GW1--06893_Well Construction - GW1_20231030

. .....•.••a.vtc.711tU1.11uN KEU)RD(GW-I) 1 For Internal Use Only.
L Wen OentrsstorInformation:
Ricky Corriher ..--- --�--_
— ------------
WeIICe�aehorl�e �, l kii __— _— -- - -----
2464-A • 69 1/D IL 1 v
liCweHOontacen Number '
Frank A. Corriher&Sons Well Drilling, Inc. > w f f -.Mill� .ti —
ft. ft.
l' in.
rataIIappE*alalcwe¢oorrstrrad onper (ce WCc*mm: Variance,eta) +1 7 1• sDR-21 PVC
3.Well Use(dteekweII sae): r `' A lkz/ 0 C/P
•
Water Supply We DEl' r,r. .T..11��r.1 in. .� e:. _ .a.cL�. .r Aid
ft. ft. isCIGeothmma -
I Supply) trItusidentiol Water Supply(single) ft. ft. in. ---
• ❑Residmbal Water Supply(shared) — -- --
°Lmgatioa OWells>100,0000TD 0 R:- Y...-./,{IIIMII....t,..rr -f..:.,.: ifi*1.0-,,.la
Non-Water wily Well; 0 22 ft Bentonite Hole Plug
CIMonitoring ORecovery fc ft. — .
_ _ Iajectim Wel>: -
QVt`�) OAgwkReohacge OOcaumdwaterRe on .
Mt:par Storage and Recovery OSahntty Bawer ffiiiiii-x• --': — vi' ,,'••• r i .
Manila Test O Drainage ft.
° tTedmology OSubsideoce Control. >i
OGeodezorot(Gored Loop) 011acQ
DGeoE�l(H CoormgRetom) °Other(expLam•mnder#21 Rematics) l ;�:�[C'�' i:3-� 'LTi
ft
C. 4.Date Walks)Completed:1 A(:9-VI Well Mit - VC) f alo $' IIIIN .• IMa
rr �*.�►
127 A,n < CRee/< Gh fed cJ %d i "r, tip )
4 �
�A .Ot,and� ;, 1 J 0 20
county . rffieel ra No (per j4 i f
5b.Latidnde and le eis or decimal degrees:
f rrett field,me]aitmgh sufficient) l/ 22.
5 w , A,,,,,,, .2.,
• ofCe Welte-,
6.Is(are)the wei(sk i or OTemporary 1 •
By mtning&Worm Thereby dn the,veu(sl was( accoadancetvith
7.la ibis a rep dr to as mien*weit °Yea of ISAIVCdCOZC.0I0tior ISd NCdC 02C.0200 WdZCoaurarawr S>a�ds m�$mta a,pv
' rdSrisaseparrfill*tdbw=xdlaaemrocYonb emmovrand the natweofthe ofrdas'mwdka'beeapvovidedtodrexeffo
repair tossier 421 remark seam or an the back ofddsfrmes. 23.Silo or=1ffilimal weR de
S.For Geogeo�dDBT ort�ced�op Geothermal Wells having the same You may me the back of this page to provide additional weIlco�ttsclioniefo
only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add See Over mRea�ks Box).Yonmayalsoshads additiottaipages ifinexsmq.
/ r 24.SIIBMLTrA1.INSTRUCTIONS
9.Totaiwr8depthbelowllandsorfs= / G
Fad> Est alldepdafd ( ++pie-• 00•� ( ) SehnBtthis6W-lwiabin3odaysofweIIco per�e
le.Static water level below top of casing: 3 ( ) 24e. For Allwells: Otigioal £o® to Division of Water Resources (OWL),
Yvette:-level is above rse"+^ 1617 MS(!,Raleigh,NC 27t➢99-1617
1L Borehole diameter:6" On-) 24b.For Injection Wells:Copyl to'DWR,Utdsigo®d Injeiglon Conical gm
12.Wellmut erJienmethod:Air Drill Program,1636 MSC,Raleigit:Nt 27699-1636
C*z mph many,cable,dant Fab,etc.) 24c.For Water and Open-Loop Geothermal Return Wells:Copy to the
meaty health dcgat gift counirwhene installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells. producing Over 100.000 GPD:Copy to DWR,CCPCUA
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I3o.Yield(man) 30 Method of test Air Permit Piogram,1611 MSC,Raleigh,NC 27699-1611 •
,�. Sterilene Amatmt S
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RCM GW-1 - Nat&Cssotma Depaatmasx ofEavao®mtai Quality-Division of Water R
Revised 6.6.101.8
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