Guilford_Well Abandonment_20230724

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
J.MICHAEL VENABLE 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-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
NCWC-2079A
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 435 (gal.)
VENABLE BROTHERS WELL CONST., INC. FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: CALCIUM HYPOCHLORITE
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc)if known 14 OZ
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 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ®Residential Water Supply(shared) a Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑ Other(explain under 7g)
['Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation WELL MIX: 3 YARDS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer REMOVED PLUMBING; REMOVED 4 FT
0 Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
CASING; CHLORINATED; FILLED
5/25/23 WITH WELL MIX i.,,•� �..4
4.Date well(s)abandoned: s
5a.Well location: d �i ��
RS PARKER DEVELOPMENT JUL 2 n 2U6
Facility/Owner Name Facility IDtt(if applicable) 8.Certification:
4808 COEFIELD RD., GREENSBORO, NC )/ In4ara: ;.k3
Physical Address,City,and Zip Signet of Certified Well Contractor or Well Owner Date
GUILFORD 7861144040 By signing this form, I hereby certifi,that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15.4 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:
(if well field.one lat(long is sufficient) 9.Site diagram or additional well details:
35.987091 N -79.804547 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)([available.For multiple injection ornon-water supply wells
ONLY with the same constrrctiarabandon,nent you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 320 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 6 (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: 30 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 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
6f.Inner casing/tubing length(if known): (ft) 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 For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
J.MICHAEL VENABLE 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-30 is needed. Indicate TOTAL NUMBER of
wells abandoned: I
NCWC-2079A 1 ' -
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 50 (gal.)
VENABLE BROTHERS WELL CONST., INC. FOR WATER SUPPLY WELLS ONLY:
Company Name CALCIUM HYPOCHLORITE
2.Well Construction Permit#!:
23-05-WAH R-00119 7c.Type of disinfectant used:
List all applicable well construction permits ti.e.U/C,County,State,Variance,etc.)if known 2 OZ
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
OGeothermal(Heating/Cooling Supply) ®Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) I Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation WELL MIX: 2.5 YARDS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer CHLORINATED; FILLED WITH WELL MIX
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
TO SURFACE. �
4.Date well(s)abandoned: 5/25/23 1 \ t.r L I ' --r'
or
5a.Well location: JUL 9 A m2 i
RS PARKER DEVELOPMENTill
3
Facility/Owner Name Facility ID#(if applicable) 8.Certification: InforirraU£•1 Pr(:•;.c„y�,
4040 RANDLEMAN RD., GREENSBORO, NC �5/3 U
`gem l/ ,4� 5/30
Physical Address,City,and Zip Signe Certified Well Contractor or Well Owner Date
G U I L FORD ((((((//////
By signing this form, I hereby certf that the well(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:
(dwell field,one latllong is sufficient) 9.Site diagram or additional well details:
35.984056 N -79.802048 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)(available. For multiple injection or non-salter 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
Ga.Well ID#: abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 23 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6e.Borehole diameter: 20 (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: 20 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft) 1Oc.For Water Sunnly&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
6f.Inner casing/tubing length(if known): (ft) abandoned,
6g.Screen length(if known): (ft.)
Form OW-30 North Carolina Deparunent ofE•nviromnental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
J. MICHAEL VENABLE 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-30 is needed. Indicate TOTAL NUMBER of
wells abandoned: !
NCWC-2079A
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 120 (gaL)
VENABLE BROTHERS WELL CONST., INC. FOR WATER SUPPLY WELLS ONLY:
Company Name CALCIUM HYPOCHLORITE
7c.Type of disinfectant used:
2.Well Construction Permit#: 23-05-WAH R-00118
List all applicable well construction permits(i.e.IIIC,County,State,Variance,etc.)if known 4 OZ
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 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) (Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ® Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slu
rry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f,For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation WELL MIX: 1.5 YARDS
❑Aquifer Storage and Recovery ❑Salinity Barrier
eftcrulfer Test QStcrrrtwuter Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer REMOVED PLUMBING; CHLORINATED;
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
FILLED WITH WELL MIX.
