GW1-2021-00274_Well Construction - GW1_20211213

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Cinnady brothers Well i� llllnc , tnc D �, i InIn
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2,Well Constmetion Permlt Mt ..L..�
! List all appllcabk all eansiawdon prrnt ts fl.e, 1 , ouh6o,gate,t'arlame,etc.) h•
t 3.Well ua(cheek wall use)z
ater ups o t 1, 1
1• Agticullural � �Mw►io' Ui'ttblic w R, ��tl.
Ooolho mal(HeatinglCooling Supply) ial WalerSupply(single)
IndustriallCommeroiol ®Residential Water Supply(®hared) UT
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Noa-W»tor supply Well,
Monitorin _ Itt x►vcr� %
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Aquifoo Recharge �(yroundvtater Remodation
Aquifer t;torngocnd Reoovety;
9atinityBbnier` t
Aquifer Test aStotmwata lhoidage Q a f*• t c 9 Yw"
Exporimonlni Toebnology subaidonao Control h
Gootharmal(Closed loop)
Qaathermal Hooti Cacti» Retunt . Ot ialn under N2l Remy s h. +'J R,
A.Date Well(s)Completed,, • ;� "3 well 1DiJ t) h' ytl h.
rh e h• er<•..a9 i
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P deal AddMc bl and Zip b t Cam ✓
Cuunly -- pawl tdendiliad"No.(PIN)
Sit.Latitade and longitude in degr vantinutwNaeumis or dedmatdeveesz
(Irwell field,one tavlong is`uMctml) 2L n Certification:,,
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stneturcoFUR- el Conaactar best
0.Islam)the Weil(B) pent or DTomporarl ►A�j.�lg'that r1ro neap!�+h�l caurnterrd in aeta*mv
R1'atgnlag tAk Jbrnt,
7.1s th1A a repair to an eziotlntl went �Yas or �AIt< u9th $A NCA 02C.af00 or 1!t NCAC 01C.0lt10 Wall CoattrttNta+Sramfo►tds and that rt
_ — -- ___ rnpy aJiblt..mOrd hm--been pm.MA�rI ro rta+rell_oarwr. --
1J itchra n ntpal�,Jlli"out�io�,n ite!(tvturruNton 1 5rnratfort end explain rA®natrrre oJthe �.Site diagram or additional troll dcialb: -
repair ruder N!l muse in+retina or oa the bock Qf Ihtr fern+.
8,For GttoprobelDi'T or Ctoard-Loop Ceotizermzlt Weals havl»g the ame You filar tun dw back of this page toi pzovido additional well site ddails or well
conslnlciron,only I OW-1 is necdW, lndlemTOTAL NUMBER of wells
eommuctlon details. You may also anaoh a"donal pages If necemry.
9.Tot �S tf.) 2Aa. " r
9.Total well depth below{and tut'tace; � Submit this ibtm within 30 days or camplotion of well
F})r multlplp url/s list all depths l fdip>arcat fm'a e•dQtJNlI'anal I tNrl aonstntotion Mahe following.
(R.) Divblon of Water tlet U t N intbn0000 Proming Ua%
I tr abode cvtshgt,urc lave)below top of etlaingt
1Q.81aHc w 1617 MAN Seaviee Center,RnNo,PIC 2760%1617
(/Hater decal "�a"
11.Boreitok diaeaetert 1311 (In.) 24b, t in addition to Ise Abig the farm to the address In 24a
above,also submit ono copy ar Ihis form within 30 days or completion or well
1%.Well coatltraotian mrXedt Rota! conai mlion to the tbllowing.
(Lo.supt.rotary,cable,dlrocl path,etc.) pbrl"of Water Resourew undsrg�»d irjedlen C"Vol,Program,
FOR WATER SUPPLY WELLS ONLY. 1636 man&n vlee Center'R%tetgb.NC 2760-1636
2, ,n �v nM ++„� b t zketia!I n In addition to Abrading the tbrm to
14 13a,Yield(gpm) b tv Motbod or teat: „ K above, also sobmij'ona�copY of this form within 30 days of
tS..I.vA Amon»t. r - complalton of well cwnsttuctian to[the county hoailh department or the county
13b.DIA1nbWOO typo. where cmttucted.
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Rori+svl$•7a.�016
Fornt dW•i North Caroline Deponnwnt orEnith= mill Quality-Division or water Rmut