GW1--06495_Well Construction - GW1_20241104

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WELL CONSTRUCTION RECORD (GW-1) For internal Use Only:
I.well Contractor Information: 1
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Ricky Corriher i 14.WATER ZONES r.
'.t.el Contractor Name
ram' 1 'tfi I DESCRIPTION
2464-A • itTrI ! Mrr?t- 3 0 `Gal
rt. I It. i I
\C Weil Contractor(-evil-miner Number I I' 1 . .
I IS.OUTER CASING(for multi-cased tells)OR LINER(if applicable)
Frank A. Corriher& Sons Well Drilling, Inc. L FROM ! TO I DIAMETER ' •I THICKNESS I MATERIAL
1 rt. I ft. I ii, .I I
i hrinam~antra
7 ainp 16.INNER CASING OR TUBING(geothermal.closed-loop)
--Well Construction Permit=: / FROM I TO I DIAMETER ' I THICKNESS ! MA I'P.RIAt-
;,.r.ill ap;;iirai'!, deli commit-hem perm;.(Lc i 7C.t'runn.SUM:. 1.W-it:Ik e.rats i L' fL i 9 y ft.'
5 1,8 1!in' SOR-2II =.,c •
3.Well Use(check well use): •T(7 y ft. I 9‘ ft. I 6,1rrn- La r- I s a/J
water Supply Well:. 17.SCREEN
PRO+. I To
DtaStl ft:R I st.orsi/)' I tHtCK\Esc I ttottiltRt.
.\gricultura! OM tcipal•Public t ft. I ft. I in. I '
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Geothermal tHea:mc Cooling uppi)I Residential Water Supply(single) ft• I ft. I in. I' I !
Industrial Commercial Residential Water Supply(shared. I' 1
I S-GROUT.
irrigation ! FRoyl I to I 'tATE:RtAt i E�iPL•)CE\tENTMETHOD f AMOUNT
Non-Water Supply Well: ft. I ft. I
Pfeniterittg ®Recover?' ft. fc.
t
Injection\\"ell: i —
ft. ft. I
Aquifer Recharec ©Gruundytatcr Rcntrdiatiun
II
19,SAND!GRAFEL PACK(if applicable)
tj-aqulfer Storage and Recovery DSalinity Barrier I FROM I TO I MIATE.RIAL. i EMPLACEMENT SIETHOD -
0,\quifer Tcst ft. ft. '
DSton;nwatcr Drainage I1 I I
DEsperimental Tcehnoloey OSubsidence Control I rat. ft. i
II1 Geothermal(Cioscd l_oot)1 OTracer 20.DRILLING.LOG(attach additional'sheets if necessary) '
FROSt I TO I DESCRIPTION((coin,hardness-soihroek bps._rain size.etc.)
aGeothernal(Heating•C•ooling Return) 0Other(explain under=2I Remarks) I v rt. ft. /✓�..ed p
4.Date Well(s)Completed: I Q'/g.Pitl ell ID= ._,— fr. I?d ft. s a�/�/ -P i
5a.\'•'ell Location: �'7� ft. 9ft. I � Qdd�
YOS/1 L' ii et- Rem a cii e/sy , I F.7G ft. I J/ `�ft. ! h.lam 6.-. -yt.d
I-acihn U nc;'art" i'aeilit.1D fapnlicabiei2m47 ft. I cr ft. i ,-•' ; , ..i R'
Y �.rS.+-' i
i 6o Co 9U 9ct/e pc ;/Sijtf/ •rt. ; ft. I •�, �;
P cal Audres;.lit}.anJ Zip'. // Q rt. I ft..1
/?a, Q ^ /�J/O/ , 21.REMARKS ,ry�
gun:_ ,/ Parcel Identilica Loan Oe.tF!\•I ! !i r• D .. •I�~
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5b.Latitude and longitude in degrees%minuteslseconds or decimal degrees:
,d-well field.one In long is sufficient) 22.Corti •anon'
35, C 6/ e/e.9 N, 86a 6 /1 Q O Q .
b.Is(are)the well(s) erma lent or EiTemporary
Signature ofl::nt led Bell Contractor Date
.i: .rar.;ne•r.r..tn!n;.d he'i'•. ,rnUr tnar•r%tc' r;lo. •s st. rr rrrr..rr:nvr::m det•rrdanrr
7.
Is this a repair to anesisting.scll: Oyes or No id,;!.4::C';iCi,'i•:rJiiln,r,•t;41C:ICI)_i".r':00itr,•'i CON ttrir lion.5:anva,! and that a
'r lint i.,a repair.fill girt.Cpn,,n I.eii rnrytrn(iun;!n(t;r,ruiin,,r:and litplarn Inc 4,1114n,:!1 hit' •'/nc rrjriva rrrnnti 4°81•. it pruruira I''rnir ire11 nh nr=-
rcpai,under e_1 remarkr.t,rc':IO,or.n•ire hark of tire:torn:.
23.Site diagram or additional.veil details:
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells ha.ine the same You may use the hack of this page to pro ide additional well site details or well
construction details. You ntay alsor
attach additional pages if necessary.
construction-only 1 GW-I is needed. Indicate TOTAL NUMBER of\tells
grilled: _ _ _ I
'SUB}IITTAL INSTRUCTIONS ,
1, i'
9.'l oral well depth below land surface: ! 6� (ft-) 24a. For All \\ells: Submit this lidnt within 311 days of completion of well. '
= rr :'
r•r• uiripir ells tilt all arpliis rf etrfi-rrnt Irwanipir-;C.z.200';;r;,;2 a;r:r•,r -
eon .ruction to the rollutying:
10.Static water level below top of casing: Q •(ft.) Division of Water Resources':information Processing Unit,
.t aatcr loci is aln•.r rasuig.tesr"-'� • 1617 Mail Service Center,Raleigh.NC 27699-1617
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ll.Borehole diameter: (in.) 2 th. for Injection \\ells: In adtitti n'le sendtn_m tile ibtn to the address in 2-La
Air Drill above. also submit one copy of this toter within 30 days of completion of well
12.well construction method: construction to the fol lowing: I
,i a auger.rtnars.:ahle.direct,push.etc.)
Dis ision of\\ate Resources.Uti'dc•rground injection Control Program.
FOR\\ATER SUPPLY \\ELLS ONLY: l b3t Mail Service Center.Raleigh.NC 27699-1636
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13a.Yield(gpnq c3 o Method of test: Air 24c. For Water Supply & Injectign I Wells In addition to sending the torn to
n the address(est above- also submit lone copy of this form within 30 days of
Sterilene J l� 1
13h.Disinfection npe: Amount:
/ annnictiur tit yt•clI construction to'!Ire count' health department of the county
where constructed.
L;0-1 \nrh Carolina Department ni Ent lrunrtetnel Qualits-Or.l..nm 01'.4 Ater Res,rurer, Re.rsed-22--glib