GW1--06503_Well Construction - GW1_20231013

. ••-•' s,.yt..�ili�ul,ltyly KL''CORD(GW A For a.
I.well Contractor Information:
Ricky Corriher -
2464-A — — --
NC Weil tonenpor
�
Frank A.Corriher&Sons Well Drilling, Inc. -Msi _�.
----.
p
Conuanyllazne
--7
69 9 5 ---iiiii- ii,-
Dva l a wellp ex.U/C County,State,Variance,era) +1 s. r-� • 1'8 hi. SDR-21 . —.--
3.Well Use(cheek well use):
Water Supply Well:
���
° last • l c � . ra ((t,..„�,., —
DGeolhannal � �r) Water Supply(single) ft. in. �_
• • dal Water Supply( °-;- —R,: -_• I '� —�—
Nonigati n OWells>100,000 GFD t__I ��
�PP�'We: Q�� �:�-�etmrr
®,laWto®g s- Beritonite Hole Plug
In®a4oa Well:ClAtpriferRecharge OR�aysay ft. ft. IIIIIIIIIIIIIIIIIMM
oGioumdwaterRtau atian
DAquirer StT andey est 4.O OSalinity Denier ©© , ;,,r--:ory �a
1Technolmy OSvbsideneeCentral• it. it
Meade:anal(Gated Imp) D l'mcer = —•_— — I. i — —
/111111
Q (H CoofittgRemm) O C�lain'usxlerxzl Remarks) 11=111111111©■ ,•_ � � =z.,3—_ �2
4.Date wefi(s)(7engsleted:/O S 03 Well ID# R
531.WellLocapea: D �ikisAl I CC1;' 'n h1 ,1(�G� U�61s(�fl it M� ,•y•,a i 1
, .Mane ;
(1.✓a� ;� 8 c �.:. �`3 6 6 0Got tii r/cr.c.,,,,,..,.b.
d(Je( = ^l'hysirdress,�,.�� a sb'�� R .T 1 2023
h 4 n 13J,8 3a �. —
comely Pmoei r>o cpu� DV. , quo —
Orwell field,e a in degneesh�ntes/scoonds or de�iniai degrees:
is=+iciest)
3503 a.) l -7 " N 800-35 3 7,, w 22. c
6.D(are)the vat** ermemeat or .OTemporaty•
s CeZr WeII Commcag�/LZA ! ��
Dime
f / By dais heeby=titip&stdrewell6) ( ) neacceezmkeleidh
��this aremtoaneaatingwelh °Yes or Ai ISA�CO2C.Q100orISA1�ICO2C.Q20b Weil Caamvesp,&„ cord tetcam,
is ilatlmwtwren ecutstruction inftemeekes and etplain the nature ofthe oftiisseoard lug'bda l to*Ewellamen
repair wafer#21netarks section or a adte back of*is farm
5;` .23.Site dam or ad well deltaic
S.For G pr or Geothermal Wells having the same Yoh may use the back of this page to.
only 1 GW-1 is needed. htdicate TOTAL NiJIvffiER of wells
(add See Over'•mRemadcs Box).Youprovide additional onalpages y.
9.Total we depth belowland surface: -3 T 24. 'INSTRUCTIONS
Far wells&iseaHhpdgdarfrEfferea r mple-30200'me1 (f) S this 2(a110o7 within 30 days of well completion per the fol owl
Yd 'V'd casing: ® ( ) welix Original E I m to Division of wale R (D
Information gUnit,1617 C,Raleigh.IC 27699-1617
IL Borehole der:6" Cm) 24b.For Inaction Wells:Copy to DWR,Underground Injection Cce trot
12.Wellcmethod:Air Drill �'I 636 �Raleigh,NC27699-i636 ( '
24e.For Water Sapply and Qp lLoop GeothermalReturn Wean
Copytp
the
tntreS cable,daestpaslS ere) countyenvironmentalhealth.department oftbe county whteinstalledFQ8 WATER,SUPPLY wElls ONLY: Wells_ over 9BB 1 :CapytoDWB,CCPCIA
24d.For Water
/� 'amt 5�.6Raleigh,NC 27699-161113a.Yeld( aMethod of tes= ir
131). Sterilene 3earS
Amount
Ran GW-1
North Carolina Department of
QailY-Division of Waass Remy • Reused 6.6.7018