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HomeMy WebLinkAboutGW1-2022-00145_Well Construction - GW1_20221219 zLL MSTRWC ION RUM( iw.j) Foe n d" 6e y; �. :) 1,Weil Cbnlraclor Internunont { Ronald 0. Ca(nnedy Well ONIAM ar Naalr JWWaIQ.r, 2126-A IL IL I1uD R, NC Well Canusew Cwtilkatleo Numbv a Cannady Brothers Well DdWn r Inc. �DdYJ/yY Censtrucdoa Petmilat� Lel aft aMrOmWe+mN rml,®nxnon pwm rk fte, nrwpt elan M Carl n• n. IL 1,Well Use(cheek well use): _^ d• " ft I s pp n I ural 13Mun V14110 Ode O12 y/ G 17e (dam"I(NoadnglCoolingIsupply) eskhmliaiwowtho (dy(single) niaUCommercisl [�Raldeldhl Wolof Supply(show)pr dr n, R• • OW ,�Op IIL fL Reahalp 130modwalerRemedim(on e• Fipm r Rtomgvalw Recovery QSallnity Barrier'ral Slon"wWor Dmltlege 0 L' 01) 16oinal Tabnalogy Bubs(derwo Cannot L a mtal(Closed loop) TMW 1 R IIunder A. S ' 4.Onto Wdlp)Completede 1D:t 2yWdllD0 Ae " L 6a.Wall Locallaot t S "' I's, et-0a►W /J•ek f 1w4u Ta aRiO�G v"' !.S "• nr Facilitylowmr Name PwlntylDa(irapptleable) &S Is p It. 9.3 'I lelJ40?%. R4 Pb•:Ym tic Pludcal Addmt.,City,and lip "' n' Q !J61444yocl Count 14nmihhnt{0 flom No.(PIN) `�r _ 6b,Lonludo and laa/kudo In doint'nafminutesfaeaeds tar detc4uml degreetit [if wall Mid,am inulanp Issuf0olenn 11,CertlRcs"ont k ^ 3s p d g'a �.�6•, N 7 8•L.,�_; 19. 14 � �,' /T'')Jcn'j frpj d�+r. 9••' �z' G.I>(ora)Iha well(q tlwaent or Qibmpenry a n /r onitwor sofa• By rldumig IAU,�pr�n,I AGI*P rafts'Thor t yr+reflfa)++w(wnl cauernrd In eccardanrr 1,la thk a spats N as vuledap twBr Ot' f„eNo +rlrh 11A NCAC d)C,df ap w 1 SA NCAC OtC,0700)pril Cauunullou l7axdard�and rAa,rt (fdthlrawpelr,JlU out lrmur+wNrosunatsw10namlon rwespioln Ike rwn"4ffke t'Wvr1till word W been➢rvvkwto* iCd0...ty, ronmr tmde'n11 salon,wilan ar m,tAr bark arthhJam. u Mk dlWotni or t'N- I villil dNalwi 1 V.Per GooprohelDM'or CIaoM.Loopp Ocdhomu l Wd10 harving the born You stay uY tlw book of thk pW to provide additional well silo details or wail contlnwilon,only I OW-1 Is iwaled• ind(atvTDTAL NUMBER of wells constructions details. You may also antwh additional pages If naoaaary. 9,Total well de1p(1th helaw,load surdcat n.) days or iwrnplwion or wall hfvmuAl/dn urllr lln t0ldrlr+kr UdlP►rrnr(Aye tif. Inryl co"MMINVonro4 a ollow�9 h this Ihmi wlihln 10 10.Stalk water lewl blew top or ngogi 3 n In.) Division of Water RMV IV ,ll%rinatlon PfOCMN VAIL (/surer lest lr adair wuhp•am"t" 1617 Mail Sem"Cu11w,Aalfli NC 1709.11111 t 1.Darehvk dMawkrl on') ub,�l In WNW to OMdhtg the Pone to the Wrote In A 11,Well coustraNlool oolassin RoUry *0va7aUert o thotNno copy of this form within 10 days or completion of well (l.r,our,rotary,able,dimclpudr,sn.) Division of Watre'1Rdmuralh Uaakr{ronad 18jMN4 Gbatrel Program, FOR WATER SUPPLY WSLLB ONLYt 1636 Mall ge"Ice Center,RdslgA,NC 17699.1616 i1u,YINd(gpm) 10, Medmd or tenh ►` tic.per WdM WWv&jet APelwt In addh(on to u-nding the form to the addrowa) shove, awe auomlt ono copy or this (one wbhin 10 days or lib.INsinl'ea0ontyirot, Ameumt V O p Completion tion of wellaatsiniction to dw a county Whh dapamnat or the county whore cons �I FomtoWd Nosh uralMe Department ofllov'twniolaw Qualify-Division or water iceaw. rm R.'i"42.27.1016