4.Date well(s)abandoned: 5/25/23
5a.Well location:
RS PARKER DEVELOPMENT JUL 2 4 2u23
Facility/Owner Name Facility ID//(if applicable) 8.Certification: iflfOiAwa' ^�,
4040 RANDLEMAN RD., GREENSBORO, NC i � .a2tU
Physical Address,City,and Zip Sigma e of Certified Well Contractor or Well Owner Date
GUILFORD By signing this form, I hereby cert(y that the well(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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional welt details:
35.984044 N -79.802011 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)ifmmilable. For multiple injection or non-water.supplywells
ONLY with the same construction'abandonnent,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: WELL#2 DRILLED abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 105 (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: 6 (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: 25 (f.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Sunnly&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 easing/tubing length(if known): (ft,) abandoned.
6g.Screen length(if known): (ft.)
Fonn GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
J.MICHAEL VENABLE 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-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
N CW C-2079A
NC Well CoeetrnctorCerti6eation Number 7b.Approximate volume of water remaining in well(s): 75 (gal.)
VENABLE BROTHERS WELL CONST., INC. FOR WATER SUPPLY WELLS ONLY:
. Company Name CALCIUM HYPOCHLORITE
7c.Type of disinfectant used:
2.Well Construction Permit#: 22-12-WAH R-00061
List all applicable well construction permits(i.e. UIC.County,State,Variance,etc.)if known 3 OZ
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7c.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) PiResidential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial 0 Residential Water Supply(shared) I Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
:Aquifer Recharge ❑Groundwater Remediation WELL MIX: 1 YARD
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stotmwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑'Tracer REMOVED 2 FT CASING & LINER;
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
CHLORINATED; FILLED WELL & LINER
4.Date well(s)abandoned: 5/25/23 WITH WELL MIX. Rsii--C,EIVED
5a.Well location:
RS PARKER DEVELOPMENT c JUL r A- 20?-1
Facility/Owner Name FacilityID# a applicable) S.Certification: • -� ,.1
(ifPP ) ctl t f....5M1iF j�Unit
4816 COEDFIELD RD., GREENSBORO, NC )ft�Y ` % 0/23
Physical Address,City,and Zip Signature Certified Well Connector or Well Owner Date
GUILFORD 7861144040 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 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:
(dwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35.986101 N -79.804249 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#: abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 71 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in l0a
6e.Borehole diameter: 6 (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: 24 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if(mown): (ft,) 10c.For Water Supply&infection 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
6f.Inner casing/tubing length(if known): (ft.) abandoned.
6g.Screen length(if known): (ft.)
i
Form OW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22.2016

WELL ABANDONMENT RECORD FortMonsda ONLY:
i� 'This form can be used for singte or multiple,wells
1
I.Well Contractor Information: WELL ABANDONMENT DETALLS
I '
Stefan Smith 7a.Number Minas being abandntied:.1
Well Coutmnor Name(ormk...ttotiu:crpctsditatlp':almtutdningrroil.orrIiisthcrprepcity) Fir rcvdupk, Infection or non;litirer sup/A. ualls .ONLY with the uni
rm:rrtcttrxr+rnbonviorrnr,?G,true emir noi,nir cvicftrtn,
3576A •
NC Wen Conlragor Ccitifaarliou•Non bcr 7b.Apptnitlmnte volume of Water remaining in weli(s)'1 (kill.)
SAEDACCO inc FOR WATER.suPPLY WELLS ONLY:
Company Name. is Type of disinfectant vied:
2.Welt-Construction Permit Aft, ,
bit 411 strrltt'+rbte Well;t xi&(ie.Conaly,&We.YuPlom e.Lrjeitirur.;rtcl if btuti t 7d.Autolta E Uf,disinfcctanl used: •
3.Welt use(cliecl:well use):
•
Water Supply Well: • 7v;Sealing rnatctiials used(Cheek all that:tpplt):
I]ttgnn.nitutal p14iitnicipalrulitic CI.Nctt'Ccnrent:Crtrort 121 llcr4onite Chips or Pellets'.
