Guilford_Well Abandonment_20220801

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned: pi `
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.1/1C,Coun(y,,State, variance,etc.)ii known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑lrri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry a Other(explain under 7g)
eMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 'Bentonite Pellets -39 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
Cement -5 Ibs
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Abandoned well in place with hydrated Bentonite
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 7/26/22 with cement to existing grade. R EC E I VI
ERID
5a.Well location:
NCDEO-Elliott's Wholesale Floral Supply,Inc. 00-0-0000032350
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
134 ManlyAve Greensboro 27404 � irlofgwabio�l Pra�o ur»
C� � RSf�ti�2
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Guilford NA
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C!0100 or 2C.0200 I'Vell Construction Standards
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field,one Iat/long is sufficient) 9.Site diagram or additional well details:
36.066424 N -79.868595 W 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.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifinwilable. For multiple injection or non-xrrtersupplywells
ONLY with the.same construction'abandonment,you can submit one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-1 abandonment to the following:
Division of Water Resources;Information Processing Unit,
6b.Total well depth: 25 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: NM (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
fie.Outer casing length(if known):
NA (ft.) 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
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned.
f
6g.Screen length(if known): 20
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY: i
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-36 is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,Counrv,State, Variance,etc)ifknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ® Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑'Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry N Other(explain under 7g)
CMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Bentonite Pellets —39 lbS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage TOPSOII —5 IbS
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Abandoned well in place with hydrated bentonite
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 7/26/22 with topsoil to existin rade.
P 99 P=�t^rm/r®
5a.Well location:
NCDEQ-Elliott's Wholesale Floral Supply,Inc. 00-0-0000032350 AIM _ 2
Facility/Owner Name Facility ID#(if applicable) 8.Certification: -:5135,19
134 Manly Ave, Greensboro 27404 ln€cr�$� �UI1l1
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Datte4�
Guilford NA
By signing this form, /hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0/00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I,
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.066424 N -79.868595 W 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.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifmailable.For niuluple injection or non-water supptrwells
ONLY with the same construction'abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 25 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: NM (ft) Division of Water Resources',Underground Injection Control Program,
1636 Mail Servicet Center,Raleigh,NC 27699-1636
1
6e.Outer casing length(if known): NA (ft) 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
6f.Inner casing/tubing length(if known): 10 (ft) abandoned.
6g.Screen length(if known): 15
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resourl es Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILIS
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-3b is needed. Indicate TOTAL NUMBER of
4330-B wells abandoned: I
NC Well Contractor Certification Number 7b.Approximate volume of water ri maining in well(s): (gal.)
I '
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.111C,County,State,Variance,etc)ifknown
7d.Amount of disinfectant used: ,
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout N Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry R Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite Pellets -39 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
Cement --5 Ibs
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Abandoned well in place with hydrated Bentonite
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 7/26/22 with cement to existing grade. RECEIVED
5a.Well location:
NCDEQ-Elliott's Wholesale Floral Supply,Inc. 00-0-0000032350 ]
Facility/Owner Name Facility ID#(if applicable) 8.Certification: e� L
134 Manly Ave, Greensboro 27404 l D71 r Unil
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Guilford NA
By signing this form. /hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.O100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.066424 N -79.868595 W 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.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach vvell construction record(s)ifavailable.For multiple injection or non-water supplywelty
ONLY with the.came convtntciionlahandonmeni,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-3R abandonment to the following:
Division of Water Resources;Information Processing Unit,
6b.Total well depth: 25 (ftJ 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:
8.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
NM Division of Water Resources Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail ServiceICenter,Raleigh,NC 27699-1636
i
6e.Outer casing length(if known): NA (ft) 10c.For Water Supply&Injection Wells: In addition to sending the fonn 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
10
6f.Inner casing/tubing length(if known): (ft.)
abandoned.
f
t
6g.Screen length(if known): 15 (ftJ I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
i
1.Well Contractor Information: WELL ABANDONMENT DETAILf S
Corey D. Futral 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the saute
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-36 is needed. Indicate TOTAL NUMBER of
wells abandoned: I
4330-B
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
I
CATLIN Engineers and Scientists FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit tl: NA {
List all applicable well construction permits(i.e.UIC,Coun y,State, Variance,etc)tfknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Scaling materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry a Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite Pellets —39 Ibs
❑Aquifer Storage and Recovery ❑Salinity Barrier
Cement —5 Ibs
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Abandoned well in place with hydrated bentonite
pellets to within 6 inches of surface and topped
4.Date well(s)abandoned: 7�26�22 with cement to existing grade. RE=CE1VE1)
5a.Well location:
NCDEO-Elliott's Wholesale Floral Supply,Inc. 00-0-0000032350 }
Facility/Owner Name Facility ID#(if applicable) 8.Certification: ^ 4� pftJ..n Ur-K
Iv Itlk3f��e'I
134 Manly Ave, Greensboro 27404 �2
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Guilford NA
By signing this form, I hereby certify that the ivell(s) was (were)abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I;
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.066424 N -79.868595 W 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.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
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.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-5 abandonment to the following:
Division of Water Resources;Information Processing Unit,
6b.Total well depth: 25 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 8.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
f
bd.Water level below ground surface: NM (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known):
NA ft.) 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
6f.Inner casing/tubing length(if known): 10 (ft) abandoned.
f
6g.Screen length(if known): 15
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

1 � �
I. m
-�� M W-5
h
MW-3R
e
�t ® MW-2
f �
ti
LEGEND
t
® Abandoned Monitoring
Well (Type II)
0 Approximate Location
of Former USTs
0 Parcel Boundary It-
jw Source:Esn,Maxar, Earthstar Geographics,and the GIS User Comm urtit
NOTE:Well and tank locations were obtained from previous
reports prepared by other consultants and are approximate. 30 15 0 30 60
Feet
MMCT LLIOTT'S WHOLESALE r E FIGURE
CA E
TLIN FLORAL 134MAN EYAVEC SITE MAP
GREENSBORO, NC 1
Engineers and Scientists
x>a No an sru[ auwn s+�am BY
8153 221337 JULY 2022 AS SHOWN IONC/SJO