GW1--06501_Well Construction - GW1_20231013

- __.--........ ,.....',LI r or!MeMal Use Only: r-------------
1,1.Well Contractor Information: ', •
Ricky Corriher '
• PROM • TO
••
Well Connaetor Name
cPa ft". 60 ft' IIPSETMMMII.
2464-A \ . ,
ft. ft.
NC Weft Conbactor Certification Number '
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Frank A. Corriher& Sons Well Drilling, Inc. sarTimm To por :*-77--,-. -,..7....7:74."- --, --
Company Name_.,.
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5- 2.Wen constructnn Permit#: -..-1 79(3 7 Y FROM TO I)"
s Lin al I°milt:126k well construction permits(i.e.Vic.County,State,Variance,etc.) +1 ft' (.57'..-ft• 6 1/8 '• in. SDR-21 PVC
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_570'. 4,0 ft 'grin- xs-i- MM.
3.Well Use(check well use): 6-5.
•. Water Supply Well. .
FROM TO lim:',14,-.1115.1rers.irallici(97: 1111.mp- Tjzsam,-----
°Agriculluml DM.- ;.al/Public . • ft. ' ft. ,in.
°Geothermal(I:Wing/Cooling Supply) kt.",--•:,,:• Water Supply(single) - ft. ft. M. •• • Olndastrial/Commercial _., OResidential Water Supply(shared) -,-(r.,.. ..,--,- . - - , - , •-. ' ..: . . •... •ClItrigation ' -'°Wells>100,000 GPD 111/ 11101.1110. -Woo g,.+4,‘,OINND:':',.4°A-..'..,1;Cr Non-Water Supply Well: ' . 0 ft. 22 it Bentonite Hole Plug
°Monitoring , -- •-,•--..,-,-- '''.1;glidO*Y ,. ft. ft. - : /- .
. Injection Well: R. 5:;{1 ,,ti..,..i' t.e S..,:-."-•` \
ft • 'ft. ' 1
_
I:Aquifer Recharge
n r T i `,- Z DA.
. .wxlwatex Remediation
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• • ..1 Barrier . FR-6,/ cinaiiii 3-. ---- -1:•;Tv-iiiVa.7.t;.ii;.6 Dv :(0)am. .
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,,.-• °Aquifer Test • !..,71 p!-.7,,,,....fiStastinWer Drainage ft. ft.
_°Experimental TechiglOgY.''..'"'&.5-A7:180;elSobsidieor.e Control. ft. ft. , .-•
OGeothennal(Closed Loop) °Tracer , • ---:,.. . --• -: , .;-:1,;:--',,', ::::-4.-a;r-;=•-,,,-_,..:-..-1-77-
S\ , oGeothexmal(Heading/Cooling Realm) 00ther(exPlailfunder#21 Rematka) IM:2.1111112/0 t9 ft. l".111111.1 ft. IWI '''..11-1--..1.--':1.1r• 14%.:7 , '
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4.Date WeR(s)Completed:17'6"•ig,3 Well ID# . 410 ft. WalillillE lepaill.11111111
_50 ft' 6 .3 ft• S a• j etd-r
sa.wen Location:
itn,;41.4kei enfic.-1‹ . . 6e9 ft- UMW/. L. ''i ..
ft. ft.
FacilitOwner Name r...., Facility Mit(if applicable)
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.1•\( .9t9q rd Ped xd eAA)e,..ar, pc, . ft- ft. :
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.... _, Addzess,01 y,and Zip
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Physig
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Parcel Idensificm' ion No.(P/N) :.:,::,;:- ..:C.,a ,'" ..---.. • I .
County -
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Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Orwell field,one 1st/long is sufficient)
110
22. • lion:
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7-4-A2 Signature ,Dat---' .
6.la(are)the w Ws): :111ceiranent or, °Temporary _.../,
. • / By signing this font:,Thereby certffr dutt thewell(s)ties(were)constructed in accordance with •
7.Is this a repair to an existing well: °Yes or 0.,1 IC 15A NCAC 02C.0100 or 1.54 NCAC 02C.0200 Well Constniction Standards and theta copy
Vizir is a mar,fill oat known well construction Mfiumatian and expictin the nature of the oft/as reawd has been Provided:Ito the w411amater-
• repair ander#2I remarks section or an the back Otis form. . .•
.. .23.Site diagram or additional well derails: - .
• &For Geoprobe/D PT or Qosed-Loop Geothermal Wells haviag the same , Yell may use the back of this page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over',in Remarks Box).You may also attach additionalpages if necessary.
drilled:
24-SUBMITTAL INSTRUCTIONS .
9.Total well depth below land surface: /.65 (ft.) .
Submit this GW-1 within 30 days of well completion per the following:'
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' • For natitiple wells An all deptkr ff-different(eraztple-30:)200'and 2E11001 .
10.Static water level below top of casing: 9 0 (ft.) 24a. For All Wells: Original forni to Division of Water Resources (DWR,),
.Informaticm Processing Unit,1617 MSC,Raleigh,NC 27699-1617
' ff water level is above anting sae"+" • -
• 1 1 11.Borehole diameter:6"
(ill.) 24b.For Injection Wells:Copy to myR,Underground Injection Control(TUC),
Program,1636 MSC,Raleigh,NC 271699-1636
IL Well construed°n method:Air Drill ,
74c.For Water Supply and Open-Loop Geothermal Return Wefts:Copy to the
anger,rotary,cable,&met push,etc.)
county environmental health department of the county where inetAted
FOR WATER SUPPLY ONLY: • ' / ' '24d.For Water Wells producing over.100,000 GPD:Copy to DWR,CCPCU A
13a.Yield(gpm) 'Al 0 Method of test r Pe=Program;1611 MSC,Raleigh,NC 27699-1611
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11b.Disinfection type:Sterilene Am,;unt: 9 6aies, _ ,
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Form GW-1 North Carolina Department of Environmental.Quality-Division of Water Resouiv..es : Revised 6-6-2018
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