GW1--07330_Well Construction - GW1_20231113

WELL CONSTRUCTION,RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Ricky Corriher her
.14 ERES.. 2� � ar� xe
Well Contractor Name FROM TO DESCRIPTION
.2464-A , ,YOt. / $ 9 a/
ft. ft.
NC Well Contractor Certification Number
15.0?)J F11 CAO(forinpltl csea.A)ls).C)Ff)I1B1Z(l appLcalle7 .. C...,........
Frank A. Corriher & Sons Well Drilling, Inc. FROM TO DIAMETER THICKNESS I MATERIAL
ft. ft. I , in
Company Name 1
1
/�/� // 6 INNER ovot I O'R?rUB1NC(geothermal closed'obp)f:.-,..ti. r ,...,, �.
2.Well Construction Permit#:� (o�/�. FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State, Variance,etc.) +1 ft. / 0/ ft• 6 1/8, `n• SDR-211 PVC
3.Well Use(check well use): /0 1 ft //,'3 ft 6 5 Icir. l fie. c. r`1.," `
Water Supply Well: 17_$GREBIW,,.?,.,.: .,.- ... .a, ...:' ..... ^'
FROM _ TO DIAMETER SLOT SIZE- 'THICKNESS MATERIAL
❑Agricultural ❑M cipal/Public ft. ft. 1 in.
' ❑Geothermal(Heating/Cooling Supply) esidential Water Supply(single) ft. ft. in.
❑Industrial/Commercial ❑Residential Water Supply(shared)
IIIIIIIllitliOtAtilliiiitiiitiiiiIiiiiMniiIiIIIIIiiiiiiiiiiiSMIIiiIignigaliiiiiMMINIMIIIIMIMIIIiIiIiIiIII
❑Irrigation ❑Wells>100,000GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 22 ft Bentonite Hole Plug
o DMonitoring DRecovery ft. ft. -
Injection Well:p ft. ft.
y, DAquifer Recharge . ❑Ground Water Remediation '
.$r ND)01a.N J.PACK(stappli.Sahle)� .,.-:: �,a M ....;: >-.:F" il l••
p. DAquifer Storage and Recovery !]Salinity Barrier19FROM , TO , MATERIAL EMPLACEMENT METHOD
DAquifer Test ❑Stormwater Drainage ft. ft.
DExperimental Technology - ❑Subsidence Control ft. ft. `'
V ❑Geothermal(Closed Loop) ❑Tracer ..:20,.bTtT1.r.IlUcIOO.Catfach addiflti`asheets:f nece"ss'aYj?)l "......... ......... .........
❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DEscRIPT[gN(cnlnr�hamn sniVrncknpe,grain size,etc.)
4.Date Well(s)Completed:/O`2 9 a2 well mg 5•-2 ft.- ¢.D ft. S; �J/)
`v ft. /00 3 ft. .S \ t' C../6..
�, Sa.Well Location: O v ��
/1 f n
Jy�/LjnCt/�'l i t^ ,l/�✓�'�ppeP.S a�•f4P�cicJi�inas lU art. �°� �u .
�o ft. ft.
Facilitny wren Name Facility/ID#(if applicablc�23
d® /�e M gr' Fo1P,y Pol 4l ft.
� ,Gl-ct -aYriP
Physical Address,City,and Zip
`�
O'�G,� /J 7 l�j.� atliniciutonlionmanamemilliiimplanumviiiiiiiitsinson
County Parcel Identification No.(PIN) Imo:_
.. :J J` '
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ? __..,
(if well field,one 1at/long is sufficient) 22.Certif ation•
35.p3 I ,��t� N 80 , -32 rl W C, ii,�t✓ ',,,4 101'„g.y—
6.Is(are)the wll(s): 61'ermanent or ❑Temporary Signature of C 'tcd Well Contractor Date
• By signing this form,I hereby certify that the well(s)was(were)constructed in accordance with
7.Is this a repair.to,an existing well: . -Dyes or a 15A NCAC 02C.0100 or 15.4 NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,f:ll out known well construction information and explain the nature of the of this record has been provided to the well owner.
' repair under VI remarks section or on the hack()Phis form. ' .
23.Site diagram or additional well details: •
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You 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 additional pages if necessary.
drilled: /� 24.SUBMITTAL INSTRUCTIONS '
OS9.Total well depth below land surface: g (ft.)
For multiple wells list all depths ifdii different(example-3E0,00'and 2(a_1100) Submit this GW-1 within 30 days of well completion per the following:
ya ) 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft. Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casin 'use"+"
11.Borehole diameter: Err •
(in,) 24b.For Injection Wells: Copy'to DWR, Underground Injection Control(1UC)
Program, 163,6 MSC,Raleigh,NC 27699-1636
12.Well construction method:Air Drill
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental-health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: I
24d.For Water.Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
13a.Yield(gpm) 0\ Method of test:Air Permit Program,1611 MSC,Raleigh,NC 27699-1611
i3b.Disinfection type: Ste rl ten a Amount: ✓ . Ga/Ps r
Form GW-1 - North Carolina Department of Environmental Quality-Division of Water Resources • Revised 6-6-201k