FA-1322_29012_CA_WR_20230630_MWsAband

220 Old Dairy Road
Wilmington, NC 28405
[phone]
www.CatlinUSA.com
Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA

ENVIRONMENTAL | CIVIL | GEOTECHNICAL

Wilmington, NC | Raleigh, NC | Washington, NC | Atlanta, GA | Charleston, SC

June 30, 2023 North Carolina Department of Environmental Quality
Division of Waste Management
UST Section Attn: Mr. Hassan Osman 1646 Mail Service Center Raleigh, NC 27699-1646
Re: Letter Report – Well Abandonment Starflite Food Store #272 1416 Fayetteville Road Rockingham, Richmond County, NC 28379
Incident Number: 29012 Risk Classification: I130D CATLIN Project No. 221072
Dear Mr. Osman,

CATLIN Engineers and Scientists (CATLIN) is pleased to provide you with this letter
report documenting well abandonment field activities performed in general accordance with CATLIN proposal number 221072.5P, prepared May 22, 2023. Services were authorized by the North Carolina Department of Environmental Quality (NCDEQ) Task Authorization (TA) #05, accepted May 22, 2023, and Contract Number N122019D. The
approved scope of services for this Task Authorization included:

• Abandon five (5) monitoring wells (MW-1 through MW-5D); and
• Prepare a letter report documenting the site activities.
Monitoring Well Abandonment On May 24, 2023, CATLIN personnel mobilized to the site and abandoned monitoring
wells MW-1, MW-2, MW-3, MW-4, and MW-5D. Well construction information for the wells
is provided in the following table:

June 30, 2023Page 2 of 2
NCDEQ; 29012_Starflite Food Store #272 CATLIN Engineers and Scientists
CATLIN Project No. 221072 June 2023
Well ID Well Type Well Depth (feet) Well Diameter (inches) Abandonment Procedure
MW-1 Shallow 20.0 2.0 All well materials left in place
MW-2 Shallow 13.0 2.0 All well materials left in place
MW-3 Shallow 18.0 2.0 All well materials left in place
MW-4 Shallow 18.0 2.0 All well materials left in place
MW-5D Deep 66.0 6.0/2.0 All well materials left in place
Monitoring wells MW-1 through MW-5D were abandoned under the direct supervision of a North Carolina Certified Well Contractor (CWC) according to guidance provided in the
North Carolina Administrative Code (NCAC) Title 15A 02C .0113 (Abandonment of Wells). The well covers were removed, and wells were abandoned in place by packing with bentonite chips to within one foot of the surface while simultaneously pouring water to facilitate hydration. The remaining space was filled with concrete to the existing grade.
The site vicinity and well locations are shown on Figure 1 and Figure 2 (Attachment A), respectively. The well abandonment records were submitted to the NCDEQ Division of Water Quality on May 25, 2023; copies are provided in Attachment B. Photographs of the abandoned wells are included in Attachment C.
CATLIN Engineers and Scientists appreciates this opportunity to be of service. Should you have any questions or require additional information, please contact me at [phone].
Sincerely,
Benjamin J. Ashba, P.G.
Program Manager
Attachments: A: Figures B: Well Abandonment Records C: Site Photographs
FA-1322_29012_CA_LTRRPT_20230630_Well Abandonment

NCDEQ; 29012_Starflite Food Store #272 CATLIN Engineers and Scientists CATLIN Project No. 221072 June 2023

ATTACHMENT A FIGURES

FIGUREPROJECTTITLE
1SITE VICINITY MAP
SITE LOCATION
F A Y E T T E V IL L E R D EASTSI
DE DRCopyright:© 2013 National Geographic Society, i-cubed
2,000 0 2,000 4,0001,000
Feet
³
STARFLITE FOODSTORE #272
1416 FAYETTEVILLE RDROCKINGHAM, NC
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY29012221072JUNE 2023 AS SHOWN KMC/BJA
FIGUREPROJECTTITLE
2SITE MAP
!>
!>
!>
!(>!>FA YETTEVILLE R DEASTSI
DE DRMW-5DMW-1
MW-3
MW-4
MW-2
10,000-GAL. GASOLINE USTs (CLOSED IN PLACE)10,000-GAL. KEROSENE UST(CLOSED IN PLACE)
FORMERPUMP ISLANDS
FORMER KEROSENEDISPENSER
Source: Esri, Maxar, Earthstar Geographics, and the GIS User Community
30 0 30 6015
Feet
³
STARFLITE FOODSTORE #272
1416 FAYETTEVILLE RDROCKINGHAM, NC
INCIDENT NO.JOB NO.DATE SCALE DRAWN BY/CHECKED BY29012221072JUNE 2023 AS SHOWN KMC/BJA
NOTE: Well and tank locations were obtained from previous reports prepared by other consultants and are approximate.
Parcel Boundary
LEGEND
Abandoned MonitoringWell (Type II)!>
Approximate Location of UST System
Abandoned MonitoringWell (Deep)!(>

NCDEQ; 29012_Starflite Food Store #272 CATLIN Engineers and Scientists
CATLIN Project No. 221072 June 2023

