GW1-2022-09430_Well Construction - GW1_20221017

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for lnfarmatlontr
Wgi(4Qntmctoriian,eWAI
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A!C\Yell Conttmcloq CottiileatlaniJut�ooi
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Cannady Brothers Well DrIlUng, Inc.
Cattttpnay idetno.. ! • 1
3.Well Coal w"on tecrol tl: 2 ddd 1 O
Liar all nnp!ltabla urfl CmtrirtrCrtoN pmntts(tc, i ,CnuNpt S7rtfe. 'artntice,Cie.)
3.Well flee(Check wil use)t �• �� t";
ator i pp 8 d�.m:..�..�.y...m..4...e
MunfoE mViiiibtia
ASticttllural •. tJ R. �,ft. �° ip, _v.!'2- 5-� t:,.t�' � �
OcOlhomlal(FlcatinglCoolingSuprply) ttal Water supply(aingic)
htdusidaUCommetoial DReeldoat(al Water Supply(shnmQ)
tdan�}ItR1erE9upply,
MO►ti110ti RCCztvG 11, tl,
on a R. ff.
AguiPer itaciiarga �Ctaittitivnttor ltemedimioti
Aquitbr Stet:as and ltocovary sollnity i}amcr t
Aquifer Toss �Stattlttifrat r 1> ;a v �• S �' t �" I I6
Bxporlmoniat Tccltnatogy �Subatdcliee Cannel 11. n•
Geothcmid)(CI
Loop) ®Tt:toca fta 1
CI-Colhatmal chitin thin Ratum 01 nr lain wrrlor 921 only a
i1. ft.
4.{)ate Wett(s)aroinpletw.. Well 10
So.Well Lorntlont ,
0 k• �v ft,
FaeHiiylOtivncr Namd Pncility IURI t{fc�ritexh}e) '
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t1J U
Aloleal Addtees,Chy.tutd zip
Y
CUU111 r Panel idmiticatten Nip.(PIN)
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6b,L atl(srdo and►ongtitsdo in tttgreula/taloute ds mods or eludmut deg.
;t (If weii nald,one 10111OD l Is su(llot.np ,CertlMallon:
Q.Islare)lug WnWmeftl anent or [3`i'efwmry °utca Cus9 0l Controctpl late
rlgTil ihis j?M,r Amby ecvt(d.&I 1hr mit(a)tray petrol cottsaticttd 1N accordance
9,id this R t birRlr to als oai�(1ig trcllt or nNo �Ih 7S,4 NCAC�D1C.0100 or t5A MCAC OxC.o1k0 MOM Comtrusrtak Srarsdards and that o
(ftltla tt a repatr,jilt out know?nrtl t�netrttctiatt ltu5rtrmtloa dadcaptata tke Nature gfthe 01'7'o f rMj^n°'J ha°t 'i P"a'1d-d to the aril,ohr .
mpatr tinder fill roumrb aerllan br on the back ethtajatm, 23.site tllgmm Or additiotiat well dtiallti
r3,For Geoprolra/aAi or C lritrCd l eon 4?COtttc^a ttlAt Weil®lusving the atrnc you may use tho Et A of this"to pravido addditiatwi wall 00 dcW N or well
construction,only I O1 V-1 is nisedod. indlcit 1VrALNUMBIM ofvt'z11i 0n dctatla, You my all*otino9+><cldidanol paged iPttac? ty.
drlltcci: �� �►
9,Total.Well di�gfi�lth b4ow lort4 swilkea: fit•} xda. BLS Submh this (b in within 30 days of campteticm of well
J%ormithwo nr11t 7Gr1 all Aa7ttdat Ud(gtatgnt texatnpta-x�il7ft0'and 1R0`1 oottsitttetla»to the rallou+ing:
j ft. DIV111011of water 4icmuvo�4106nmilan0mvenhigVA
10,Statictenter iONt'i halm top o4 ai�ln�t.� ( )
Utmtar fe+vl is abow enahigo ive"+„ .1617 Mail 90FAM Canter,t oldgh,NC 27690.1617
d 1.Borehole dhlateterr z �y (in.) 24b. 4blaIN.M1 6n addition to Wding the fomt io the addtstts in 24a
above,also let nit oijo copy of this lbtm within 30 days of eattiplet(an of well
12,Well sopsttiueiloil rlutlltmdt aonaltuctlon to IN Eblfovtina:
(i.e.auger,rotary.Cable,dINCI push,etc.)
olv'ialon of Water Rmunth wkigmad ttlleaton imatrat 1 lwmta,
t'�13 WATiilt SUi'Pt.Y W(:IA.S Q1Vt,Yi 963ti Mail Setwkc CanteP,On1e4g4t,NC 276�?�?1G36
130,Yield(epm) I S Alothod of test. / 34e.fir! til'A es'tRrlisa 1 let to addition l®aeriding the form to
°�•- — -^ilia 6110 null I ens espy of this Perin within 30 days of
tab,i14s1nfesilnn typo: I�ntoant:- v� p cotnpkstion of wall construction io t IV County health dgw1trtmt of the county coun
Form clw-1 - tgarth Cotentin l}npattlncat of Unviroiint nioi puallty•DIvIahM of NY01Qr ltwWM i sl6Yi, t z-as-30t 6