GW1-2022-00327_Well Construction - GW1_20221222

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1.�:'htl G'ontrtialnr llntilrttidNont � ,
%Y011000lmolor Name
NO Wolf conimelor Cosilomiton Alumt+ar I'
y CannAd Brothers Well D�'11J1, , Inc.
Cotnpatiy iJomo d b S
2,Well CoactruQtlon Parttilt Of 2 � ..
Litt 11 timlivible nail ram}ri"tot ton;n7rri}s�1►e, .,t`nunnti nM,�'artnNcna Cie.) �, 'no
3,Well Use(ot%elt well uffe): no
ptar ui>p Wo 1
AgtiuulutmlMsnifo' V)+ublio 0 qt, ft, in. • a/2 co! t) Cz`�`�
001110MMI 0101111118 ogling 1$4pply�) dantlal We101'9uPpiy(atn(yio) 1}�
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Indosidat)Comme ai E)Raldwiti01 Water Supply(ohnred) •»
loan 1s
Non) oter Suptilywc-.1fl—
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! AqulfarllQQharpa Croundvrntorltotnaeliotina rr. rt. - ��
Aqullbr%turbo and Recovory 0901111hy Darner silly
Aqul►brTm C)Stonn%vulcrDmink4o d1,p Q. FfDft. t g f /b
Exporimoniol Teahnatogy 'rjsUbmalvea Caniml ft.
cleathcnnnl(Closed 1.000) Ptaaap lit' n
Ciaotito a1 auN,t�/fwoal n otu d a� faM of dor!) I omotlla�„ (�' `
n, tt, i9, 5
.Date Well($)C011411eled: %Vail IDP W7 ' _
3n,WQii Locntlont=3001w� oft is 11,
FnoilUylgwnorN nio !^ieaitlWlpH(ifuntflinnblo) O
Nl,yeical Addtopa,Chy.and Zip no v
Couniy ptn�I tilrnt{llretlnn Na.(p11V) �..�..,.�..
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tab.LoOtuda and Iont3tludo in tivSvaQsltnloutasl t ude a:'detitual deyr om
si (irwelt t1o1J,one inVinng b ruttlatamt no Urtlomlom
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6.is(are)Ilia well( manent or Dromportiry ftl m a o onlfactar I }c
Ay img(It(a�t+"no I hot*.oil&tlrpl firs 11VII(s)wtu/uvn+)eo}lermcmd/a orearrlance
7,Is this a klinir to An"etltstittg woul C)V0V or ++tth 11,(NCACCOAC,410Aor f9,t NCAI:01C.Od0U Ir'oll Gbrutrvrrttaf YrandarrlsAnd tRa+n
I'this is R minty,fill etal Anowl well mismtetlom lonnallon slid cxylaln Ihr nalttra of the cop.4Pthlr rerortl hta Drtlt yro+Vdcd re tM,+rl1 oavxa.
m/xtlr ride•NN mitar&,soNtaf}&o!t the back grWR m.
23.Site dlgmni or pridltleml trail(lctaltal
B.For GooprabOMPT or Cloud-Lop Geo1hcrttinl WQSIII)KA1q 410 aaind Y04 may tm(Ito back of 11110 pt}go to provide uddillonol wall silo doluns or wol)
conslniction,only i OW-1 is nticded, lodicalo'I'PAL NUMHS(t of wallo const:uotion dtalls. You may alto nnuoh tiddidonal PaAw if namewry,
drilled;
9.Total%volt da(�119 blow land surrncee.,,,,,�. Q� 5suhmit thin Rirvn within 30 days of camplotian of�vatl
!'oP tu}dnj}to nvtd9)(c1 all depths}rtl((ibronr l9�vanylht.y llrtlt'n eNM 1 I (.'a ssadon to r too Ilowins:
�10,Statle venter Iml below top of enpingt '�'"� (n,) elyliton of Water tteoliumh lalbrmatlon Pmel sing Vnll,
?If unter fowl is Aim rA4htR,ttte"p, 3 1611 Milli Sotwteo Centel*,Ruldsh,NC 27609«t017
1 I.Roveltolo dinntotert -�►ti .„(lu,) 241), MJWMbLW&t In addition to In3tltlblg the fohn to the nddim In 24a
nbovo,also Nubniit ono capy or Ihie pim within 3o days of completion of well
12.Well copstmallott 0114I}odi ooll8tiil4liQn t4 the(blloyAngf
(I.e.nu2ar,rotary,aablo,41met Owl),etc.) i
111vis1on of tstjaettfln 0oatrol Program,
FOR WATER SVPPI.,V WFI,L$OHM , 1G3d Mnll&taswlco Cmiutir.Hotalyh,NC 27tS913.106
130,Vield(aptft) Method of lost: Vic,Utft :,WI dS�ll t In addition'to snndino the form to
�#se ttddrasu(ca) ubaIlg atsg aubm t�ono copy of this Iowa within 36 dayo of
13b,ttloln4oet)an typal ,,., Its MAl completion of wail consiriiction 10 rise county Iwmltl, dopnnmant of t1+o oaunty
� where coitattucted, '
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Form OW.1 ,Neill,tktfbttao tudtaottt of Cwyironnnnim owilly•DWblon or%Maier limufm RQV6 d 9•9S•2016
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