HomeMy WebLinkAboutGW1--06511_Well Construction - GW1_20241104 ; .
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• WELL CONSTRUCTION RECORD (GW-1) For internal Use Only: i - •-•,. ..
I.Well Contractor Informatinn: ,
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Ricky Corriher . . ! 14.WATER ZONES .I I -
1,00st I TO . I t)ESCRtt'ION
Vi ell Contractor Name
2464-A • . . .
/.4f(ft' I V! - I I .
..(..WdI Contractor Certification Naraber
I 15jig OUTER CASING(for MUM-cased imIs)OR LINER(if aprplicable)
Frank A. Corriher& Sons Well Drilling, Inc. i FROM I TO I DRMETJtt , I THICKNESS I MATERIAL
1.1.3 ft. k ,
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'.ompan:.Name ft. 1 1 .
I +I I fn. I P 116-- ISit) -2-1
—2 .44/ n '7 1 )64N,, R C:AST2SR-TUBrgGitinal closed-1:c/
\Yell Construction Permit.g: .--",./..1 i‘-..i til ( _
{,...„ .,),... , r( ,
al:pile:1Hr tent coca triiC;itIrt perrnirs ti C. i'IC.C011,11::.StCliC. i.t7ric.rn..e.:lc 1 ft. 1 it 1 C 1.5. I CP- 1 cop...;1
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3.Well Use(check Well use): . I• ft. I ft. I : •
', in.
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I water Supply Well; ; 17.SCREEN
A.gicultural- - OH ,unicipal,Public ,
Geothermal(Heating Cooling.Supply, Residential Water Supply(single) ft.
Industrial Commercial
'11-1-iation
Non-Water Supply Well:
Nlonitoring
Injection N.Vell: . DResidemial Water Supply(shared)
ORecovery
. . FRONI l• To I otAmt....r1-:a I sun.sizt, i I HICKNESS 1 ‘IATEntAt.
ft. 1
18.GRfrOtt ,UTL. .f r. 1 in. .
in. itl '
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1 FROM I TO I MATERIAL I i DIPLACEMENT METHOD&AMOUNT
I ft. I
ft. 1 R. 1
ft. i
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- . " ft:—l "— ft.'I-- -
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.\qui fer Recharge DUrountht.ater Renicdiatiun {
1 19.SAND:GRAVEL PACK(if applicable) -
lAquifer Storage and Recovery OSalinity Barrier - - LiROM I To '- I MATERIAL I EMPLACEMENT METHOD
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Aquiter Test DSionnwater Drainage
, It. I ft. ' I ,
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Experimental Te‘chnolo,2y OSubsicienceSTontrol
1 rt. ; it. I
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Geothermal(Closed-Loop) Di-racer 1 20.DRILLING-LOG(attach additional sheets it necessary) . „ _... „, „..
' I I DESCRIPT/ON(color.hardness.
Geothermal(Heating•C:ooling Return)
DOther(explain under FROM 'TO soil/rock tTpe.grain SiZe,etc.)
.21 Remarks) . , '
( rt. I 6:0 ft. 1
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W
4.Date ell(s)Completed: to-a-g41 Well ID • - ':60 ft. ft. II . /2-/—
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[Lev ft. 1 I 25" !
5a.Aell Location: .
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15. Celtoi.d.POIrf --- -7: -• - • • - 12_5', -r-Z_S "'-.1. ' h'.1:i.6e:G r•crije_, - -
Gt4
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i•ac,i,t. 0,tier Name - - - •f-acility.IDn fit'applicabicaYitc ft'' I ft- I . L --- —'I ' .; ; i',...,
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1.33-8 ef0 le Weiv., /-, procesz.17/eric : - n--1 , ... n- . 1
.! . . . ft. I ft..I ,
sIdre;,,Cit:,..and Ziff NOV 0 c.t re 024
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, , I 21.REMARKS, • •. ;
IIr,,...:;:;74.z.-..: .,,-,-..--1-7-,z:-,•2'._%,-..-.',-
Lounf:.. Parcel.identificatton No.1PIN i . • ' 1-..)..‘,..:- — i''';-{ 7i,•
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Sb.Latitude and longitude in degreesiminutes/seconds or decimal degrees; ' .
,;I well field.one lai.long is tall-Tien;i • . 22.' Cert. cation:
._6,- N 80,„ 72 299 Q. .9
W ,.. ,
OZO,),•! tf'°--/?—a97
Signaturc of"i'' led,i1 all Contractor 1 t lbtc
6.ls(are)the wellts) 'Permanent or.OTemporary
7.Is this a repair to an e mz xisti well: ID•V cc or No Etif/ • ,,i,h L.:A m....ic/;:c,eIloo.f,1..i4 'Cl (12C,'1:0?Weil CIP11Trileli),1 Sialldardt and that a
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jutsi.i it I epair.fill OW;:lif7,r,,al cf117.,;ruenon itybrmciiii,a emd e.lpitiln.lih.rklihri'or rile - -S'aP'l'I'zi"'"''''''''lz;""lit!,."r""'‘IT''ih'"ril"'`"`" --
r-vpa:r under=.7 i rcniarks,i-ection.,.a,,k,.,,,4;of!hi,I,,,,, 23.Site diagram or additional welt details:
`i'oli may us: the hack of this page 1.0 provide additional well site details or well
R.For Geoprobe/DPT or Closed-Loop Geothermal Wells 'ireha the same'
construction details. You mayalso fitt4ch additional pages if necessary.
construction.only 1 OW-1 is needed. Indicate TOTAL NUMBER or wells 1,-
dulled.
SUBMITTAL'INSTRUCTIONS• i ,
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I.Total W w 1It--)ell depth belo land surface: 2,_1-:-
•14a. For All V1 ells; Submit this lOrm within :•41 days of completion of well
v.,..nuitipir,.....eiL,hs:a,!eirrih:I i airierrn;'example-..=,c.z..:ari.and 2,:a i.00`)
, construction to the following:
3 0 10.Static water level below top of casing: ' ' - (ft.)
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Division of Water Resources.information Processing Unit,
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.,';Oilier level is abovc camng.!INC-'-, . 1617 Mail Service Ceinter,Raleigh.NC 27699-1617
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-II.Borehole diameter: --.-lb. _. ._.(in.) • -- : - - 24h. For Injection W ells: In ttdditLitiii to sending die form to the address iri 24a ,
Air Drill -.,bovc. also submit one copy of thi fit,,i7111 within 30 days of completion of well
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12.Well construction method: , construction to the followings 11
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,Le..,eger.rtddr:......:abit.dirdcl.pu)41.Cie.)._.... I)
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Division of 11 ater Resources.Underground Injection Control Program.
FOR:W Al ER SUPPLYWEL1.S ONLY: ' 1636 Mail Servicenter.Raleigh.NC 27699-1636 ,
13a.Yield(gpm) • - -• - Method of test: Air-3 24c. For-Water Supply & Iniectioin Wells:_In.iddition to sending'the form to
the addre,s(es, above. also submit on copy of this ftrin within SO days of
Stedene
13b.Disinfection type: Amount: ,..5 CO_ .1e5___ LI I . . i .
.. nil let i on ,t)r,.‘a construction to thic county health department of the county
where constructed.
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1.,;no OW-I :,.omit Carolina Derailment in 1-.1“ironincniJi ettaiii>-Di,s;on 01V:titer RC,l....1Tet'S t 1 Re.isod 2-2.2-20lt,
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