GW1--05434_Well Construction - GW1_20230821

. ••=Bali l.A/1110 L AUte tel MN RECORD(GW 1) For Internal Use may:
L Well Contractor Information:
Ricky Corriher „ ::. —
Well Co rxame `'s � :'=i iK��::,_., ;- .. . --- . .: ----
2464-A ��i.�..� �� ��-��R DEN
NC WeuCaatraaarernNumber
AUG 2 1 2023 ft-- ft. ° �'�
Frank A. Corriher&Sons Well ( iliagTlilTer'C .Ut IBM `ro :— D» nilakre ijaERIAL
companyName
2.wen construction Permit# 30972 FROM io a - . _
rluaucppacabknrllconstrur�onpermits(ie.viC Cow;sore,Variance,etc) +1 � �8 ft- 6 1/8 ill SDR-21 PVms mama.
3.Wen Use(deck well use): . d ft. . 2- fi!. 9-'7, m. �/ e Qa(/
Water Supply Welt _.._- d
vim To DIAMETER stars g Tmt .- MATavtes ClABncalbaal • alfPublic . ft. ft. m '
❑Gt a1( Cooling Supply) Water Supply(single) ft ft is.
• • ❑ /Commercial ❑Residential Water Supply(wed) —-— -.. . . —
.
Olnigation ❑Wells>100,000GPD FROM TO DOLT refer tafri.AcnirgirrOUSTHOO&AMOUNT
Non-Water Sapply Wen: 0 ft. 22 ft- Bentonite Hole Plug
EMonitoring ❑Recovery ft it-
•
Injection Wen:
ft: ft.
0ATni:fm Recharge ❑Groundwater Remediation _
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM,.'T.TO.J _ mAT MA SDrrLACE mtrMS1HOD ..
❑Aquifer Test ❑Stormwater Drainage R. ft
1Tecbnology 0Subri3 Control. ft ft.
❑G a1(Closed Loop) ❑Tracer. :.._::.,.:. -=� ` .:;r =- =.•e - �. .__
❑Gro at(Beating/Cooling Return) ❑Other(explaim+n' er#21 Remarks) c •e■," "a' 'k >�.
fr: !. it. i `,fit,_
�y
4.Date Well(s)Completed: 5'/' 3Welllt# - te,o ft. ft. s ,/
tf5a_Well a
hq; G` a e/ 8110144/ ft. ft.a:pity/owner Name Feadv" _ - 15-'aft. A cll. /S Cu..e C�rry.t
you Yoriple.ii-gicie-v Sew ft. ft.
LA res.ass- ft(if app7--2:ye
pr- ifif . - . — red e 719'3 7 _._ ....,.....,..... . . . . .
Camay Parcel IdsmiSeationNo.(PIN)
Sit.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field,one htAoagis sufficient) 22. rr:
CZelA ���
6.Is(aria)the wells} rr anent or ❑Temporary S °f t Date
7.Is this a repair to anItt si gthisform.!hereby cer6ly that the well(s)was(mere)co rstucted ixaccordance with
e>�tingweal Ores or o ISANC4CO2C MOO orISA NOW 02C.0200 Weil Construction Standards and that a
capy
If rids is a repair.f Il+ out boom:well cans:ruction agcunrasion and ezplein the native ofthe ofdds record has bear peer rider m the Iva ownen
repair solder#21 remarks section or m the back of this form.
23.Site diagram or additional well details:
S.For Geoprube/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well spa info
doll only 1 GW-1 is needed Dedicate TOTAL NUMBER of wells (add' Over'in Remarks Box).You may also attach additioaalpag s ifly.
construction, �j 24.SUBMITTAL INSTRUCPIONS
9.Total well depth below land surface: IG
Far muldple'"dls)btall repro ifdiBeea(example 3®200'and 2Q105'0) ( ) Submit this GW-1 within 30 days of well completion per the following: .
10.Static water level below tap of casing: a (ft) - For All Wens: Original farm to Division of Water Resources (DWR),
If»level is abate casA&USE +^ Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter:6" (t -) 24b.For Injection Wens:Copy to DWR,Underground Injection Control(DUC),
Program,1636 MSC,Raleigh,NC 27699-1636
12.Well construction method:Air Drill
6`auger,ma
.��dent Pam,tat) 24c.For Water Supply and Open-Loop Geothermal Return Wells Copy to the
county enviimmientalhealth,department of the county where installed
FOR WATER SUPPLY WRlf.i 4 ONLY: 24d.For Water Wells prodncinu over 100,000 GPD:
. (gpm) Method of test Al r Permit Piogram,1611 MSC,Raleigh,NC 27699-1611 �Py Dom'CCPCUA
13b.Disinfection type:Steil lene Anoint ? Ca4,/S
I '
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resource;
Revised 6-6-7018