4116_Guilford_WIHighPoint_CDLF_Phase3_Wells_FID1320679_20190510

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
SMITH{ GARDNER
ENGINEERS
May 10, 2019
ABBRESS TEL WEB
14 N. Boylan Avenue, Raleigh NC 27603 919.828.0577 www.smithgardnerinc.com
Ms. Jaclynne Drummond
Hydrogeologist
North Carolina Department of Environmental Quality
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
RE: LFG Well Installation and Well Abandonment
WI Highpoint CRD Landfill (Permit No.41-16)
High Point, North Carolina
Dear Ms. Drummond:
The Phase 3 Permit to Construction Application for the WI High Point C&D landfill included a
Landfill Gas Monitoring Plan (LFGMP) that proposed the installation of five (5) landfill gas
monitoring wells to replace previously monitored bar -hole punch locations. S+G personnel
met with drillers from Geologic Explorations Inc.' on June 6, 2018 to install the new landfill
gas monitoring network. After well installation, LFG-2 was frequently observed to be
watered in due to its proximity to an on -site drainage feature. Consequently, an additional
well was installed by Piedmont Industrial Services, Inc. on April 23-24, 2019. During this
mobilization, Piedmont Industrial Services also abandoned three (3) piezometers located in
the Phase 3 footprint and attempted to install proposed groundwater monitoring well MW-9.
All site work was observed and documented by S+G. The following letter summarizes these
well installations and abandonments.
LFG Well Installation
Five (5) LFG wells (LFG-1, LFG-2, LFG-3, LFG-4, and LFG-5) were installed at depths ranging
from 15 to 20 feet below ground surface (bgs) in accordance to the approved monitoring
plane in June 2018. These wells are located as close as possible to the previously monitored
bar -hole punch locations.
One of the newly installed monitoring wells, LFG-2, has exhibited elevated LFG
concentrations in two consecutive monitoring events following installation, which is believed
to be the result of intermittent flooding due to its proximity to an existing drainage feature.
To address the intermittent flooding of LFG-2, an additional monitoring well (LFG-2A) closer
to the property line was installed on April 24, 2019. This well was installed to a depth of
approximately 15 feet below grade and was constructed with ten (10) feet of screened pipe
Geologic Exploration, Inc. 176 Commerce Blvd, Statesville, NC 28677
2 WI High Point Landfill Gas Monitoring Plan, Smith Gardner, Inc., November 2016 (part of the Phase 3 Permit to
Construct Application)

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
Ms. Drummond
May 10, 2019
Page 2of3
and five (5) feet of solid riser pipe. The well encountered bedrock and could not be installed
deeper.
LFG wells were installed in accordance with NCAC 2C regulations. All six (6) locations were
installed with a 4.25-inch HSA and finished with an outer steel casing set to approximately
three (3) feet above grade, a well cap with a quick connect fitting, and lock. LFG well
locations are shown on Figure 1. Construction records and boring logs are presented in
Attachment A.
Monitoring Well Installation
A monitoring well (MW-9) was planned due south of the future Phase 4 at 30 ft bgs; however,
bedrock was encountered at 15 ft bgs. While moving to an alternative location, S+G
personnel found multiple outcrops of exposed bedrock. As a result of the shallow bedrock
MW-9 could not be installed in close proximity to the original planned location.
Well Abandonment
S+G subcontracted Piedmont Industrial Services, Inc. to abandon three (3) previously drilled
wells GW-2, GW-3, and HA-1 in the footprint of Phase 3 as part of the permit to construct
application. Due to the well locations within the future cell footprint, proper abandonment
included over -drilling and grouting to ensure conduits were not available for potential
contaminant flow.
S+G and Piedmont Industrial Services, Inc. mobilized at the WI Highpoint C&D facility on
April, 23-24, 2019. Well abandonment procedures included removing the concrete pad, steel
casing and the PVC screen and pipe. The steel casings, PVC pipe, and screens were removed
with a special hydraulic tool attached to the drill rig that removed them from the ground.
Well pads were cracked and removed during the steel casing removal. Following PVC pipe
removal boreholes were over -drilled to well bottom elevations with hollow stem augers.
Grout was force injected through a tremie pipe starting at the well bottoms and pumped to
the approved subgrade elevation in one continuous operation. Each well was grouted to the
surface. Well pads, casing and pipe were disposed of properly.
Proposed Modifications to Monitoring Networks
As summarized above, a new landfill gas monitoring well, LFG-2A has been installed due to
periodic flooding of LFG-2. We request that LFG-2A replace LFG-2 in the monitoring
network. S+G further requests to abandon LFG-2.
Additionally, S+G was unable to install the proposed groundwater monitoring well MW-9. In
lieu of this monitoring well, S+G proposes to add a contingency surface water monitoring

