Guilford_Well Abandonment_20241115 (2)

WELL_ASANDOINIMENT RECORD rertittermlUW,ONLY
Ws forth can be itsed foi.sin$tabr iuultipte..Weifs.
1:1YctE Cat>tractos lnfnrnllii(tt1: WRLL:ABANU()Nh1RN'C D&MILS
Stefan smith U Number of wells ke iv tlhandonvi. l
}Tc1E'Codm�tior[r'aut4,4tticllgn_uy tsgtcitl IilJanlmdno:uLSluafi Mgr fin rt' For� Nrxlnple, Plliilli"r LV i'via-water -sity"Xi T++fls` ONLY well) lbe •soma I .I
- 06AYf7trCfJ(N1.ew>G17N5�fNINJITI/f,IYJN.LCUP,S41N11 tGVldfrJRJ1,
3576A ?I►.Apjttrfiiitnat¢Vulniist of vtattY�tC!ttainin hn}i'cl0(s}T1 (t;al.)
NC WA Ca7ItTd66rCCftlB4boi191111b n �I'
SAEDACCO FORAVA :I.: UPPLYWUS;ONLY.
Cnnv:tty Nan_'c 7c Tylte'of diiinfiYfant risen.-.N/A
2:Nell Construction Pertait't(a.
L-Awl uyp14ro 1v u2HrirmlJs f%c+.:L+uJrJy,.Sia!r;YarlrL.ee.lrrjek;nlr,glr.l Jkuuvrr 7d Aniiiunt ofillsinfertiint used:
3.�Ydi u!x;(checl: ;ell ttse}p
Water-SupPly Wcll:. 7e.5calirtb 6)afcri:ils ii til(chccic•illl that lipplf):
I]agriroltttt tl. phlStnicipalJPtthtic Cl iVcat Cctetcut. iput. 13cntoliite Chips ar E'cllcts
gGcalhcm>:tl(HGa(i lg/C.aoling 5lt Ly) dkesidgntial W'atcr Supply:(singlc) ❑Sat>xl CcrttK►tt rout ❑Dry ct;iv
❑hukuslrialJ�'otnnlcariy1 ❑Rcsidenti#tlWiitccSltppty:(sl>dnxi) '[]Con�ceteGtotti D Diill•Cutfli
[]ion anion. ❑Sp ciall}-Grtlut: Cl i3ravei
Ron-�Vatck Supl+ly�i'etE:, 0 BerAoniite Sluny D other(explain under 7g)
RgNiallitodai DRecovety
Tn�cctian;1Ycft: X For each material.sclected above,provide amount o£ttlatetials used:
�Agaltifei Recharge. pGrottitdttialei ltrtuciii:liiott '
D.4gttifei Stange�tni-l�ecias'en []Sidiiiiiy i3ariier ,
DA4uiferl'e5i Bentonite.:331b ,Wtr:gal,'
l7E�tp dlelenlal Tcii hngtoe_}+ I7Subaide»re`Cotticul. 7 FtxrVictc's hrhf iiiscriptiun of the aliatidnnmcnt jervc�tvlure:
Meothemtal(Closed Daop} CCllracer
Pour bentonite chips; hydrate, then push using DPT.rig to
®Geothcrawl(Heaati 'CoolinzReturn) 00ther.(es laiaunderLm
compact sealing material,.
d.:'Date tF'Cll{a)ab ttpipptled: 10/25/24
�~.�
Sa NYctl location: d' - ?^' ,i i
Intl '��`.
Colonial Pipeline - Greensboro Junction
rabilityl0Wt*vknnv raiiitc•iDA(if ilpofirkic) $•Certllintdont NOV 1 ti 2024
411 Gallimore Dairy. Rd. Greensboro, NC - ir,� a-�,•„e 11/11,2024
Lhysiral-Addim Cite-:and Zip 5?+Zilure<<.Csntl'xvt�Ve1l C'�ntr: �ctt�r W'eSt Chet�,�;y l; i_:� Da:e
Guilford J3;t s ling thes frrnJ,-J lreribyeetPlfy,firn7 tke ueJ!{s)llgr tkerr}trheurifoned uP
County Farrel Id:ntiiFaat107t Nq;iPtLV) rtcccrir7crix.•e itfrlJ{!�:4-AC�IG'O�t:.11llJt)_tJr=a?C.(Y?t)():iPE1i'CUta,1.lJYttYiGtJ Sfriniktrifs
' - � � irnrZlJrtit:a.cvrpyafflri�riwrtJhrJo beEie prvvlYJcrJ{O 1Jleit'eJ1 Crit'17E1:
51t,1 iltlt4.ltC'alld loi-iotude in SIC 4^Si817:00 datrit9:
llr,Yctl rald,u,><.L� k+�ia u 7ilitc 1�) 9.Site diagram or,additional Fell detalls:
You tuiy icse,tlie back,of dds 0g6';,to provids•addi`n6nat tell site details.or.well
36.070093 h 79.940271 1Y abandoatncattdetails. You,nta�Talsii:alltachadilitionalptgrsifuecc%saty.
t It11Ct't(IAt.DF'TA1tA OF WELL(K)URINE.ABA IINDONEn SUA11itTTAE.iNSTREiCTTnYfs
rltatlr irc11j"fintrudinrr evcoi-l(ar WavrH1,rite. .Ptir multiple iiYeniwr W rxn•Nt<l(u`sujjj ly
Srfllr'f)NLY tritJe tLn stirnnrrnlr,u r&vc n5mr�h»rmrr�t.}ya ens slrGrr&ta�r�t�nre- 10a: Nor All Wells- ,Submil iliis faint ninon.30:days of eothpiction of tall
tia.Weil IIl-#:
RDc-10A_ ab,%Zoogtctit to tha fallo�i�in ;
Division of'YuteeRet tiurccs;Information-Pril-Mina Unit,
6b1 Ill tat well dclitli: 22 •) 161Z 11iai1 Seitice Cctttcr,R:tU Ie,Nc.270994617
10h..je r 1 ia'clicin Weds: In a0libit to sending.tl t�rn►.to tIY adilirss,i» Wa
Gc.Borcbolediauteter.l {in:} aboW uLfio'staG7tiil;otie•bopy of this:Eonii nidliu 30.0ys of:t:titliptetioit of tell
abzin>Ititwtetil to the Ctalla�t'itir:
i '
rid'.Vi once t rJ hslow�tbetnil stlrture:; (fe,) DMMott;of Water Resuur,ces Uuderj;fo=d injecttun Control Mgralu,
163fi Mail Ser4ice enter,Raici2h,NC:.27699-1636
66,Outcrcasin isuMth(if.latt►lrn): 17 (ft) life.arm t-, tittilV fil inn�Vet1s;. In addition,tg scodWg—the form to
the address(es) above_ also Albalil bile cdp%' of this-fond within 30 days of
coniptcticn of,Wrli ab:lhdotuttrnt to We cottw.hraith d4kruncnt of'the county
6C 1nnereasin T tnbi!u+m tenl-th .if Inta1vn• �ti rc abcrudamed.
6g.Screen.length(if1[nolrn):5 M.)
176MtQW-3u NonliQuotimMx wergdfEmimmixfitaiAlLuumtResomecs-DlvisianofWaterq,�Saiun.s Rc�iscdAugust20t3