GW1-2022-03894_Well Construction - GW1_20220412

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Ontme(or Infarpm :tion
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Well Coramstm Nome �3 SR• 1$S R. t�v ow�{-
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we Wer{rom,�racQ,,t(u twarsa, -
Cannady Brothers Well DdWng, Inc.
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2.Well Cartatrttcdon Perir&JI:
i to a(I ap�pi(taWo ttcN ear►srrtrctton perm►r f1 e. aunot Srett,lbr(artec erc.)
3.Well Us=(cheek wall use): R. tG ►a.
'tultuml �Mutifafpiblia SSA. R. i>a f� S) o Po c tpA.0-PO
harmal(HaalinWCooling Supply) [)Residential WaterSttppiy(sin&) R. R. to.
induattbucommercini DResidentlel Weter Supply(shared)
None star t,�l1: R. u R. u Ak 0 wv1
Malilofi Rsaove
A, or Rachatge �l3roun4wakr Remediat;on
Agul&r Stotega end Recovery 130811411y 13mrieram
mum- madamytimm
AquifetTal �$totmtval�Dtainage R• S R• )/� f� //b IPA`
SxpMmontal Taehnology C)$uba(dam Control A. R.
thctmal(Closed i.o*) ronar
Qaolho 1 neat tdatttm lain under 02l HamLis t) R L41d4WS h
d.slate We1t(s)Cottgtleted: 32'Wall 100
0 R. /
Se.Well Location: 7 o R t y° A. M.f t"y'-Q
e. 5 s� An;
S
FaoUitylt3wrarNama WNW it]IU(l wdtoeble)
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Physical Addmrs.Chy,and Zip Avon. kSR' •
21.
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County 1►oW Identiitwim W(FIN) 5..Y;uFt F,&ry
fib.Latitude and longitude to dogrees/aillim tfavem s ordadintl degrees:
(if west Ilotd,one ta1llang Is sultkla'rtq 22.7r •
114, 2�
6.11(are)MC Welt( ('minam or [3Tolttp$raty are►ur¢oi 1 mrallor � (Kac
4 r(gtttog this,�n►Am*,cad-dkat AAa tn1((s)atsa Aran)eaunxrt(d!n aecnrdame
7,Is this a"pit to air ottisttl�tedlt ms or +doh i!A 1fCAt►D,tC.0)d(!or tl,1)vCAC 02C A700 tPt)!Cbnrhtrrtton Sasdarffi amt rhar a
(fthtr is p rrpa(r,Jill out Armutr nittteoatrrtrethm tttlbrmaMon end�ta(n the morns�fAo caPY 2/rha rend hm bear to tit"►trot omaa►•
roparr under d!!rrxmrds seNtna ar os rAe bast gfrblsfinrr. 23,Site di v*m or adtRtlonat well debtbl
8.For CoeproW ADPT or Closed Loop Geolliffl tl Wetly having to.Out You may use the of tbis paglt to ptnvido additiotati well sirs dusts ar well
constntelion,only 1 OW-1 is Be". iAdicoto TOTAL 14UMRRR of welts eonsttuetion detetls. You may aieo attach additional pages,irate""*,
ddiled: '
mmem
9.Total well depth Now land suttlraet S ..�........;LQ.1 24o.aw Submit this than Wilhin 30 days of completion of well
Miwmnh)hlenrolIs]fitnlidapoks(/dhror+tfexaayria•111(N1 �smmeft�jiopljj
10.Statle water ieval NOW top of esaingr ' t• S� t�) Dil+letop Of wow Rmrveo Illarmon Is big Unit►
(/omrer feet it atom strsht,m"+"3 1617 Mau somm ceal�,PAW4 NIC 2709-1617
11.Botreltole diseetert V#7 24b.&C jllltis ol'1.�i t in eddldoe to n AIM the feat to the address In 24a
�igt� abssva,silo submit ono copy of this(brat Wilhtn 30 days of Completion of well
12.Well coasts uft tit,., .. tmnsttuotian to am%IW MN,,
(i.a.aagw.man+.«�e�,a>t�t peg,et9.)
Ohm"of Wow FA tV,Vakwonad Imieetlma C®atrml Fmvm
FOR WATCR SUPPLY WeLLS ONLYt 16m Mali Serviee Coatm Aatatgtt►NC 27til IC16
Method of test: ��' Me.Far W •""8u--§.A 1n In addition to send aS the tbrm to
t3a.vie"Ism) � aftmas(c's)ottovo►also submit an C' of this Ibmn within 30 dep of
t3b.1llslafeetMtr ty(►e:,j�f A u r d emPlat(on of Wctl ctstmollon to ttia county hnhh dcparement of tba county
where consumed. I
Form OW-1 Nosh(krothto O�attamm oi0avtronmstusl QWttlty•Dlvbtatt of Ward Reaaurocs Roriud b42.30{6