WQ0006317_Well Abandonment Records (GW-30s)_20231129

Initial Review
Reviewer
nathaniel.thornburg
Is this submittal an application? (Excluding additional information.) *
Yes No
If not an application what is the submittal type?* Annual Report
Residual Annual Report
Additional Information
Other Well Abandonment Records (GW-30s)
Permit Number (IR) * W00006317
Applicant/Permittee Colonial Pipeline Company
Email Notifications
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
Name* Colonial Pipeline Company - Greensboro Junction WWTF
Email Address*
[e-mail]
Project Information
.........................
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Well Abandonment Records (GW-
30s)
Phone Number*
678-213-7365
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https:Hedocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:* Wastewater Irrigation High -Rate Infiltration
Other Wastewater Reclaimed Water
Closed -Loop Recycle Residuals
Single -Family Residence Wastewater Other
Irrigation
Permit Number:* WQ0006317
Has Current Existing permit number
Applicant/Permittee Address* 411 Gallimore Dairy Road, Greensboro, NC 27409
Facility Name* Colonial Pipeline - Greensboro Junction WWTF
Please provide comments/notes on your current submittal below.
Well abandonment report for wells MW-1, MW-2, and MW-6.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
Well Abandonment Letter(CPC-Greensboro).pdf 1.2MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be accepted for pre -review until the fee (if required) has
been received by the Non -Discharge Branch. Application fees must be submitted by check or money order and made payable to the
North Carolina Department of Environmental Quality (NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
Submission Date 11/29/2023

September 25, 2023
Colonial Pipeline Company
411 Gallimore Dairy Road
Greensboro, NC 27409
Attention: Mr. David Reedy
Reference: Report of Well Abandonments
Colonial Pipeline - Greensboro
411 Gallimore Dairy Road
Greensboro, NC
S&ME Project No. 22050816 phase 03
Dear Mr. Reedy:
On September 25, 2023, S&ME abandoned monitoring wells MW-1, MW-2 and MW-6 and the well abandonment
records are attached. S&ME will also submit the records to the NCDEQ Division of Water Resources and Guilford
County Department of Environmental Health.
If you have any questions or comments regarding this report, please contact us at your convenience.
Sincerely,
S&ME, Inc.
'z—�—'
Gary Simcox
N.C. Certified Well Driller
Registration No. 2944-B
Michael Pfeifer
Senior Project Manager
S&ME, Inc. 18646 West Market St., Suite 105 1 Greensboro, NC 274091 p 336.288.7180 1 www.smeinc.com

WELL ABANDONMENT RECORD
Guilford County Division of Environmental Health
400 W. Market Street, Suite 300, Greensboro, NC 27401, [phone]
(In order to remove this well from the permit or close the permit, this form needs to be submitted to the
Guilford County Environmental Health within fifteen days after completing the well abandonment.)
1. Site Name: Colonial Pipeline - Greensboro 2. Well 9: MW-1
3. Well Location: 411 Gallimore Dairy Road, Grrensboro, NC 27409
4. Well Owner: Colonial Pipeline Company Well Permit Number:
5. Well Abandonment Contractor: Gary Simcox / S&ME, Inc. Registration Number: 2944-B
6. Name of Project Engineer or Geologist: Michael Pfeifer
7. Type of Well: monitoring x air injection air sparging groundwater recovery SVE
8. Depth of Well: 21.9 feet 9. Diameter of Well: 2.0 inches
10. Method of Abandonment: Backfilled with bentonite pellets and removed existing protective cover.
11. Remarks:
I do hereby certify that this well was abandoned in accordance with, and meets the requirements of, the Guilford
County Well Rules in effect on this date, and that a copy of this record has been provided to the well owner.
'z_,e_ September 25, 2023
Signature of Contractor or Agent Date

