GW1-2022-03188_Well Construction - GW1_20220307

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is Well Contractor inrmatation;
ROM1.4 % Qannady
Wolf @oedarolor No""
2126-A
NC Well Ca&wor0milliaadoeWwrbor
Cannady Brothers Well Dtillln rL ,
2.Well CotutOm"On P9tTlt u:
Ltar arl aRpRrabte trt1J raetrrurtlert prrneitt n•a, ., oartp�,Sites,t arlturcr,tnr.) R. R, tn,
3.Well Use(check well m): R. it. s06
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Ooothermal(HeatingiCooling SMIy) E)Ro Walial Water Supply(single)
industriatlCommerciel DReddenlial Water Supply(sharod)
NEWG y dt! C) A.
Molihoti Rex► � �• ,
Aquit9r Aochtvgtt 00mun&mter Remediation
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Aqu{lbr Stomp and Recovaty C)SalWty 8atrrer a
Aquifer Test 8totmwater Dsott*ge ,t l� R. i R. }4 f11 td PvW\
Experimental To4tmkgy DSubsidartoa control
Ckathennal(C(wW Loop), DT"H 9r
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4.Date We14s)Coetptded- Wall 1011 O R, -3 5 R. G (�u�}
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I'mility/my1wNeate `tr ) PscilhylDY(ifappltmblo) (� R. g R. a^,ye.
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county Parwl Momtiwim No.(PIN)
Sb,latitude and 1ot11*de In dsgreatlralne smote or dedmt degi m- 20 `
(if wall Ikid,om ht%N b suiliefont) 22,(XvIfficellon;
3�a� / � (�,?r3' 9,7 3 �; � y -. w /mom ,� � ^� 3,- ate
6.Is(ntv)me wcm(0) neat or OTtmporary t�era o m M
!I)'NQ�ng►tdt f Rereby tit rhos the,rrii(a)a>gs(Iraro)rorutnutQtf in arewdrteke
7.is this a repair to on asi we11t over or eeil�b lJA lK'AC'udc,0fU0 or t3A XCAC OYC'.OM Well Cvtuer wkm SrWdards and(Act e
(frhit is a nrpair,fill ow Iholm avitrotttmrcrloa G(Jbe dad end apkin 11M nalttre o1Ike qrshit nsord ho iW PVVkW ra the apii saner.
mpalr rtadw 011 minor&arellan dr an the bac*gPdttrf". E3 ��� �or addmontd WO detalbi
y' to of this gage to provide additional well site details or wail
8,For Gcoprobe)DPT or Clod-lase Qeotlremtat Wools tuwitig the same tul"t
cnnstrueilon,only I OW-1 is nts�. tadlcat9`(YrAi,NUMBER of wells csmatruatton r�teils. YOU may also attach sddddena)page►iPnecasmary.
ddited:
9.Total well depth below Mrtd surfhcot,...,.. f 3 . �R•) 34a. t Submit this lbrm within 30 days of compiotion of w911
h'ar neah(p/o uvib for all dgptb(tdtftml frttaarpWM 3�i M'OW M?1 qq') rnstnseti i}o ing:
10.Slette water Loyd b ow top of mangi (/ (ii.) DtyMn of Wfit"t nnftM ittlbt=flail PIS Unit4
d tmter 10trt it dbmd atri t,m r•'+ 1617 Mail liery W Cater,"it,NC 37699.1617
i 1.�reAoie dhiti>cters,_.,_ ► 3l (In,) 2&yALWUMffiJMj in edditiotl to mdW the Rehm to ttttl address to A
Rbovo,site utsbmit one copy of this ram within 30 days or compktlon of wet{
IL Well condrtit"methods �® , �,. ,.,��..�,m exmsintvt(on to the%%lowing:
(i.®.Rugec,rotary,cebfn,dGect puslt,do,)
DfvWaa of Wales'RmatveN Utsdtrgroand h4sctiaa COMM PfW"+n,
FOR WATER SUPPi.,V WBIU ONLV: 106 Matt ticrvlra Center,ii6Mgk NC 27600.1636
13a.Vi91d(gem}l v Mottled of test: t4c. tetr 6t"r�lv inks t In t+ddhion to sosin8 the form to
ire gym) abovo, site wbtt(t one copy of this Am within 30 dsys of
13b.DIslnbation typo: % Atttattatt mmietion of well construviwt 16 the county heallh depsnmont of the county
wltarc cartstttxted.
Fomi OW,I NCO urolim Dapammu of EwAmo ttsatsi Quality-Division of Water R9acutcce Rovisod 2.22.3016
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