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
Ms. Drummond
May 10, 2019
Page 3of3
location. As outlined in the existing Water Quality Monitoring Plan', a surface water location
is proposed at the outfall of the proposed Phase 3 underdrain. It is anticipated that this
underdrain will be constructed with Phase 3B and this location will become active at that
time. S+G proposes to add a surface water monitoring location at the confluence of the
drainage the underdrain will discharge to and the main stream channel to the south. This
will allow for surface water monitoring downgradient of the site. It will also provide a
consistent surface water monitoring location if the underdrain outfall is dry.
If these proposed changes are acceptable, S+G will revise the Landfill Gas Monitoring Plan
and the Water Quality Monitoring Plan for the facility reflecting these changes and submit
these plans to NCDEQ for review and approval.
Please contact us at [phone] or by e-mail below if you have any questions or require
any additional information.
Sincerely,
SMITH GARDNER, INC.
DocuSigned by:
E
G.2,�"5
3B8305C978EME6...
Seth C. Rickerts
Staff Geologist
sethfdsmithgardnerinc.com
BEAL
E
DocuSigned It � 1369 5/ 0/4)19
bcl.l�t, Q. $
B9779EBA711F48
Joan A. Smyth, P.G. •;4
Senior Hydrogeologist
ioanfdsmithgardnerinc.com
Attachments
Figure 1 - Approximate LFG Well Installation and Abandonment Locations
Attachment A - LFG Well Construction Records and Boring Logs and Well
Abandonment Records
CC: Seth Heath -Waste Industries High Point
W. Mike Brinchek, P.E. - Smith Gardner, Inc.
Dusty Reedy - Golder Associates, Inc.
File
H:\Projects\WI High Point Landfill (C&D)\WIHIGHPOINT 19-1 (Phase 3A Construction)UG Install & Abandonment Letter
3 WI High Point Water Quality Monitoring Plan, Smith Gardner, Inc., November 2016 (part of the Phase 3 Permit to
Construct Application)

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
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DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
Figures

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
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DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
LEGEND
EXISTING 10' CONTOUR
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(SEE REFERENCE 1)
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APPROXIMATE PROPERTY LINE �//
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FACILITY AND
PROPERTY
of
REFERENCES:
1. EXISTING TOPOGRAPHY FROM AERIAL SURVEY DATED JANUARY 6, aoo_l I II /
BOUNDAR
a
2018 BY GEODATA CORPORATION, ZEBULON, NC WITH FIELD SURVEYS
DATED JANUARY 18, 2019 BY SURVEYING SOLUTIONS, P.C.
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m
2. FACILITY PROPERTY LINE REFERENCE: SURVEY BY MARK TERRY AND/� //// /// /// j//� / / /
ASSOCIATES, INC., DATED MAY 15, 2001. / / // / /// // j / J
%809.7 %810.7 x
SITE EN TA
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3. MONITORING LOCATIONS AND SPRINGHEAD LOCATIONS FROM DRAWING j //// // / //� / / f
"ENVIRONMENTAL / /
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MONITORING PLAN", SHEET EP-5, DATED 12/19/06; / / /�
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STORAGE AREA
PIEZOMETER LOCATIONS FROM DRAWING "BORING, PIEZOMETER, AND / / / /// a
/ /� / / / �� \
MONITORING WELL LOCATION MAP", SHEET DH-1, DATED 4/13/07, / �/ J/�/ / // I% \�
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PREPARED BY GOLDER AND ASSOCIATES, GREENSBORO, NC. i/ 1 ( v J 1
ADDITIONAL POINTS FROM FIELD SURVEY DATED 3/18/16 BY
SURVEYING SOLUTIONS, YOUNGSVILLE, NC.
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DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
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DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
Attachment