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Gary Simcox
Well Contractor Name (or well owner personally abandoning well on his/her property)
2944-B
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling _
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑ Tracer
❑ Other (explain under 7g)
4. Date well(s) abandoned: 9/25/23
5a. Well location:
Colonial Pipeline Co.
Facility/Owner Name Facility ID# (if applicable)
411 Gallimore Dairy Rd., Greensboro, NC 27409
Physical Address, City, and Zip
Guilford
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
36 04' 02.99" N 79 56' 32.30" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: M W-1
6b. Total well depth: 21 .9 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: 12.95
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 1.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
■ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7L For each material selected above, provide amount of materials used:
35 Ibs
7g. Provide a brief description of the abandonment procedure:
Filled well casing with bentonite chips and
then hydrated. Cut off protective stick up and
PVC casing.
8. Certification: "'z 9/25/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
Guilford County Division of Environmental Health
400 W. Market Street, Suite 300, Greensboro, NC 27401, [phone]
(In order to remove this well from the permit or close the permit, this form needs to be submitted to the
Guilford County Environmental Health within fifteen days after completing the well abandonment.)
1. Site Name: Colonial Pipeline - Greensboro 2. Well 9: MW-2
3. Well Location: 411 Gallimore Dairy Road, Grrensboro, NC 27409
4. Well Owner: Colonial Pipeline Company Well Permit Number:
5. Well Abandonment Contractor: Gary Simcox / S&ME, Inc. Registration Number: 2944-B
6. Name of Project Engineer or Geologist: Michael Pfeifer
7. Type of Well: monitoring x air injection air sparging groundwater recovery SVE
8. Depth of Well: 25.5 feet 9. Diameter of Well: 2.0 inches
10. Method of Abandonment: Backfilled with bentonite pellets and removed existing protective cover.
11. Remarks:
I do hereby certify that this well was abandoned in accordance with, and meets the requirements of, the Guilford
County Well Rules in effect on this date, and that a copy of this record has been provided to the well owner.
Signature of Contractor or Agent
September 25, 2023
Date

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Gary Simcox
Well Contractor Name (or well owner personally abandoning well on his/her property)
2944-B
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling _
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑ Tracer
❑ Other (explain under 7g)
4. Date well(s) abandoned: 9/25/23
5a. Well location:
Colonial Pipeline Co.
Facility/Owner Name Facility ID# (if applicable)
411 Gallimore Dairy Rd., Greensboro, NC 27409
Physical Address, City, and Zip
Guilford
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
36 04' 03.76" N 79 56' 35.55" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: M W-2
6b. Total well depth: 2 5. 5 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: 9.73
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
■ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
40 Ibs
7g. Provide a brief description of the abandonment procedure:
Filled well casing with bentonite chips and
then hydrated. Cut off protective stick up and
PVC casing.
8. Certification: "'z 9/25/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

WELL ABANDONMENT RECORD
Guilford County Division of Environmental Health
400 W. Market Street, Suite 300, Greensboro, NC 27401, [phone]
(In order to remove this well from the permit or close the permit, this form needs to be submitted to the
Guilford County Environmental Health within fifteen days after completing the well abandonment.)
1. Site Name: Colonial Pipeline - Greensboro 2. Well 9: MW-6
3. Well Location: 411 Gallimore Dairy Road, Grrensboro, NC 27409
4. Well Owner: Colonial Pipeline Company Well Permit Number:
5. Well Abandonment Contractor: Gary Simcox / S&ME, Inc. Registration Number: 2944-B
6. Name of Project Engineer or Geologist: Michael Pfeifer
7. Type of Well: monitoring x air injection air sparging groundwater recovery SVE
8. Depth of Well: 21.2 feet 9. Diameter of Well: 2.0 inches
10. Method of Abandonment: Backfilled with bentonite pellets and removed existing protective cover.
11. Remarks:
I do hereby certify that this well was abandoned in accordance with, and meets the requirements of, the Guilford
County Well Rules in effect on this date, and that a copy of this record has been provided to the well owner.
Signature of Contractor or Agent
September 25, 2023
Date

WELL ABANDONMENT RECORD
1. Well Contractor Information:
Gary Simcox
Well Contractor Name (or well owner personally abandoning well on his/her property)
2944-B
NC Well Contractor Certification Number
S&ME, Inc.
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling _
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Groundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑ Subsidence Control
❑ Tracer
❑ Other (explain under 7g)
4. Date well(s) abandoned: 9/25/23
5a. Well location:
Colonial Pipeline Co.
Facility/Owner Name Facility ID# (if applicable)
411 Gallimore Dairy Rd., Greensboro, NC 27409
Physical Address, City, and Zip
Guilford
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
36 04' 00.98" N 79 56' 33.76" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: M W-6
6b. Total well depth: 2 1 .2 (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: 8.64
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): 2.0 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
■ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
30 Ibs
7g. Provide a brief description of the abandonment procedure:
Filled well casing with bentonite chips and
then hydrated. Removed protective stick up and
PVC casing approximatley two feet below grade.
8. Certification: "'z 9/25/23
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Iniection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016