GW1--06306_Well Construction - GW1_20230926

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vT.W.i1J a.. mp 1ALM-I/UN KECORD(GW-1) For Internal Use Only:
L Well ce dor Information:
Ricky Corriher _ ,
Well Caaratarliaute
To
DMCIIIFTEON
2464-A • Il o ' g
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• Nt:weaaoametosoatiftmtioallt®ber v2 9� 32 _ I e 1-re e
Frank A. Corriher&Sons Well Drilling, Inc. F TO y -" ~ _
rl�e i. m.
2.Well ac ionPermitd:37900 > •.,,p= = � _iiiiiiiiiii _
List all appBeablewdl construction peradts az.WC Camay.saw Variance,etc.) +1 g• 7,YR 61/8 ' m' SDR-21 PVC
3.Wen fire(cheek well sse): I S� 7ft' C-fir / fi' g a,ii/ -
Water Supply Wee: Mom to sarsrm TRIMMER 1es++t..s,,
DAgricultaaal ho ft - ft. is
OGealbermal(Heatmg/Coal Supply) - Water Supply(single) it " ft. at. -
• nRP:a".C°t Water SnpplY(dialed)
(,DECIlgafion DWelts>100,000 GPD FROM TO MAIRMAL EIMMACIERRITINIMBOO aanoma•
Non-Water r Supply Weer 0 ft: 22 f Bentonite Hole Plug
t) l t IRe overy ft.
Injection W�
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o on
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"\�) DAB St and °s�kyBa TO m; .�;
°AquiferTest • O Drainage ft. tt
i.Techhnology °Su side nce Control. ft. ft
N OGeata1(Closed Loop) OTacer _._ r
OG �eotial(HoolingRedmm) 00&es(explain'Imder#21 Retaaatits) � fr. t;i 0� ' Pi cam rA:reckecte'sTala
V 4.Date Wens)Completed:e -11 23 Well LDII - 4,1 Oft 16 ft. . 5'Ch ,�h-Q-�
sec.W .Se 72 ft. c�
V� r..,aa., ../o .. me�M i Faceily1D#(if appieable a $ ft_
ft.
iiiTrIt
.My,sod ft ft `tom r.J l,.m I.��' s
44i4,/1 7/90/ Ar30tJt i I — .
t7omtty PlEtei IdemaificasionNo.(PIN)
Re.Latitude and Inor decimal degrees. illi*JstT {en�7 . .:�J.t•� �1!'
{Nee field,coo ltt/loegis sufficient) 22. in: ,,,g...dei)G:'v 4 r2io
350-c'33 " II800—y0?"•— 9(' , w 5--117,-
,23
6 ls(a:e)fire wejl(s)c or OT Sigmmoe ofCe:te d Well Date
is BY• g larm Therebya�itvfUer&noeU(s}Km(were)aa¢�aciedina cadancewith
ZIslb'tt:arepairtoa8axial*we� l]Yes or 1SANC4CO2C MOO a►Ill NCdCO2C MOO WaCoamr+rson Samar*and sktaagv
ri isisasepatr,filloaabnwt>.rllosearrrxtianaava.aaonmidesplerinthena4orofthe oilereeos.dkarbeetpmwdedtrthewellmseer
mob.m,der#2l:marks scams ormthe back ofdrisfanrt 23.WS Magee=or adeldional well detail=
S.Foa_Geo e/DPT er Cooed-Loop Geothertmrai Wells having the same Yon»use the back of this page to provideadditional we lc n
only 1 GW-1 is needed }adir�e TOTAL NUMBER of wells (add See Ovd iaRt s Box).YOU may also attach add>simmlpages iflteoessaiy.
do7kd: '`1 / 24.SUB
D4 ITAL INSTRUCTIONS
9.Totiitr+e8 depth bJewland sm V 9/ _ •
Far.owe,wdirretandrpthsrW ra(e fe-•iWWOOO'and2ezoo) (�) Submttleisew_1w;thm3oaaysofwenwa aapertiervnvwiag: .
le.StadewaterlePelbeen,topofcasmg: Vg ( ) 24a. For All Wells Original,farm to Dsvisioei of Water Resources (DWR),
router teed isabo a am"+" 1617 MSC,Rateagh,NC 27699-1617
11.Borehole diesels.6" Cm,) 24b.For Injection Wept Copy to DWR,Undemoth Injectkm Cowl(IUC).
Air Drill 1636 MSC,Raleigh,NC27699-1636
12.Well a method: 11
Air For Water Supply and Open-Loop Geothermal Return Welk Copy to the
(i�auger,rotary,cable,Tweet mob,est) testy eovuonmenMI.health department elite county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells prods 1 'over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gin) / /oZ. Method of lest:AirZ/ Permit Program,1611 MSC,Raleigh,NC 27699-1611
13b. typftSterilene Azi I dap. .
Fan MM. North Ra< liaa Depaaami of Eavao®mml Quality,-Division of WaterRwaces • Revised 6.6-2018