GW1--07567_Well Construction - GW1_20231121

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..- • ,a.v1/10 LAM,HUNV KLfcuRD(GW 1) 1 For Internal Use Oniy:
L WeR Contractor Infor isa:
Ricky Corriher =.--•- - - ---
WeliCaamednirli�e • pieR.— ,., ------ --- - --_
2464-A i 0 el.' r `�
• A-Zet-
NC Well•Comoactor CatiEscatin limber
Frank A.Comher&Sons Well Drilling;Inc. ,0-,f.aide;a ..0- 1-- - -
Compeny
Al®a ft. I.
listen eppTnoabletdceasea permits at imG Variance,a +1 sit' imp ziga SDR-21 PVC
"CC 3:we$Use Weds welt rase): • 1111 I r-c IMISMI
Water Supply mtom .: i�< II n.,_,.:. r.�4;,. lb.:,.,;.jf:.N...r
hDAB tic . ft. it. fa.
OGeotitermal� ) - - Water Supply(single) ft. ft. ie. _--
\ • IIResidmtial Water Supply(fin _ '- ,::- ---
a QWells>100,000GPD A`t'�l:rr,....r��*..- n,T..,._re::,.:--..1--
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Non-Water Supply Well: 0 il: 22 ft Bentonite Hole Plug
Mdcatitosing DRecovely >t_ ft.
Injection Welt = ft. . ft. -
DAgaiferRechazge OCeemadsvaterxemediation _ - - ---- -- -- ----
OAgmtier Storage adRecovery DSali i yBariel MA.r®ler_ - - *: ,e •.•.r i. . MEM.
DAgai Test D wataDsamage =11U7-__211111
'1'; CIFarpea>mretta1Technology OSnbsideaceCancel. ft ft
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V F Owri¢PfameQ FacnityW#(ifapplicabk) 8 L, <' � ;
pQ l �G l< S'GI'S�a/ 0 7 / ft. tft. ti , l , ' .:n;I , 4�. •!-"}i
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�, County PmnelideadSe�naNto-(Pre° IRS�;r:'-;:'Z ". '..: •:n ;I.•,}
Sb.Latitude and longitude is or decimal degrees: `'o ::i°�`v;�; v
35Ofwelt fold.�' b` 80 '' �'
& N -3�1 �-(93 w .,� .0/� 9--a/- .�
6.i(are)the wek(s): or DTesapeaury • one d Well Coamctor. Date
b'signing*Worm Thereby cart@6=a:euella)xm(am)ceastraciedaeaaz►dencevia
7.Is this arepair to an existing welb °Yes or lsd NCAC��� or I MAC O2C OZOD Weil a ids andnloeto copy
Pk&is a?epav fi i5tdw%n well m on informs feet and erp/aa the nakve efdw of Poni"to the well,oKner -
` -- repairmtder#Il rmrLsseraae oral tie bar�oftlds fans 23.Ste t gram or Relational�dot lm
&For CeopeabdDPT or Closed-Loop G 1 Wells having the same You may use the back of this page to provide additional weIl info
cagy 1 G•W-1 is needed. Idicate TOTAL NUMBER of wells (add'See Ovef,rResoarks Bad.You may also attach adtQooalpages ifnecessmy.
Mlle 24.SUBMITTAL INSTRUCTIONS
9.Total well depth belowlandsurface: 30.E j
For multplewells Est al1 Ardis ifMaac( 3@2Chr and Z0Ipp� (�) SabaritthisGW-lwithin30daysofwrII perttie
le• .Static water level below top of casing: I/a ( ) 24a. For MI Wells: Oapival;farm to Division of Water Re canes (DWR),
lf> lead daru�%test"+' Ia�ationPtoe g Unit, MSC,Ragwgb,NC 27699-1617
11.Borehole tre :6" Cm.) 24b.For Iniec ion Wells Copy to DWR,Un ra®d Injection Capitol(IUc),
Well=mambos- • method:Air Drill Program,1636 MSC,Raleigh,NC 27699-1636
u etc.) �e
24c.For Water Sapply and Opi-Loop GeothermalReturn Wellm Copy to the
- emvl heatthdegaz�t oftbeexrmtywbe=eitssraIled
FOR WATER.SUPPLY WELLS ONLY: 24d.For Water Wells!weaning over 1,i :i GPD:Copy to DWR,CCPCUA
13a.Yield(wad -T Method offest Air Permit Progmm,1611 MSC,Raleigh,NC 27699-1611
13h.Disinfection typft Sterilene A„nant 43% eqq
Faso OW-1 North(.uol'manep an=ofEavao lQua]uy-DivisioaofwuerRosw�aors • ' Revised642018