GW1--06944_Well Construction - GW1_20231027

•..1.,1•n ixv..duly it.ECORD(GW 1
For I»tetna1 Use palSr:
L Well Cualndor Ingormaties:
Ricky Corriher
f t •
•
NC Went Number
Frank A.Corriher&Sons Well Drilling, Inc. - ',m` -- iiiiiaa - _— -- _
1 Wen CAIStradinn Permit it 2 0 g3 --L3 gao3 ---iii-o--m- -20
Liss all appti�1eqamatructionpertalts(Le.u1S Comfy.State,Yarimeoe;era) +1 � / -
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3.Well Use(checkwen use): MU SDR-21 231111111.
. Water Sapidy Well:
Hai lic > ft. i'° �; 1i,.� �:: .�—
p1Y) Water Supply(single)
O.Resaeahal Water Supply(dialed) - — —_
°Wells>100,000ItEZ:1♦ TO l s- ,..i_ing. ga
Non-Water Well: GPD 0 22 a BenfiDirite Hole Plug
�� m DAan Well . ft.. it.
Qmfl3Rechazge 13Grormdwater ft.
Test eudR�owwy. t3S3iiniiyt3asies u.•rmar t .wT.;-�-.,e,i
❑Starmwater Drainage
ft. !- a
ClExpaimentalTechnology OSabsidence Control. ft
DGeotbennal(closed Loop) OTaeet —^- __ I.
dal Remm) p0&a(�laia'tmder#21 ) 11 : - :C_-�immicr_T�
gpirseirim
4 4.Da Weil(s) -le).- 23 Well DM PWEA Os
WeilLocmen: 1Gr�$ 3 111111, 2,1,c2211L_����
Vo- Fo/-e 6`/bole-- 5LLc ft • .►
Ph
44
County ._..- ,,.
7 Panrel No-(PM) —_-i,f a vyj �iin—___
Sr.Latin and in u s/seconds or decimal degrees: G i `�
dismal Eel&one lat Aegis 7freSe et)
3505•a" {0` N 80© �� ' j -�a u2 :/
6.iKare)the well(* or [7Tnpora y W Signatureof welt • ` G0
i l(s)mess(were) dEsaazrdmeewith
ar�toan existing welk °Yes or SdNCdC .0100 dCO2C.o2.0200PlaCow,St1DhiOniS and that aapv
�I+aDfillad limas vadla�r¢bournfoaeatan and esplcie the nata-eofthe 4- aerovdkarbemrpvovidadmthew+ omen
repair roabtre2l searailsseeks area the betakofdrislann---
S. 23.SUB diagram or add detaric
For GeoprglJOIDPT or CJesed.Leop Geothermal Wells}saving the same You use the back of this page to psavide additional well construction info'
�° only I GW 1 is needed. >o ate TDT.�I�Nb UIv18ER of wilts (add See Ovet.inEe, Box).Yon may also attach ad paw if
9 Totalled'depot brow land steam 3 v 3" SUBMITTAL
For wrT rrlhTataBdeptTaf (�rple-3®200'ard2®loo) M.) Sab�tthisO -lwitin30daysofwellco» nperthefollow�
Static water
I, d oneQlow top of easing: 3
(g,) R' Original £oaa to Divisor of water R (DW$)
Processing Unit,1617 MSC.Raleigh.NC 27699-1617
IL :fi" Gn-) 24bk For Infection Wells:Copy to DWR,Undergroundn Control
12.Well constractim. Air Drill Program,1�M NC2I699-1636
�' sager,
table,daeetpetsh,etc.) 24e.For Water Sappiy and Oiler-Loop Geothermal Behan Copy
ecatuty Welkto the
FOR WATER SUPPLY WELLS ONLY: t health depatfrornt ofthe comity where installed
24d.For Water Wells
i3a.Yield(� Method of test Air PmSs'�.161I Raleigh, C 27699-16Gi � to MR.CCPCUA
SterileneArmonk 3� ZA S .
Ferro FrW-I -
Nott i Carolina Department of Environmental Quality-Division of Water Resoeaees • Revised 6-6-70I8