GW1--06540_Well Construction - GW1_20231013

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••--- •s..v1i.71itU1.11VP4 Kr/CORD(GW 11 I For Internal Use Only:
I.Well contractor Information
Ricky Corriher -_ -__-_--
Wen Cot lls= • J --
2464-A la
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Frank A. Corriher&Sons Well Drilling, Inc. F Fs . i?A , : ,- —
CompanyNarno
2.Well Qom oe nPermit#: Dal 3 -CV137 .11ff ii t;.:*.1:4 ba 1::1* : :1 1.-- ---- .
Lista 1 appSe tble>,e(l p, (i.e.U!G County,Shoe,vim,etc.) 4-1a'© SDR-21 PVC
3.Well Use(eLeckwell else): Egginallarff / ��/ a
Water Supply Welk FROM Illaf...111i,r+-,y,:.es r,li.v,,,Mbt:,.'. :aW-iv n
DA1 ltc ft ft. in. —
OCseothrnnal(Heating/Cooling ply) . Water Supply(single) ft. ft. 1
• ' D OResde tialWaterSupply(wed) - -- -• - -
Ohrigation oWells>100,000GPD fir` 11:0,.:.,'n111111111111.-,�n,T..',:'rr !.a.::.,i.30.•;1:31..ii
Non-Water Supply Wes: 0 22 f Bentonite Hole Plug
atelouitceing ORecovery ft- ft. .
5 Injection
DAquiferWRecharge OCcounawatesr ReMediation _= __ —_--.___--• --_-`— --
n IAgui Storage and Recovery DSa�ay Bon o is :...,:a,, 1 w).:, a
' .) DAgui Test DStorarwaterDrainage ft. i
1Techeology Dalwidm„-P Corers'. ft. >i
OGeotbeaal(Clost dLoop) DTI - ter_,°_--=-- -= I- - -_ _ _- -- --- --- --
DGtwZvamal Realm DOtber tmder#21 Rom) ���"•• •• :" ' `• { —T
( Coo ) ( r umra .. rbil
v% . F� �� ,
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a Date Well(s)c :� /en DM
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: t "�#G ee c / 6Ce5 �i S' �� ,i �.M\ - 4 l fiDt a n°� �.
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ft. MENINMEN1111
p� I ft..
ft. aimiiimmanni- .
'?i' PhY3177gRR&S ..-:77.7,-,,-,_=.:.-- _ _
County Race!Idensiscation No.(PIN)
•
CQ Sb.Latitude and longitude In degrees/minutes/seconds or decimal degs:
(dwell feed' ) //' ; ;, :;•22. a
350�g�% N 80Q —a0 -'�f - ,s'..:-, z,.zzi4 , .-4/
N. / 6.Is(are)the web(s): or DTempor ry sib of Well Contractor.
v Bpsi this)bra;!heebyoetti.(i,that*Iva biat(nee)mmtraso rda
editsarroraewi
7.Is Ibis a repair to an existing well: DYes or ®iVo- 15ANCAC 02C.0I00 or ISB;NCdCO2C.0200 WeiCo�rraa, and rya copy
&kiss a rep&fi l out ant Iva coniermaraa b furaarioot and eeplain the nerve of the ofthirt+�oond has bw.er pr t:°theia the leaonwter
repair tattler#2Ir®ra$a section or on the buackof this farm 23.Me dLagram or Maltiftional well del
S.For Getrp:abe/DPT or hoop Geothermal Wells laving the same You may use the back of this page to provide additional wellinfo
construction,only 1 GW-1 is needed. indicate TOTAL NUMBER of wells (add See Ovet'.inR®ads Box).You may also attach add 1pages if necessary.
drilled 24.SUBMITTAL INSTRUCITONS
9.Total well depth below lend surface: 5-0 (ft'
Form lenensrutaildepda•y aa(esompte-3@200,ma2@,100') ( ) Submitthiscw_iwit in3odaysiofwell pertheLoHuwieg: .
10.Static water level>>dtrw top of casing: g '( ) 24a. For All Wed& Original form i to Division of Water Resources (DWR.),
yours,-tevet is above me"4- ft Information Pm tg Ifm
Processing MSC,Raleigh,NC 27699-1617
24b.For Infection Wells:Copy to DWR,Underground InjectionControl(RTC)•
IL Borehole diaaet=6" On-)
Program,
, jr Drift 1636 MSC,Raleigh,NC 27
24c.For Water S 699-1636
12.Wellod'
Cu mazy,cal*,diteetptts�etc.) apply and OpenLeap Geothermal Return Weis:Copy In the
comity envimmtxmtal.healW department ofthe comity where installed
FOR WATER SUPPLY WELLS ONLY: •24d.For Water Wells producipp�l a 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpird 6' Method of test Air Permit Program,1611 MSC,Raleigh,i TC 27699-1611
L3b.. typmSterilene Amount _,g7eQrf j
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FormGW-1 North Catalina t1.r+.nn.n.ofEnvao�rtnral Quality-Divsion of Weser Resources
Revised 6.6-2018
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