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
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DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
SMER
Client: Waste Industries USA, Inc.
Project Number. Highpoint-18-2 Logged By: SCR
1+GARGN
BORING ID: LFG-1
Site Location: WI High Point C&D Landfill
Boring Location: North of Phase 2A
Sheet. 1 of 1
Drilling Method: Hollow Stem Auger
Monitoring Well Installed: YES
Sample Type(s):
Boring Diameter: 4.25"
Screened Interval: 10-20'
Weather: Clear, Hot
Ground Elevation: NA
Date Started. 06107118
Depth of Boring: 20'
Drilling Contractor. GeoExploration
TOC Elevation: NA
I Date Finished: 06107118
1 Water Level: NA
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MATERIALS: Color, size, range, MAIN COMPONENT, minor component(s), moisture
content, structure, angularity, maximum grain size, odor, and Geologic Unit (If
Known)
Monitoring Well
Construction Details
1
2
3
0-5'
no
0-5': Orange -brown, medium soft, sandy clay
4
5
6
7
5-10'
no
5-10': Tan to light gray, soft, sandy clay
8
9
10
11
12
13
10-15'
no
10-15': Dark brown, clayey sand
-
14
15
16
17
18
15-20'
no
15-20': Dark brown clayey sand
19
20
Date
Time
Depth to groundwater
while drilling
NOTES:
Checked by Date:

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
SMER
Client: Waste Industries USA, Inc.
Project Number. Highpoint-18-2 Logged By: SCR
1+GARGN
BORING ID: LFG-2
Site Location: WI High Point C&D Landfill
Boring Location: North of Phase 3
Sheet. 1 of 1
Drilling Method: Hollow Stem Auger
Monitoring Well Installed: YES
Sample Type(s):
Boring Diameter: 4.25"
Screened Interval: 5-15'
Weather: Clear, Hot
Ground Elevation: NA
Date Started. 06106118
Depth of Boring: 15,
Drilling Contractor. GeoExploration
TOC Elevation: NA
I Date Finished: 06106118
1 Water Level: NA
p
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MATERIALS: Color, size, range, MAIN COMPONENT, minor component(s), moisture
content, structure, angularity, maximum grain size, odor, and Geologic Unit (If
Known)
Monitoring Well
Construction Details
1
2
3
0-5'
no
0-5': Light brown, silty sand
4
5
6
7
5-10'
no
5-10': Dark qrav, soft clavev sand. Moist.
8
_
9
10
11
12
13
10-15'
no
10-15': Liqht brown/liqht grav, dry fine sand. Drv.
-
14
15
Date
Time
Depth to groundwater
while drilling
NOTES:
Checked by Date:

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
SMER
Client: Waste Industries USA, Inc.
Project Number. Highpoint-18-2 Logged By: SCR
1+GARGN
BORING ID: LFG-3
Site Location: WI High Point C&D Landfill
Boring Location: North of Phase 6
Sheet. 1 of 1
Drilling Method: Hollow Stem Auger
Monitoring Well Installed: YES
Sample Type(s):
Boring Diameter: 4.25"
Screened Interval: 5-15'
Weather: Clear, Hot
Ground Elevation: NA
Date Started. 06106118
Depth of Boring: 15,
Drilling Contractor. GeoExploration
TOC Elevation: NA
I Date Finished: 06106118
1 Water Level: NA
p
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MATERIALS: Color, size, range, MAIN COMPONENT, minor component(s), moisture
content, structure, angularity, maximum grain size, odor, and Geologic Unit (If
Known)
Monitoring Well
Construction Details
1
2
3
0-5'
no
0-5': Orange/ light brown silt with few lithic fragments
4
5
6
7
5-10'
no
5-10': Oranqe/ liqht brown sandy silt
8
_
9
10
11
12
13
10-15'
no
10-15': Liqht brown clavev sand
-
14
15
Date
Time
Depth to groundwater
while drilling
NOTES:
Checked bV Date:

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
SMER
Client: Waste Industries USA, Inc.
Project Number. Highpoint-18-2 Logged By: SCR
1+GARGN
BORING ID: LFG-4
Site Location: WI High Point C&D Landfill
Boring Location: Adjacent to MW-1
Sheet. 1 of 1
Drilling Method: Hollow Stem Auger
Monitoring Well Installed: YES
Sample Type(s):
Boring Diameter: 4.25"
Screened Interval: 5-15'
Weather: Clear, Hot
Ground Elevation: NA
Date Started. 06106118
Depth of Boring: 15,
Drilling Contractor. GeoExploration
TOC Elevation: NA
I Date Finished: 06106118
1 Water Level: NA
p
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N
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MATERIALS: Color, size, range, MAIN COMPONENT, minor component(s), moisture
content, structure, angularity, maximum grain size, odor, and Geologic Unit (If
Known)
Monitoring Well
Construction Details
1
2
3
0-5'
no
0-5': Light orange/ light brown silty sand
4
5
6
7
5-10'
no
5-10': Oranqe/ liqht brown sandy silt
8
_
9
10
11
12
13
10-15'
no
10-15': Oranqe/ light brown sandy silt
-
14
15
Date
Time
Depth to groundwater
while drilling
NOTES:
Checked bV Date:

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
Client: Waste Industries USA, Inc.
Project Number. Highpoint-18-2 Logged By: SCR
3MI1I1+GARGNER
BORING ID: LFG-5
Site Location: WI High Point C&D Landfill
Boring Location: Northeast of Phase 6
Sheet. 1 of 1
Drilling Method: Hollow Stem Auger
Monitoring Well Installed: YES
Sample Type(s):
Boring Diameter: 4.25"
Screened Interval: 10-20'
Weather: Clear, Hot
Ground Elevation: NA
Date Started. 06I06118
Depth of Boring: 20'
Drilling Contractor. GeoExploration
TOC Elevation: NA
I Date Finished: 06106118
1 Water Level: NA
p
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MATERIALS: Color, size, range, MAIN COMPONENT, minor component(s), moisture
content, structure, angularity, maximum grain size, odor, and Geologic Unit (If
Known)
Monitoring Well
Construction Details
1
2
3
0-5'
no
0-5': Light orange/ light brown silty sand
4
5
6
7
5-10'
no
5-10': Oranqe/ liqht brown sandy silt
8
9
10
11
12
13
10-15'
no
10-15': Oranqe/ light brown sandy silt
-
14
15
16
17
18
15-20'
no
15-20': Oranqe/ light brown sandy silt
19
20
Date
Time
Depth to groundwater
while drilling
NOTES:
Checked bV Date:

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
ER
Client: Waste Industries USA, Inc.
Project Number. Highpoint-19-1 Logged By: SCR
3M1+GARGN
BORING ID: LFG-2A
Site Location: WI High Point C&D Landfill
Boring Location: North of Phase 3
Sheet. 1 of 1
Drilling Method: Hollow Stem Auger
Monitoring Well Installed: YES
Sample Type(s):
Boring Diameter: 4.25"
Screened Interval: 5-15'
Weather: Clear, Hot
Ground Elevation: NA
Date Started. 04124119
Depth of Boring: 15,
Drilling Contractor. GeoExploration
TOC Elevation: NA
I Date Finished: 04124119
1 Water Level: NA
p
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N
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=
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MATERIALS: Color, size, range, MAIN COMPONENT, minor component(s), moisture
content, structure, angularity, maximum grain size, odor, and Geologic Unit (If
Known)
Monitoring Well
Construction Details
1
2
3
0-5'
no
0-5': Light brown, silty sand
4
5
6
7
5-10'
no
5-10': Dark qrav, soft clavev sand. Moist.
8
_
9
10
11
12
13
10-15'
no
10-15': Liqht brown/liqht grav, dry fine sand. Drv. Auqer Refusal at 15 feet.
-
14
15
Date
Time
Depth to groundwater
while drilling
NOTES:
Checked bV Date:

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
WELL CONSTRUCTION RECORD (GW-1)
Print Form
For Internal Use Only:
1. Well Contractor Information:
Ronald F. Barron
Well Contractor Name
2091-A
NC Well Contractor Certification Number
Piedmont Industrial Services
Company Name
N/A
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
(Heating/Cooling Supply)
p irrigation
Non -Water Supply Well:
Aquifer Recharge
Aquifer Storage and Recovery
Aquifer Test
Experimental Technology
Geothermal (Closed Loop)
Return
[]Municipal/Public
Residential Water Supply (single)
[]Residential Water Supply (shared)
[]Groundwater Remediation
[]Salinity Barrier
[]Stormwater Drainage
[]Subsidence Control
[]Tracer
under #21
4. Date Well(s) Completed: 4-24-1 9 Well ID# LFG-2
5a. Well Location:
Waste Industries C&D N/A
Facility/Owner Name Facility ID# (if applicable)
5830 Riverdale Road, Jamestown 27282
Physical Address, City, and Zip
Guilford N/A
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.952973 N 79.922443
6. Is(are) the well(s)oPermanent or []Temporary
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER if a licable
FROM
TO
DWMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
+3.5 fl-
3 ft.
2 in.
Sch 40
PVC
ft.
ft.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
3 ft.
13 ft.
2 in-
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
1 1
Portland
Poured
1 ft.
2 ft.
3/8 bent. chips
Poured
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2 ft.
13 ft.
#3 Filter Sand
Poured
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessa )
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, gr.,un size, etc.)
0 ft.
7 ft.
Brn Clayey organic Silt
7 ft-
13 ft
Brn Clayey sandy Silt
rt.
ft.
A.R. 13'
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
Landfill Gas MenReFiRg We".
22. Certification:
W��-f
Signature of Certified Well Contractor
7. Is this a repair loan existing well: []Yes or gNo
If this is a repair, fill out known well construction information and explain die nature of the
repair under 921 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: N/A
9. Total well depth below land surface: 13 (ft.)
For multiple wells list all depths itdifferent (example- 3@200' and 2@100')
10. Static water level below to of casing: NIA �
If water level is above casing, use
11. Borehole diameter: 10
12. Well construction method: Auger
(i.e. auger, rotary, cable, direct push, etc.)
4-30-19
Uate
By signing this form. I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division or Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water SupDiv & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Fonn GW-I North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
VT i2 LL i �17H1\I.JVl\lV1L' 1\ 1 n �,,�.VnlJ
1. Well Contractor Information:
Ronald F. Barron
Well Contractor Name (or well owner personally abandoning well on his/her property)
2091-A
NC Well Contractor Certification Number
Piedmont Industrial Services
Company Name
2. Well Construction Permit #: N/A
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) Ifknown
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)
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned: 4-23-19
rt.
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
ROther (explain Linder 7g)
Sa. Well location:
Waste Industries C&D N/A
Facility/Owner Name Facility ID# (if applicable)
5830 Riverdale Road, Jamestown N.C., 27282
Physical Address, City, and Zip
Guilford N/A
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.950360 N 79.921799 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attachwellconstrvcliarrecord(s)ifavailable. For multiple injection or non-waler supply wells
ONLY with the same conslruclion'bbandonment, you can submit one form.
6a. Well 1D#: HA-1
6b. Total well depth: 5 (ft.)
6c. Borehole diameter: unknown (in.)
6d. Water level below ground surface: N/A (ft.)
6e. Outer casing length (if known): N/A (ft.)
611 Inner casing/tubing length (if known): N/A (ft.)
6g. Screen length (if known): N/A (ft.)
For Internal Use ONLY: ?::" A
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
11 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:
5 Lbs 3/8 Bentonite chips
1 gallon water to Hydrate
7g. Provide a brief description of the abandonment procedure:
Removed 2" gas Monitoring well.
Proceeded to fill open hole with 3/8 Bentonite chips
and Hydrate with water.
8. Certification:
- 1/L-`' - 4-30-19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the ivell(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Constnlction Standards
and that a copy of this record has been provided to the ivell 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 Infection 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
1Oc. For Water Supply & Infection 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.
Form G W-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
VV L' LL 1i>'ul-�l\1JVl\1V1L' 1\ 1 1\L' l.Vi�1!
1. Well Contractor Information:
Ronald F. Barron
Well Contractor Name (or well owner personally abandoning well on his/her property)
2091-A
NC Well Contractor Certification Number
Piedmont Industrial Services
Company Name
2. Well Construction Permit #: N/A
List all applicable well constme ion permits (i.e. UIC, County, State, variance, etc) (known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Irrigate on
Non -Water Supply Well:
e Monitoring ❑ Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s)abandoned: 4-23-1 9
El Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
eOther (explain under 7g)
5a. Well location:
Waste Industries C&D N/A
Facility/Owner Name Facility ID# (if applicable)
5830 Riverdale Road, Jamestown N.C., 27282
Physical Address, City, and Zip
Guilford N/A
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latAong is sufficient)
35.949781 N 79.921839 W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well consiniction records) ifavailable. For multiple injection or non-watersupply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: GW-2
6b. Total well depth: 35 (ft.)
6c. Borehole diameter: 10 (in.)
6d. Water level below ground surface: N/A (ft.)
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): N/A (ft.)
6g. Screen length (if known): N/A (ft.)
For Internal Use ONLY:
Inn no
WELL ABANDONNIENT 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:
500 Lbs Portland
50GIns water
7g. Provide n brief description of the abandonment procedure:
Remove protective casing. Overream gas monitoring
well to remove well pipe, Bentonite, sand pack.
Grouted open hole to ground surface
8. Certification:
4-30-19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the ivell(s) was (1vere) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Constniction Standards
and that a copy of this record has been provided to the ivell 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 Infection Wells: In addition to sending the form to the address in l0a
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 Suoaly & 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.
Form GW-30 North Carolina Department of Enviromnental Quality - Division of Water Resources Revised 2-22-2016