ATTACHMENT B WELL ABANDONMENT RECORDS

WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply)□Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop)□Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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:
8. Certification:
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 Injection 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 & Injection 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.
For Internal Use ONLY:
1.Well Contractor Information:
Corey D. Futral
4300-B
Catlin Engineers and Scientists
Bentonite
Concrete
37.5 lbs
16.5 lbs
5/24/23
7g. Provide a brief description of the abandonment procedure:
All well material abandoned in place with hydrated
bentonite pellets to within ~ 1 foot of surface and
topped with concrete to existing grade.
NCDEQ - Starflite Food Store 272 NA
1416 Fayetteville Road, Rockingham, NC
Richmond 747310357941
34.945485 -79.754974
MW-1
20
8.25
3.19
NA
5
15
5/25/2023
NA
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply)□Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop)□Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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:
8. Certification:
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 Injection 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 & Injection 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.
For Internal Use ONLY:
1.Well Contractor Information:
Corey D. Futral
4300-B
Catlin Engineers and Scientists
Bentonite
Concrete
25 lbs
25 lbs
5/24/23
NA
1416 Fayetteville Road, Rockingham, NC
Richmond 747310357941
34.945485 -79.754974
MW-2
13
8.25
3.55
NA
3
10
5/25/2023
NCDEQ - Starflite Food Store 272
7g. Provide a brief description of the abandonment procedure:
All well material abandoned in place with hydrated
bentonite pellets to within ~ 1 foot of surface andtopped with concrete to existing grade.
NA
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply)□Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop)□Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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:
8. Certification:
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 Injection 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 & Injection 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.
For Internal Use ONLY:
1.Well Contractor Information:
Corey D. Futral
4300-B
Catlin Engineers and Scientists
Bentonite
Concrete
37.5 lbs
16.67 lbs
5/24/23
NA
1416 Fayetteville Road, Rockingham, NC
Richmond 747310357941
34.945485 -79.754974
MW-3
18
8.25
3.22
NA
3
15
5/25/2023
NCDEQ - Starflite Food Store 272
7g. Provide a brief description of the abandonment procedure:
All well material abandoned in place with hydrated
bentonite pellets to within ~ 1 foot of surface andtopped with concrete to existing grade.
NA
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply)□Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop)□Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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:
8. Certification:
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 Injection 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 & Injection 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.
For Internal Use ONLY:
1.Well Contractor Information:
Corey D. Futral
4300-B
Catlin Engineers and Scientists
Bentonite
Concrete
16.67 lbs
16.67 lbs
5/24/23
NA
1416 Fayetteville Road, Rockingham, NC
Richmond 747310357941
34.945485 -79.754974
MW-4
18
8.25
3.10
NA
3
15
5/25/2023
NCDEQ - Starflite Food Store 272
7g. Provide a brief description of the abandonment procedure:
All well material abandoned in place with hydrated
bentonite pellets to within ~ 1 foot of surface andtopped with concrete to existing grade.
NA
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply)□Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop)□Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
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):(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:
8. Certification:
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 Injection 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 & Injection 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.
For Internal Use ONLY:
1. Well Contractor Information:
Corey D. Futral
4300-B
Catlin Engineers and Scientists
Bentonite
Concrete
100 lbs
16.67 lbs
5/24/23
NA
1416 Fayetteville Road, Rockingham, NC
Richmond 747310357941
34.945485 -79.754974
MW-5D
66
8.25
28.75
53
61
5
5/25/2023
NCDEQ - Starflite Food Store 272
7g. Provide a brief description of the abandonment procedure:
All well material abandoned in place with hydrated
bentonite pellets to within ~ 1 foot of surface andtopped with concrete to existing grade.
NA

NCDEQ; 29012_Starflite Food Store #272 CATLIN Engineers and Scientists
CATLIN Project No. 221072 June 2023

ATTACHMENT C SITE PHOTOGRAPHS

ATTACHMENT C SITE PHOTOGRAPHS – MAY 24, 2023
NCDEQ; 29012_Starflite Food Store #272 CATLIN Engineers and Scientists CATLIN Project No. 221072 June 2023

View of MW-1 with hydrated bentonite.

View of MW-1 after abandonment.
ATTACHMENT C SITE PHOTOGRAPHS – MAY 24, 2023
NCDEQ; 29012_Starflite Food Store #272 CATLIN Engineers and Scientists CATLIN Project No. 221072 June 2023

View of MW-2 with hydrated bentonite.

View of MW-2 after abandonment.
ATTACHMENT C SITE PHOTOGRAPHS – MAY 24, 2023
NCDEQ; 29012_Starflite Food Store #272 CATLIN Engineers and Scientists CATLIN Project No. 221072 June 2023

View of MW-3 with hydrated bentonite.

View of MW-3 after abandonment.
ATTACHMENT C SITE PHOTOGRAPHS – MAY 24, 2023
NCDEQ; 29012_Starflite Food Store #272 CATLIN Engineers and Scientists CATLIN Project No. 221072 June 2023

View of MW-4 with hydrated bentonite..

View of MW-4 after abandonment.
ATTACHMENT C SITE PHOTOGRAPHS – MAY 24, 2023
NCDEQ; 29012_Starflite Food Store #272 CATLIN Engineers and Scientists CATLIN Project No. 221072 June 2023

View of MW-5D with bentonite.

View of MW-5D after abandonment.