GW1-2022-08503_Well Construction - GW1_20220418

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Well Canlnvoler Nome
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NC Well caenuator Cohlnatke ftmO er -
Cannogy Brothers Well DdIlIng, Inc, ft Is �• M t s�yo vL
Z.Well Oaatruction Peradt Nt u2c, a-2. ,Dam 1y
w►all a>ar+lrrabk rwtr eaar nrr+ran p ►r r t a.., r l "Isar amn,cvaj 116 n. a
3.Wc4l Use(ohaek well usa)t nt rr, tn7
pier
Agricullmsel Muii!'oif inUlttibiio I e ft, 35 R, o, r) S•� 1 n 04 ` 't^•''
tloathottml(thtatinglCooling BMW) Res th►i Water 811ppdy(Single) a,
1adUtntlaUCommerofal eSidonttal Water Supply(Shttrod)
ott• Ater u oft 0 n. U
A4ulPar ReSha»gn tfratndwater Romodimlal e,
Aqulfbr Stomp and Recovery Solinity Banda
Aqulfbr'ft»t $tolmwatart?ruinwBo U R. / n• r t ¢, / . v -
BZporimontal Toobnolov ubsldortce Canttrsi
(laothemOal(Closed loop)
t3ao1 sMina
t n tai I S n. Mt v fl, IBM
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4.hate Welt(s)Can*letalt 11-: l loll a e y 0 ��•�+1 � �
So.Well Localiont N d
Faollfty►Owr:arName Nscaity ION(ifoWlaoblei v e n• /s n• l ,vs.
as 5 ► 0c. C" Pj . met v% Ni
phyoknl Addm ii,Cl►y.and Zip
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3 t'uunty ••�•r•.••,•�••� ihusel tdentltlatbon No.iplN) i
db.l adindo and tonpude is dspt Willibuteo/sec mb or dWmal draremt APR 1 -
(irwall Oakl,am tatllong H sufiabnq v t' G q U.C.o afkaHons
3 . 1 w1 • A
G.Him)the welipl) rnntaent or Drom rary tura a oRtsslor �+c
ins elanhdt rAlr �f A r*.cma,+trot 14 ird(s)arts Afro Mam�ered rn acca+rranco
7,is this a repair to as ot(itrNad wrdit or or No - —+rlrh M. , I ptc,eloo or-IsA NCAC OX.uaop well-Conrbt,c+too RuMardi and tharp- —-—
(f+hle tt a npatr,JIII Got lital►n rnrt(eanitruH(an tl(b+tnallort a aotprala+ko Molope q/Ihe CM,AhRtr roevid kaa boas praNdad ro►A+r r� Jl'a�vrc►.
mm r'loiter 01 rrameAr rea+nn or an the W gPthiii jbM. 33.IN*i fast!or oddit;attat well details;
B.For Coeprobe/DP1'or aDK44ARP tiealbetttlal Wear ltavin8 the sumo You May use the bank or this page to ptavido additional well silo dolls or well
consttnotion,only I OWt Is no*. ladioato TOTAL NU1MBIR oPwells conmuctIon dMils. You stay alto attooh additional"M(Pnaaosssry.
drilled;
9.Total well depth below bad surftltm 35 ....::fn•) me. t Submit Ohio tbrm within 30 days of w nplolion of wall
h w notMpk ur11R]N►all denthv udi�raa+raranyr rt• t� ► 1 conettuct on M flowing:
10.9tatle saner ravel bdinv top of goings �5 A) Divide"of Waty Raataarmult Ififor m"n Ptqgtitt6 Volt,
dun►ar lrtat is ahatw reams,ow"+" 1617 Moo lloWteo Color,Raitth,NOD 37094017
11.Boroltole dismotert ► (In,) 24b. in O;Moti to usilling the formto the address In 14a
obovo,Silo w On t ono espy or this filial winch 30 days or cempmlon oi-woil
I L Well toastr0ho NWA00t Rotary. ae"Motion to the(bllowing:
(60.sues+.rotary,mblo,Met path,M.)
Dtvblotl of Water t�ttrtS►tittdprgOAoaad t�{attOq Control POrogata,
FOR WATER SUPPLY WE lu ON1.Yt � Igo Me"8ervke c ntir,9XIA h, 1c 37t IG36
e'" mow of tat• t/t. t fit addition to sundiag the flttm to
13a.YIc1d(gpm) 'M Wd %)abolm, also ru, t one aopy of this firm Whhin 30 days or
13b.Didnfeation typos„ -5� Amoantt d D� complaton of wall catwtntalon to tha co"Itatith dopattmall of the county
r� wltero catOstttOoted,
Fotm t]W1 Noah(bmlino Dope rOat of boo nvaill QUAMY•Divbton otwaler Rmilrcas Itoviisd 3•at-3016