GW1--06062_Well Construction - GW1_20230921

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.. ..•a..1..s1'.7 aitul.11VPl 1a Ct)KD(G 1) 1 For Internal Use may:
L WeR Contractor Information
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Ricky Corriher -=- - _ - 0..__________:_______.- -
WenCo riim� • is nM ._ 1i --
ft.- ft.
NC well Contactor Ceri aNumber
Frank A. Corriher&Sons Well Drilling, Inc. -' '3 ;.,,,Z 1.- �- «aii T. --
CompanyNanre
2.Well Qu r Permit*P0213-�t7( 7 1 / ,-. ,::a �;:; . �- - -
rsstall app$�Jemlt mn ostr o rpmtrits(Le-cat~Comity;State,Yearn' cc,era) +1 f. 6 r f. • 1/8' . ' SDR-21 PVC
3.Well Use(checkwe l use): b�/� 7z2 .ft- 6 gym- a t
Water Supply Well:
111=±11111-1111h..!w Li it .,iN.=al*t::,. ,:,: _
ClAgricaltruallie - ft ft. in., -
DGeothemal(Heating/Cooling Supply) " Water Supply(single) ft. ft is _--
• • ❑IndasmaUCommereial OResiden:iai.Water Supply(shy) - — -77:
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ahrigation Dwells>100,000GPD l:rN.:.:,„oillill!-..`,.,". Si-:.rs-:-7.::rij.d}p.gi it
Non-Water Supply Wes: 0 22 $ Bentonite Hole Plug
DMo ng DRecovety ft ft
Tniectoon Well: •
ft. -
-- DAq�sRe Dcurn r mdwanaRtion
DAquiferStorageandRecovery °SalmdyBarrier 0— �.-,,w=.1 ;,{..: ;,a
DAquilaTest Dst.waterDrainage ft.
• 1Tedmology OSnbrisl nceControl. ft. ft. I
C fl be mnal(Closed Loop) ❑Tian
(H /Coofmg Return) DOthez(explaia'tnrder#21 Rema�s) . _---7— m r"`Y • axe.'
4.Date wells)Cates: Well l-ay3 wen mrx ft. 0 ft. iM
Se.Wen Lentinn ME `7D i
t 1111110
Ala' 13askve!l W . w
EMNIEVIREMEME
r..as io g n Facility mx(ifapwlieable) s
iic F73rLa n' Gk7 Qct Aloartcvl/i ft.
> cit,and Zip ft. ft .
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County Paul Id oa No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decmral degrees: I, . .
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(tfvelt geld,ame hr/lomgis s> ) Gi 22. n;
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6.Is(are)the wei(s)s or DTemporary S' o Cecq d W�/l/C�coor/ 1}�
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by signing thisim,t hereby cm*that Ilse wall(s)wm( )cnasttartedinaccordancewith
7.Is this a repair to an existing well: DYes or Ott 156 NCAC 02C.OIOO or ISANCIC 12C.OIOO Well Caeosutson&o dor*and that a copy '
Ifs is ataxia;fill otdbtoun Kell oomtraIImn htfo mauawi and eplab,the one a of the off 71 xond1=v been grwided m ll tweet
repair rorder011 remarks matron was theback of this from.
23-Site Wagram or additional well detail= _
i.For C rebe/DPTor Closed-Loop oop Geothermal Wells having the same You may use the back of this page to provide additional well�tttxioainfo
only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add See Over'mRemarks Box).Yon may also adaipes ifneoessa;y"
drilleck
d urf 2 .SUBMITTAL INSTRUCTIONS
9.Total well depth below lansur ace: ` C�
For male'ple> Tat ail depth'a ss(example-3@200'mtd 2 a l00') (�) Submit this G9V-1 within 30 days of well completion per the following:
16.Static water level below top of casing: Oil c'7 . m.24a. For AR Wells: Original far to Division of Water Resources (DWR),
VI')
Ifwaaa 1e►el&the e o me-+� hm Unit,1617 MSC,Raleigh,NC 27699-1617
1L Borehole diameber;6" Cm-) 24b.For Infection Wells:Copy to DWI!,Underground Injection Control(1UC).
Air Drill Proms 1��'�gh,NC27699-1636
12.Well construction.
mr ..4- i
(u ace tp�elm) 7Ac.For tauter Sapp and Open-Loop Geothermal R nrn Wells:Copy to the
county environmental health depart of the county where installed
FOR WATER SUPPLY WELLS//�� ONLY: 24d.For Water Wells producing over 100,000 GPIk Copy to DWR,CCPCUA
Ma.Yield(gm) -5 V Method of test Air Permit Program,1611 MSC,Raleigh,NC 27699-1611
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13b.Dimon type:Sterilene A,,,,i,,,,,. e).., C a e 3
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Form OW-1 North Carolina Department ofEnvitomincoal Quality-Divsioa of%ater Resources .
Revises 6-6 zols
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