DocuSign Envelope ID: CADBCE90-C8CE-4AF6-ACCB-DFC4A2A83337
♦ � a -/Li t aaJ<11 \LVl \l�liJl \ 1 1�1'JV V1W
1. Well Contractor Information:
Ronald F. Barron
Well Contractor Name (or well owner personally abandoning well on his/her property)
2091-A
NC Well Contractor Certification Number
Piedmont Industrial Services
Company Name
2. Well Construction Permit #: N/A
List all applicable well consdmction permits (i.e. UIC, County, State, Variance, etc) iflntown
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)
I Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned: 4-23-19
❑ Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
190ther (explain under 7g)
5a. Well location:
Waste Industries C&D N/A
Facility/Owner Name Facility ID# (if applicable)
5830 Riverdale Road, Jamestown N.C., 27282
Physical Address, City, and Zip
Guilford
County
N/A
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one laulong is sufficient)
35.950723 N 79.922067
W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well consintetion records) ifavailable. For multiple injection or non -water supply wells
ONLY with the same construction abandonment, you can submit one form.
6a. Well m#: GW-3
6b. Total well depth: 16 (ft.)
6c. Borehole diameter: 10 (in.)
6d. Water level below ground surface: N/A (ft.)
6e. Outer casing length (if known): N/A (ft.)
6f. Inner casing/tubing length (if known): N/A (ft.)
6g. Screen length (if known): N/A (ft.)
For Internal Use ONLY: 11 nn fD[D
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only I 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):
e 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:
250 Lbs Portland
25 Gallons water
7g. Provide a brief description of the abandonment procedure:
Remove protective casing. Overream Gas Monitoring
well to remove well pipe, Bentonite, sand pack.
Grouted open hole to ground surface.
8. Certification:
4-30-19
Signature of Certified Well Contractor or Well Owner Date
By signing this fornt, I hereby certify that the ivell(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Constniction 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 Infection 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 & Infection 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.
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016