Union_Well Abandonment_20241115

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WELL AB AINDONNIENT RECORD \ For lomat LW-OHM- •
Tlii .fortii,ant be used for or tintitiPle.'sellS ' . . . •
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. I.,Wctl Cnt1.04e.totr.1,0101114.0.01: tylitLlt....A11ANOONMENT.DET'AtES
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Richy Lenore • . • 7a.Number of wells-being abanduneih.1
. Wf.l.eptiraei:15iya ate:(4t ikal 6")vicrp,IC,Oliaili,e b4iiiiillill,Pv!=11..6113ifsilLee 0.001.1y) Rip reWojilet five-iron or imakititel.: ..$1ippts. i.folis':-. ONLY WA th-4. ...CA71
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etviltstre4+110aiitlainiair,pti piutoisitif*cy(efimim.
2533-A . . .
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711-APPriiiinUoillrfillilite'nf Wnit4--..rtinntiningiti-Well(s.
lkitc Weil teititaOrCertiliotionNinther• - • 4#0-) •. •
'FOR WATPR:SPPPI.Y.W.F.1...14ONLY:_ . .
SAEDACCO •
Co'nliany Name' . 70..Type'of diOn1eetnrit0e(B. !,. - •. .
2:Will Qinstructitin Pernik-ft, , -
4:arg./4,pploNe.it41iii,,Itiin fLe.titar4A-.Viii.iVeira&e.ce,Atft.tFiiini„orr.,1 if km.o/n -
10,Antinttir Of disinfectant-traeL11.
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- ,.T Well gmri(i*C4.1Vr0.eit.):
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. . 'Nyatter Supply Well 7.0...Sealing ntaterinIsAked(cheel:;s111hat apPly);
P,Agricuhttrl. It.Minic'ipiliBohlic-,. fR(Neal.Cernalt:Omni: . a-8ontonkchi0$kir B01.0.7
DOcofficrlIVIIInc41111601itlt SuPPLY) -Elitzirlential Water Supply(singtc) , 0:s405o*r-tetit# . -in Thy c.!: ,
' • Eamiliwiaticotunicklat. - 1:1Residential'Witter SupplY:(sloioni). . P. .9i1FtP.. -C..!0I!!. ' 1:1 PtilkPiqin:.10:• . .
Lilt/Orion• .. . . .. . .. .
. . • I:1 SpNially.Crout, .- : . 0-Gravel
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N51117Water Supply Well: : • El Bentonite Stogy .
• Cl Other(explain under 7g)
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13Monitorine. -1:IRecov.cty - . . .
•injection Well: - . - - • • .. 7E-For each Mateflai selected shove,pitiride amount of materialS used
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ClAiptifer:Recharse. TIOtinnidwilek:FtentediariOn; Neat Cern.:9416:,Wtr:7gal.- Sand Cem..:lb ,Wtr:gal.
. ' itIAAtkifir, 08000,f( ory .OsAiiiiikEirtil.- .
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ipAimiotigt . . - bicino‘litql.graietkg
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,Eixprintent4i Is-MI[400g -0§0 70
.s.idANC914ppi.. • •
..['roil&it brief elf td;t1)e itiraridnnnient-prpect.Inte:
liGeotherwl Mosed.Loop) .tar4Cer:
Tremie gr6uted well' from-bottom to surface.
• EIGeothermal(11wting/CoOlinrilletun)) : ClOther(explain under:7g). ..
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4.4)ate1145).ohilndoOccit 11/1/2024 . . . 1 ...L.''.. .,4'.F1::::`,,:'',,,i r::•,U
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50,Vett Neation:. : NOV -1 &. 2024
Former McCain Grocery • • -
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raaiitil, hekiirl,liativ Ficiliii:IPU(irupPliratit0 R.Certilleoritaln.. iri•c.5:-.M-",,:.,t. -''','•" ^4:
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10018 Lancaster Hwy. Waxhaw, VC-28173 t44te °VI aw# • •-Vr'"•` 474r^' 11/5/2024
..e9- EIi.,R;;.2'.1•''''03
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PlIsical.Aticii•es City-40 Zip . -Signiiise"of 1.,..titic4 we,n CoiitrvcIo7'0.r Well 0,,vtur pme
Union . . _ . Op.skgpilig;thrs.firy,.I kivtry c0.16:11,112r 1l12 weilf4 weq oyero qbapilip.ttd ye
Couiti, ' Pu-cd likniiiricitlott No,WIN), • .d4thicatcg ly'illi•ISA AC,LC 02C:01(1,q.ig=2C.4260.Weil tlinsIi:tithari-Strinikarits:
pii411rot:kc,,opp.oftizi*-ioorel ltoti:hoon.proyideatplIrOnwit ownet:. - '
.i.p.1.,ittilitiltlifiti longitude in dc.grOginttn,qpg&ecOndi.ord4ini0 dOgriir*
. .(tr!.veilfok,Otte,iat(hin is pit-11.:O.:0f) - :.'' .. • . ' ' - 9.:Site diagriuto or addittnnal well details:
. . You tna Ose.tlie bad of this pitue.to proi.ide.nddijiOnal well site details or well
- • N- - W .-abandomitetidaaits.-You toay alsnattaeltadditionat pages if necessaty.-
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torysTRioN.nrjrAms OF WELL(Si;ilkiNi:ABANI)t)Nkii' - . 1313MITTA1..1NSTRUCTION: ; • •
.4/60 tt••11,-Aiiiw.rginlay e etvie•W If avallsthle..'Air:iriulimee iVeditkrg-or;:ban•wald4.iitpigi, - , I
lOregi*tpo#0 -obitir,.00mirdefioreariorapplif.pia ctiu x!i1mitt,u03hti-,_ • 11.00-:.Fa,All Wells: Submit fhb; faun Within.30 cloys Of completion of well
'6s.Well 111.4:2411-8 -atiaodountent tn.the following:
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Fliyision of Watef Resoureo,;lnformationiernee.tsing Unit,
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• • 1611.41ailSeivice Center,Raleigh,.NC...17699-1617"
6billottliwelideptlit.48 ' :. (rt.)
Bib.Fa r Ink-0ot)Wells: In addition to kading..tlforntta..the addtess;in 10a .
.abn(;:e. also sobnid:.otio•bany of ibis loon widini'SC)ilays-of eottiidetiOn of well
lie, tn 89febnk.diaeter:2 (in.) abaddcitintent to thefollowlui
Viii.sion-of Water Rotturces'ilindertrionid Injecilint ContrOlPrOgratu.
9,.Water;leVel;brit*kiollidstirfileci: 00 1636 Mail Service,Center,Raleigh,NC 27689-1636
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We.-Mir WarictSunnly&:Ittileition Wells: Ill additiOn'to sending the fOrm to- -
6e.'Onter easing length(if haunt's); 33 . . . .(ft) the addIttst(0) above:-alS.O submit one-eOpy of this-roan Within 36 days of.
cottiptetien‘-of well abandontionn Co the.county health-deparnocni of the county
Wirt-4 abondoned,
61.Inner easing/ruhing length(if[quoin): (ft.)
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6k..Screen lengthi(ltatown):18 (ft.) I
Rap GW710 Nosh Carolina pepatuile.al dilEnvhnoment ancl*oral Remixes-Envnion of WatcOle5oincia: ' Res,zed Anus;20 t .
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