GW1--05156_Well Construction - GW1_20240830

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: Mr
1.Well Contractor I
Ricky Coniher -gam - O.. ..
- T . , -
f orsC�- nofot+ , •
Well Coutocsir lime (, ',R- )2 it •J, l (^c 1
2464-A fr. ft.
NC Well Contractor c, atwoNumber — — -- ---- -------------.------- ------•--
THICKNESS
Frank A.Corriher&Sons Well Drilling,
TO tRng, Inc. >t. >t.
2.Wen Construction Permit#: 1C) 13 ; O O �) � C,Ela' ,>
lean well construction permits(Le UfC Crawly.State.Vane Ace.etc.)
/' ft. -7 ft, 5..2 bL f 5 u' • !G
3.WenUae(cheep welle) -- - - -
Water Supply W* To BIAPEET U 88STI Tattaaftia Mn1saw.
D �hc ft. ft. ni
t Cool*Supply) Water Supply(single) tr. n. is.
DR�de al Water Supply(shared) --- - - .. : - _ :_
PROM TO MATIMAL EMPLACEMENT METHOD&AMOUNT
ft. R
Naa-Wtrlar Supply Wed:
injection Wen: ft. ft.
DGmrmdwater Remedsatian -- -< -- — —� -
- -----
8 -..,.,- Storage and Recovery OSalimty Barrie PROM io - MAi1ar1AL - - -.. voit.s-cseinsti.issixaon
ft. ft
■ • .:..:. Test QStnaau.+atz.Drainage _ --
I T
Subsidence Control ft. ft.
II -..,-...-. ((used Loop) DTraca -eitotw TO : .,;.:. _-,.ar„ek __
_.a* ....l(HeatinalC ooliorTLehs nOther( under#2T Remarks /} ft. - L��ft. l�) _ i)''
4.Dose Writs)CaamletJ g 7 P Swell MS 9 ' tt. - O " S Ir 74
s.,walwar o d a ft- So- �/
j1°,9w at. a
i
3‹" /9jiri• !ail flc 1130214.0k a. s.a.
l.'k�siesi Adiass,�.atlZlp I ffi ---- ----- - -.----
�36' 03C
C r�I taeatiar rro
5s.Latta Latta&and rsape ae in degreeshonnutesisecends or decimal degrees:
(Word fski arc tit/Ions is taEfiei e) 22. _ -
35.5 111 / I 1 N 80 , -7 13 7 C w0C7---� ,.?-
S>a
6.Is(are)the weill(s or DT r9 e°f pg well Coseracsor Dare
ay signing this fora.,/ierehv colt:that the wells)was(were)co.r.asesed o.accordance
7.Is this a repair tn an existing wen: °Yes or it t with 1SA NC,4C arc
.0100 or
p 15 NCAC
th 22C C.0200 l owes.Well Comvaarm Ssmsdarls and that a
reins is rd�.air.fill art Inman well construction i.01'n aatian and explain the neon ay-the Cc t of
ac record ben beenrepair under 421 resvr,t section or an the back of tlas.fanu- 23-Site diagram or additional well detals:
Gail Wells having the same You may use the back of Mr;page to provide additional well site d tails or well
ft For Geepro only
1 Tor Closed-I.oap congruence details- You mat also attach additionalif
construama,only 1 GW-1 is needed- Indicate TOTAL NUMBER of wells pagesD0
drilled_ SUBMITTAL INSTRUCTIONS
9.Total wen depth below land surface: ( (ft-) 24a. For An Wens: Submit this form within 30 days of completion of well
For aadripk wells fiat all domes V (eranrple-3@200'and 241)1001 coastroetion to the following:
1S.Static water level blow top of wing: - �6' . (ft-) Division of Water Resources,Inisrniatlea Processing Unit,
Yuma-heal is abase coaing me"+^ 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole dam: 1^ (t .) 24b.For Waxiest wag 1n addition to sending the form to the address in 24a
Air Drill above,also submit one copy of this form within 30 days of completion of well
12.Won ea strsetioa mrdhed: construction to the following-.
(i may,cable,&tact posh.o)
Division of Water Resesrea,Underground Injection Co.trei Program,
FOE WATER SUPPLY WELLS ONLY: 163E Mail Service vice Center,Ralergh,NC 27699 16i6
13t tinsel(gp.) 3 0 Method of testAir
24c.For Water Simply Jr Iniatbn Weis: to addition to��the form to
A�wa� � the add<as(ea) above, oho submit one copy of this fa® within 30 days of
13b t Shiriene oontpletioa of well construction to the city health department of the county
where consitucied
Form GNP-I North Carolina Department of Environmental Quattty-Division of Water Resources Revised 2-22-2016