of well
oa.%Nell ID#:
P-24 Amidonnictu III[tic foll0wm>;
Dicisiun of WaterRessumrcet.lotormation Procniiing Unit.
1617 Mail Senior Cater.R.rlrigh.N('276"-1617
61P.Total well depth: 18 (ft.►
Illb.Fur loleeriun Wells: 6t addiiioli iu xcudutg due furnt to the addtess net Ilia
alw%e. also submit one Copt of this form%%ilhui Sit daps of completion of well
6c,&Ir smile diameler:2 lin.l abandonnwim to the following
Di%ision of Wager Resources,end erxnwod injection Control Program.
oil.V1'atcr k%ri below ground wrfacc: 10 (ft•1 l630 Mail Senice('enter,Raleigh,N('276"-1636
Irk. For Water Sumth A Iniection Wells: in addinori to sending the font to
6c.Outer casing length iif"ow a): (fL) the address(esi abo%e. also submit oik: copy of this form within Ili da,.s of
completion of will:ilia danmcnt to the cotuw. hemhh depannlern of the course
Irf.Inner casin,_,,'tnbing on:,Kh lif I:nnwnl: (ft.l u I let c aKirdntied
6g.Screen length Iif IwownI: (ft.)
Form GW-30 Non Cawlim Ikpannien of Env ironnkim;aid Natural Recovers-Dh ision of Waser itewitirces Rc%I"August?01 A