Randolph_Well Abandonment_20241115

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. . WELL ABANDONMENT RECORD e-.6
For;Atm!Usd ONLY: . . .
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ThiS•foiniean he 4ed.ftieSingle.olitiltiple.Well — - ' \0%4 . •
I.Well V.oniiraetur jitiftitinotituu \
WRELARANIIONMENTRETAltS,
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Stefan Smith , "a.Nitnilicr of wells bring altandnneil:,128 ' • • .
VIT41ItpntradMr.NMs!.(dt‘illd'atiOpOr;dii..illy,.iiiiiSianisi:s. 11.dd 14.11ktr piiip015,) YAP iniilidile,. tlyeeitan or lioni)ineY •.../iipfits., Weils.:'. ONLY will the ••soiie
einistrucOnlithatiqemmajt,.nu On niliniii'?,/tefinivi,
3576-A
• ?b.ApprtiOnsti'volintte of.Wsiei•xetnuininghiWell(sii..- - -•09 •
Ng.WdiftedinifitoresS*146allinii,ici,
'FOR.WATMSEMPLY.WELLSONLY:
SAEDACCO • • .. . ., . •• -.•-•
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Co'nvan'ttaine 7e.!Type:ofillstirfccirrit Uscd,..,
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2:Well CiipstructEciai Penhit 0:,, , wit)4 0 0 83 0 - I . •
Lat...0.4ipioNe tvAitarrik fie.X.'dpsy,-44.,itirinski,,liiie0iiiiietesi inner, ' 74;-Anionut of.disinfeetautirseih,..
S.Well uk(cligekyiell,irse);
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'Water Supply Well:. • • . -7.0;;Sealing niatetialsAktd-(cheekill thatlipPlY);,.•
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• ELigtienhittat itik,limieipaiVOlfc•.. •LI:N6fcm6it,orGUi: 1 Dll•13enklaite•clitser Pellp1S,.
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l:14rothennal-(14caling/Ceelinf,i'SlIPP[34.- diWiretial Water Supply.(single) .1:1.11"nd, 6 tne-itt... C Min 0.DrY'f•!.1'
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Cliockustri011eoitimatial- • Ditesidenthit'OfinterSupply:(ilian.x1) ,.1:r.'g911*l..*..Pi4 ! . -13.pol.poifil$:.
Elktigatiell•• , 0 i".Sgcciallydidnl, :
• '17-0 tavc I.•. ,
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ttp-Wattec Supply Well:. . .ClBentonite Shiny Cl'Other(ezIplain under 7g)
' Ellquiti.lorini . . . 1:1ilecovety
injectiOtiVell; . , • 71.tror each mittetial Selected alions:proride.,antoitttt Of materiels used:
)3Aattife:titeeliatge. • '
j/20.iiiiii0144110:14initibp
CfikoniferiStorai a etlikii4iiNgiy ti4diiiii.3.iiiimer. • .
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Bentonite.:251b ,Wtr:gal.
ClAtpaircitrst , . !....1$101PnWat5•Djaia4,gg . ,
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f.igxperinientol Te,.:Iumfogy inSithshteneetontrel. . 70iPoiide a brief.cle*eriPtiOn of the abandonment procedure.
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C30eolltentr0(Closed Loop) ElTracer
Removed DPT tooling and backfilled borings w/ hydrated
CICeothermal(11mi tige'CoolineReturm NOtherttmlein under:to
bentonite.
4-'13ate*01(5).abanaloned; 10/16/24 C
• IT'1''7•'. ', '-`t :'‘.-: '''''''i I
S.V.glljt.l.Pgon: . .
•#4 1 NOV 1 i. 024
Auddies
Iki;i14t:ION(Oloilicair0 • ,8;Cdrtiftcsikn,
• ,i • --,,- ,, ,:-,,,1 4* t,13-
• 117.•••71.-,"Zi17.:71 ;• .....s17,,•-:•;. ,ii...A
4105 Old.Lexington Rd. Asheboro, NC 27205 . , .34 ,41?/..i.,q,, : D'••.,.lik:ii3 3 10/25/2024 '
Physical•Adtirczeity,-and Zip ,s, .."-iiirq,.7/0,100,11i/dIlComrsmi.frWe5.0soo Palo
Randolph By signing.114s,1074,,I-liovliy.,celify•dun fhe,srell(s)was(seem)qlwiinleined in
Of.iitily. Parcel klmalfIafmt No:4910i ,OceStikiscr:d1111'15:4 AUrIC 9ge;01(10..tir ZC..06.0 Well tinislettelion Stenieltir'ils-
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iliriel.guit'a'ropy 411:14:i'eenrilliss:fnien'jiecnn'cld tiillte1s•ell owner:
Sir.,Latitude and lonettnfe in tiggiyegintnuiteAecendi.or deeinnil'degree* • l'..
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or win1104 One titii6itg ivtoiicio) - " - ••• •9.Site diagram oradditional well detailsi• ..,
You'nay nse.thelgiek.of this.pegOic prat:- ide:00600 well site details ot.we. 11.
, N • • -%t' .a.6 a I)4 a n n!:ett i d th i 1 s. Y.ouIttiy-alse:atlach additional pOge:s if neeeisarY. •
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CoNsfrtitictiox.RETAILS OS WELLIS1 BON( ARANDONikli IIRMITTAL INSTRUCTIONS
.4tir,t1,/-*,/,..y.tast.rithitent Ociiiiksi.if•civrilidife. :Piii'.iipliiple,iitiectiiire 0:nuipsre*..iiith'y
Ii4biONLY linty iii ..s.alitit:eori,n7ntlini:Oiyriliniviivnt,yin iyi11.5111.*1141,qhnii. 100'.. Foe All Wells: Submit Ibig'farm Within.313:,days of eatiiplation of well
abattilatiiitent f0 Il*.felloling; 1; .
6,1,wei/.164:ip-1. - IP-128 - •
Diyision of iNateiResonrccv Informatiso:Prneetsing linii;,
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1617.3141 Seivite Center,RalCigh,NC.21699-116t7
61),:Total sell depth: 23 . . irt4 - .
intl.forloieo fen.Wells: Ili nadilibil tO'ki)40.E.ilk.:fonn_to the addtesshi Vila
.abo%;also,sitbnift one copy of this form within'30'clayS of completion of well
6e,•Borehole tilatucter:.2•25 (in.) abutidonnientm tiktelleiving; I
DiiiSfon:of Water Rdoureesi'ilJudeigiettrul lhijeetlen Control Pregratn.
ffil,WateileVeltelon•ground sy rfacei, (PO . 1636 Mail Stii.icOrntet,Raleigh',NC 276994636
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10e.17n r Water:Sutink&infection Welk: In ndtlitienlo-sending the form to
6e;Outeecasing.lenOr(if Imown): (ft.) the pildreSt(0);okke.. also submit;one-copy of thi :Tatin Within 30-days of
coniptetiaii of Well.ob:endonittni tO the comity.heatih'department-of'Ilie teen!),
*Ie alx.oglol.
Or.inner casing/Milting ignittlp(illsioWn): - (et.) •
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d'g,Sci•pen.lettgth(if:known): A.) ,
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Eonn GS‘&38 •Nd nh Caplan Depattment df Eswirosment,an:I Natural Resources-DIslsIen of MienI R*drce& Revised AtigIfS 2013:
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