GW1--04917_Well Construction - GW1_20240816

WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only 1111111710
1.Wei Ceatradsr Wormhole
Ricky Corrihef . _ ..
..P .. --.TO . ._ - _ ..-- --- --_:._ ..
ROM
DMOUPTION
Well eaaeearrtr -
9 — /OS-- d $ CI/
2464-A ft. ft.
NC Well Comm eeetfa5cseioo Neater --
Frank A.Com'her&Sons Wel Drilling,Inc. PROM TO mow= 7INCX7181$ w►Ttm+i
ft. ft. ha.
CcaeyNamc �a -oo03 - - _
2.Wei Ca.rlrae ion Perot TO ow�sg MATERIAL
List all applicabk wet caw.r.�ow permits(Le A!C Covey,Start YaenaaR reed) / �' t .�- A' 6 tta �' St3,.21 rsc
3 war Use(cheek well ttae) 2 2—". 4 "Ift' &s r7•1IL /�� )Li
Water Supply We& PROM To DIAMETER siwriu TERaaNIss MATERIAL
■ ■�• ,�.'..;.. .lit tL ft. n` 1
• -...-...- ( Supply) ',.1 ..,-.... Water Supply( ) A. R. h`
■ DResicianialWater Supply(shared) —11 '
Met _TO MATERIAL net-sc61�IT IQws)&miaow
Irrigation R ft_
Nat-Water Supply Welt: _
>! CIRewvcrY - aft.
•
-. Welt ft. ft.
:, Reese
°Ground eater Ret ou - -
■ . ••••••- SOxage and Recovery Y D Barrier t� TO MATERIAL S1 PLA�TMI
as mw > ft ft.. . ...:._ Tea —
ce Control Q ft.
ill _..,..... (Closed Loop) QT m „p D s:aa.ae eRs•t. .0
L ■ e..,._ .. (t1 Regan) �Oflter(obtain antler ff11 xemarirt) 0' R /4 a L'C r 1 J
r, _+ . 1 -�ft- IL i31 a n
4.Dane Wei( Coautpiesed J r�yWeH IDtF 'i @- f�-S a iu e. „ ��"='„�,L-e
44,
92-
1.� ( Sa Wen L�/ / y a I l v.. es �(�,��t c a. R
�1 rye r`(n(^ / (�gra _4 -- ft. m
-
`-1 l milk H I�if � °O �, R .1,UG 1-
xes
t #C A1`r1, IPrt
Comity Paine Identifitatice No.(PIN) ,A
5b.Latitude and llengitade in degreentidnideMearads or deimal degrees: .
(3twea s(ead,are billow is sufficient) 2- I' 1
// ._ /,,,_ „ii,, 5----43_49 r
e�
of ellDwe
6.la(are)the wells or OT s •
By signimg this fo.a,1 hereby rnofy that the eeell(s)ens frets)aoweroeted he accordant
7.Is Ibis a repair to as ode*wed Dyes or me 1 SA NCAC 02C.0100 or 1 SA.NCAC 02C-020o Weil Conine:ens Sandie*and gets
rd.::a a repay,fill ma known+eel aoarrvdioe information and ezplats the nature of die copy°t is raved has bees peronidud to the well owner.
repair wider t121 remarks section or an the back of tuns form. 23.Site diagram or additional'.welt data
&For Geopreidppf a Omed-i.oep Geothermal Wells having the same YOu may me the back of this?q¢ provide additiaoal well she Mails a well
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells °OO�r�Os derails YOU may also attach sd�ianal pages if necessary:
dolled: ) C 5 ciTBIVl11TALI1VSIRUCTIt7tgl
9.Total well depth below load surface ($-) 24a. For Ail Wenn Submit this form within 30 days of completion of well
For seehrpit wdlt Hoag depths V&Omens(wrangle-WOO'and 20100') uuct on in the following
le.Stake waterer level Wow**of easing: ( 5 (It.) Division of Water Resources.Isfse stiost Preening Unit,
rimier lewd it above easy,use"4- 1617 Maria Service Center,Releigby NC 27699.1617
1L Borehole Cum-) 24b.For Iaieettoa Welts: bi addition to sending the farm to the acktress in 24e
above,also submit one copy of this form within 30 days of completion of well
12.war wa a tructie method:: Air DtDrillcommotion to the following
( anger,may,abbe,direct pest,etc.)
Division of Water Resources,Underground injection Control Program.
FORWATER SUPPLY WILLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
Lin Yield(0,..) A.5 Method of test
Air
i /� 24c.Err Water Swdr& njeclion Weil In addition to sending the form to
the 136�Ditefoe _. A>•oot d tC�� ) move sirealso submit one copy of this Foenn within 30 days of
Smr4ette of well cons:maiam to the catty health depastmeat of the ooeady
where canna-acted_
Form GW-1 North Cambia Department of Envaoeeeneatat Quality-Division of Water lbecances Revered 2-z<-2016