GW1--06419_Well Construction - GW1_20241025

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: , • .7....:::-.-••:.
I.Well Contractor Information:
Ricky Corriher 14.WATER ZONES
Fni)Ni I to I DESCRIPTION
%k ell Contractor Name =„?•
2464-A : Yqi9 ri' 160n- 1, 57 cetv .
m..Well Contractor Ccnitication Number • toC-4i
, 15.OUTER CASING-(for mtilti-canedwellS)OR LINER(if applicable)
Frank A. Corriher& Sons Well Drilling, Inc. , . FROM I TO I DIAMETER i I THICKNESS I MATERIAL
i
ft. ft. ! :I:n.•.1
t ornpany\idrde
Q • 16.INNER CASING OR TUBING(geothermaclosed-lonp)
/.55 .
2.Well Construction Permit#: g - /-5 . FROM TO I DIANIETER. I THICKNESS MA fERIAL
.:ii applicablr elell con,i'election per'ffir.,'cc IA'.(.e.eileice.Stale ilie.ione.e.cu.e :11 ft. 70 `1.- S
."8 ,in, SDR-2I-
1
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3.Well Use(check well use): IP.70 It. 00 ft. 1 ,S. -4111. igs, 6--,E 1
water Supply Well:
Geothermal,bleating(.:uoling Supp12,1
Industrial Commercial.
•Irription
N
I\lonitorin s: 0 Rceovcry ft.Mu.icipai,Public
csidential Water Supply(singlel,,
DResidential Water Sunni:,(shared')
17.SCREEN
FROM ft. To. fftt: Ili DIAMFfER I SLOT Mil- I I rticKNKss myri.3,u..1/41,
Agricultural
ft. 1
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18.GROUT
• i To
It. 1
!
in.
in. I l
I I i
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ft. mATErum.i ! EMPLACEMENT METHOD&AMOUNT
on-Water Supply Well: -
It.
injection Well: ' • '
ft. i ' ft.
, • -Aquifer Recharge airoundwater Remediation '
19.SAND/GRAVEL PACE(if applicable)
,Aquifer Storage and Recovery DSalinity Barrier , FROM - I TO ' ‘IATERIAL I EMPLACEMENT METHOD
Aquifer Test 0 Stormw ater Drainage i____ ft. fr.
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F.xf"&imental Technology Subsidence Control . it. ; ft. I . • ,
• ()eothennal(Closed Loop) OTracer 20.DRILLING LOG(attachadditionaf sheets if.necessary)
-•. -. .., .
FROM I To DESCRI vrtoN.(color hardness.soiltrock type.zrain size:etc.)
Geothermal(Heating,t ooling Return) OOther(explain under"21 Remarks?
.0- ft. 4/0-ft. ged7e
4.Date Well(s)ympleted:/10 ‘29 Well ID# 9fe, fr. 1 .-----..' , ft. C.0?0Wp(fr ) •7V7
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Sa.We I Location: • 155'0 ft. 1 7C2 ft. S'c7L-PA ir-Ca /c-
)
sT251/ VcigXer ReOgleK9' 740 ft- I i t- I R ze,.g -61-7-tz (.. I
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Facilit:,0,,ner Name 1-.acility ID.tit'applicabiel I ft. i ft.
6/1e ...._
$0/- -cde igf. 404"5 ,y 7t )aayi ft. I ft. ,
Prr:s. al..‘ritircs.eils.z,,id Lip ft. ; ft. •
,,
tvo A ejo/i'.. 6:76-14k I I
21.REMARKS ; .: . OCT 2 & zo24
...thinly Parcel kicanfiennon No.(PlN i 1
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ii.i,...,-,,,,,:6-iiET:i."4.2;,./....0„,..5o.Latitude and longitude in degrees/minutes,seconds or decimal degrees: '
,if well held.one at long is su)ficicrei 22.Certif.'-don:
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35 /- N 80 ,,
6.Is(are)the well(s)[: <manent or DTemporary zi W .io-seLa9r•
...
si . ,.. ,,,,,.gurc ,,,,,, cli Co ctp P ntrar l I ate
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7.Is this a repair to an existing well: Yes or : o e
,,i:i.;..,..i.%(...*:±c 0:C.,0),?,,?.Li./.%cqc().:(.02r)flni,a10,1,1mcriou Standard:and that a
I.,a repair.Iiii ma lenolere eecll con.,Irinic,,n by:P.M:Mon and explain th,lal:,-,..";the -....pt re ill;:,re;,,,%i;::.11,..t.li prGtt.lid:.e ilie.eve!:or.he,' _
repar Under-,.:i remarks Rectum or out he.,,aek of this tor,
23.Site diagram or additional well details:
i.For Geoprobe/DPT or Closed-Loop Geothermal Wells havin the You may use the hack of:his pnecto provide additional well site details or well
g same
construction.only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells constrdczion details. You may also attach additional pages if necessary. •
drilled:_
SUBMITTAL INSTRUCTIONS 1. .
S.Total well depth below land surface: / 5-
(1-1 1. 24a. For All Wells: Submit tin-:1 form within :',(1 days of completion of well
.,,,,,.nuirrpie wells its:ai!drprilq if drifi-renr'example.-
o. .0 .:Qnstruction to the foliowing:
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10.Static water level below top of casing: (ft.) Division Of Water Resou'rees.Information Processing Unit.
/71,arer level is abolc taAing.USE'-' . . 1617 Mail Service Center,Raleigh.NC 27699-1617
II.Borehole diameter: (in.) • 24h. For Injection W ells: In ,akiiiion to setidme the fonn to the address in 24a
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, Air Drill • above. also sUbItill One copy of this hornwithin 30 days of completion of well
12.\\ell construction method: . construction to the folldwing: :1, :
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aaut"er.riitar..,:abt,.....direct pusb.etc! },
. ph ision of W ater Resources.:Underground Injection Control Program.
FOR WATER SUPPLY wEi.i.s ONLY: 1636 Mail Service leiter.Raleigh.-NC 27699-1636
13a.Yield(gpm) 7.c Method()Nest: Air .. 24c. For Water Supply & Injection W ells: In.kichtlon to sending the form to
the addressees? abuse. also subn'it one copy of ibis form within.30 days of
13h.Disinfe Sterilene
etion type: Amount: eQ Cr-3 annpl,:iion of well construction II,-die county health department ol the county
where constructed. 1,
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1.orn Liw-1 . \orth C37011111 Department ot F.ricironaleni,d Quaili%-tics tamer.to'1.%aicr Re,ourco,.. FL.,,:sed.......:2-ZO I(..