GW1--03010_Well Construction - GW1_20240520

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: —
1.wail Caatratesr bdormatione
Ricky COftiher --- . .PROM 11111
Well Contractor Nerve sew, 4
2464-A a. 1
NC wail caoEz,es,r Certification Number
Frank A.Corriher&Sons Weil Drilling,inc. FROM 7o
e. ft. ta.
Compaq Name
-713
. 2 we,C...�,m.a Permit$: 6 S 50 --1em-�—y�.y� TO DIAMETER ,ter, a
7- tux all o p&abir.et..va-.ma..per It.tar,c.o.stole.user.•.sat:) 1 R- ) 7_OR- a t ,--ebl.
SOR-21NM
3.ovUse(deckarH e ..e)
Well _-- -_ -----
wsterSiQsplywelR MOM TO mamma Nor au THICOOMB MlAtf IAL
v ■ ::.. .•..i:�. :. R. ft. is.
`1 ■ _...-w awn- ( Cooling Spply) l'-..-wawa Water Supply(single) t. ft.
C ■�:.... .: DRendential water Supply(shared) -
PROia TO MATERIAL DfPLAtaisclrr minas a Armen
f krimtionft. tt- —
Nan-Water Simply Welk
ORec°VezY ft. ft.
fk —
,, -• welt ft. ft.
,: DCaounciviater Remadssdon
■ Storage and Recovery eaAit TO MATIMn A� pt[aa
AL t rMo
a - - Test
Dstormwr�s DrainageIt.
f r . Ted sulk Control R ft.
..
f c_...'... ((loved Loop) QT Mem run ...ddtrsart+e,era
■ e..,.:.:.. (xeatmg/coo5ag`Return) DOflMa(explain tinder#21 Remarks) a i . rI, it. r
Date ova() J 'O`"a Ywaa m# `I Oa- 7-1) e. 9,4.\py1 '�,J'
- , QD a- ) 2ZIL SJi-f— /(.0c 4--
sa.wean Location f 2?� �y'S� /S j4�t G�.Jd it
a��, ,e�,n o/l
IL
(::::
.readityrOwLake yaao f9tr`Ge Somewat ID*(if spetbasinolt
14.5�1 g
mop Adders,Cray.small*
?ia Z 7 ,, N., . , ,
...., Paul id.:�6eetiaa No(PDt1
s..Imeinde and ie.eibde ha degreatiminetesisecoods or decimal deg ea::
Mime is
� (Y, pC effete)N 80" f i/ .2 w
sz /� _ (y
6.Ware)the wells orsafwt ()Temporary Ste°of wen Caaaacroe Dac
/ By rids far,..1 harbv 0016 thin the wadl(s)*us(swee)eaustrarled it aeaeedeace
7.h this a repair to an a s*ing welt DYes or )`i wilt 151 i 4C 02C.0100 or ISA,vCAC 02C.02001►el Ca stniaioa SYsdash ad for c
. e- =2t kr+ee',di c•Ierrnwc! .e iwjrnwation and emlaat the nature of ate DPP of this d has bees Pesuis td i,the well away.
repack-ander 121 rsm>!s sea*:or oa the back of this forts. Z3.--diagram or additione well details:
g Far or deed-I,eop Geothermal Wells having the saute You may use the hackle well
of this pa to provide additional well site details or w
-1 is needed Indicate TOTAL NUMBER of wells constructiondew. You may also attach addition!pages if necessary.
drilled SUBM rrAL INSrRUCTIOr'(
9.Total (S-)
d ma depth below land aetac 24a.Far All wefls Submit this form within 30 days of oampietioa of well
Fo►amblpdr wells list ail depths if dwjffurwit(example-3W200'wsd 240001 construction to the following
10.Stolle water level below tap of casing: ) 0 (R-) Division of water Beseeew,ItstMeaatioa Proeesdl'Unit,
tfame r level is above use"+" 1617 Mail Service Cinder,RaL.g.,NC 276994617
1 L Borehole diameter: ' Cm-) 24b.For laiectioa welts: ha addition to treading the form to the address is 24a
above,also submit
one copy of this form within 30 days of completion of well
22.Well eoastreetim method: Air Drill construction to the following
(Le_sum teeny,cable,trued peak ask.)
Dlvisioe at Water Resources,Underground injection Centre)Prograe,
9'OR WATER SUPPLY ILLS OPILY: 1636 Mail Service Center.Raleigh,NC 27699-1636
•13a.Yield Wm) V /d- Method of test AS 24c.For Weser Svmoly&l vie ice we& In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Dioiabaceta type S6erilmtss Amoot______--•-e - completion of well coustruction to the county health department of the county
whereconstructed_
Fain Gov-1 North Cambia Department of Easvaaammta Qwatity-Division of Weser Resouoass Revised 2-22-2016