GW1--05431_Well Construction - GW1_20230821

. .... •.,a.A.Amo rout,limy l(EU)KD(GW-1) 1 For Internal Use Only:
L Well Contractor Information: '
Ricky Corriher -:.=-_-_---
WellCornoetarName •
© - -- - ----
2464-A g/►`- 4 ft. 111144rr AIIIIIIIIMMIll
liC Weil Contractor Certification Number _..,...--. - ..-..,---,.----• _
Frank A. Corriher&Sons Well Drilling, Inc. il-a�ii 7; =7+ -; z ii >
Con nyNatac ft. ft. is =
Lista gloied*Iotlt cottstrtectikonyermits(i.e.WC.County.Store,Yarience,era) +1 CC ft- • 1/8 m' SDR-21 PVC
3.Well use(towel ace): IMT ! gg i
Water SnpplyWell: ^ - . §),r.1::rY,aMg:,l.i*8r AlIII1I`r{; /� 4.an
°A�cultuml ❑ lic . ft ft. in. �!'—
OGeothermal(Heating/CoolingSupply) i Water Supply(single) ft. t. in. __—
• Dindl/Cammersial °Residual Water Supply(shared) —_-- - - . '
Oluigattnn DWells>100,000GPD 1:�.„•-,nr,%WWI p-..-.,,n,f.,',,.;rt...r.::rs, v;tn,,A
Non-Water fly well: 0 - 22 ft ,Bentonite Hole Plug _
DM nitoriug °Recovery ft. ft .
Injectinn Well: it ft.
❑AgniferRecharge OGroimdwaterRemcdiatian — — ----. _-----
°AquifaStorage and Recovery DSalinityBarrier FROM- - !;..,w .,,:.1 4 '
Aquila Test °Stammerer Drainage IL• ❑
lTechnology °c++i ►cu-p Control• ft ft
°Cs al(Closed Loop) OTracerFROM -- _, — -- —
DC l(Heating/Cooling Return) °Other(explain winder#21 Ream) � �
4.Date Well(s)Cam:-/2,493 Wen l _ MIAILIMIIIIRE111, as C.
5a.Well IMIIIMMINIIMMIXIN
,� c/CAi1c ft. EllirairdITHERNIII
ft-
1".,..3410..,...Name pi,(if leVely
t 6t5:c tiaer cAle 1 Yad ca(4,9, ft.
City,s Tap
Ra him r) !` 7 4ca V' _..-:..„.-:-_,..._ _-- -- - f?3__ ------------__
DWQ
Camay Pmulyd �No (PIN)
5b.Latitude and lade In or decimal degrees:
(dwell seta.caw his sufficient) ' 94 l/ 22- - LL p�
6.Is(are)the walks) t!l or °Temporary of weII C Dom
by signing thisfarm,Iherebv cc:*that the walks)>wi(mere)ownb with
mcaaabe accordancewi
7.Is this a repair to an e> gwelk °Yes or o 156 NCAC 02C.0100 or ISANC6C 02C.r7200 WdlCaraslntCfarr S�rdards artdthata mar
Vals is a repair;fill out bsowa well end e:plam the nature of the ethic rnwd has been Provided to the well awe
reps wtd¢r#t1 rota section or on the bath cartels fans 23-Me Magma er additional well details:
8 For be/DPT or You may use the beck of this page to provide additional well construction Mt C�opro Closed-Loop Geothermal Wells having the same
only 1 GW-1 is needed indicate TOTAL NUMBER of wells ( 'See Over iaR®ar3ss Ban).You may also attach adadamalpages if may.
//' 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: /�/(9� R .
Far and*Jeweils&stall depths ff as(®maple-3Q200'and 2®100� ( ) Sabot this OW-1 within 30 days(dwell co lea per thefeHowieg: .
10
OLa' - 24a. For Al Well= Original•form to Division of Water Resources (DWR),
ticwater]tool below top°f ( ) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
Ywrmale►el&above eas foe"+"
1L Bream diameter:6. CID-) 24b. In
For
Injection
MSC, els:Raleigh,Copy
yC o to DWR,
-1636 Camel(IUC).
Program,12.Well s method:Air Drill 24c,For Water Simply and Open-Loop Geothermal Return Welk Copy to the
(ie.sager,rotary,cable,daestpush,mac) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells prodaciw over 100,000 GPD:Copy to DWR,CCPCUA
I3a.Yield(gpm) 1' �of Air Permit Pmg'mm,1611 MSC,Raleigh,NC 27699-1611
1 ntypc Sterilene Amount 2 &y
Form GW-1 North Carolina Deparm ear of L,,.-
-'•Quality-Division of Water Resources Revised 6.6-2018