I7(rrothcnntl(HeatinWCaoling Supply) i7Rcsidential Water Stipp!}'(shigle) ❑Satu1 Content Gout 0 Dry Clay
• ❑hutustrial/Comnterciai' ❑Residential Water Supply-(shared) El.Conctett:-Giant • Cl Drill Cuttin•is
❑irti:'ation -• o Specialty Grout .Cl Gkavel
Non Water.Supply Welt: El Bentonite Slung 0•other(explain under 7g)
Ill14lunitorine DRerevety
in jcetign Well: • 71.For each material selected•ah'wc,provide antooutnf tttaterials used:
❑Aquifer Rec[r arge l7Groundwatet Rentediatirii
❑Aquifer Siomgc aid Racuvet ❑Salinity Darner
❑AyuiferTest ❑StonnwatcrDrainage Bent:onite.:- -—- ,Wt______
DExpeineit haul Tttilrualogv DSubsldetrce Cbtatnil 7g..Pn)vide a brief description of the abandonment procedure:-
. . . - ElGeothennal(Crosed Loop) C0Tracer .
Removed well and backfilled boring w/ hydrated bentonite
-®Cmothennal(Heatin>z±Cootine Return) D0iherlat-plain under 7g).
-------------- ----- --
chips •
1,Date wdl(s)aharndoned: 6-9-2023. . • p '°9 Ei
D
Sit.'lFetl Iueat[on:
Morisette Paper JULc
2023
Faellitl•iOn•ner Mum rwility tog(it-aapplicable) S•.Qcrrillcattipiu:: <,
1nit3Fi749,:lL'ti 1'r..� 4 tin,,/
5922 Summit Ave. Browns Summit, NC 27214 YI ��`�:6t t�.a 6/28/2023
Physical Address.City,•aud'Zip 5.,..Stine Cetti icdWell CuntrtOuii ut'Well oicn:r WU:
Guilford • 13v signing.this firm,.1 lteouby-ci_•rtify•t ai the iidll{s) was(uere)ninirds,,jed at
l etinh• tuned Idatinfiivittnn No.iPtlt etrturtlrt)ti,•e with f d.T:'C-1C 02C..0100.or 2C_0200 Wilt Ciuiattur wc,Standards
and lhai a copy ales record has been provided/a the Well owner.
51►:i atitude and longitude in degrees/mluutes/seconds or decimal degrcei: -
Ors-yen nett,one latnnrtg'ic van-1 cia) - 9.Site diitgram or-additional well details: -
You.may.use the back•of this page to provide additional well.site derails-or well
- 36.174039. - R 79.717785 W abandonment details. You may also attach au[ditionalpa:s if nt•cessaty. -
Ct}NSTRIJCTIO}N DETAILS OF WELL(S)BEING ABANDONED •SUBbiTTTAi.iNSTRLJCTiONS
mode id/1 way/maim rltvrettst'!!t,iialfabk. biir irultiple irfrtrieirr at rbn•trater atrrplr
wesiv ONLi`',th a!e c c).,..a •:or„Nortanh,trnmryrt.lue con irdanit rute_Me . ion.-For All Wells: Submit this form'within 30•days of completion of well
Ga.Well ill#:T -1 abandonment to the following:
'Dfvision of Water Resouret,lnfonuatiou•Pnicessing Unit,
•
15 1617 Alail Sen•ice tenter,Raleigh,NC 27699-I617
61r.Total well depth: (ft.)
l0b.'ftarInieetlatt Wells: In addition to sending the foot to the address in 10a
fc.Boreholedi:luteteo:l (in•} 'above,also submit otte copy.of Ibis form within'30.daay's-of completion of well
abiwdonment to the.fallawing:
6d.\Vuter¢cvcl.hclon ground surface:" (ft.) Division.of Water Re uur�ces,.Undergrouad ltijcettuu Control Program. -
• 1636 Mail Sen-ice Center,Raleigh,NC 27699-1636
6t»Outer casing Icnrtla(if Imown): 5 (ft.) Inc For Water Srnnlr�.cr.itilettian WIN: In addition to sending the form.to
. the.'address(es) above. also-submit,one copy of this Ibtm within 30 days of
completion of well abandonment to the county hearth depatlntent of the county
6f.tuner casing/tuhtng length(it latuwn): (ft.)
where abandoned,
6g.Screen length(if Imoon):10 (ft.) 1
Form OW-Sit North Carolina Dep.:ttimni of Environment aril Natural Resouxcs-DFYision of Water ReSotn cs Revised August 21)l3.•