GW1-2021-01629_Well Construction - GW1_20210430

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cans actio%omty LOW-1 is neaki Ltd MO TOTAL NUMM oftvells conmuction deWIL You msy&*afth edaNjonel pw_es f nf4 sty..
dulled: �� �Ag,.l{h' x�1P
9.Tatei well depth below land ant&= ��5 f�) 941L lion A l,�ell� submit this JbIm within 30 days of completion of well
:1ff�P tet,�rc�rr�prta�P s� ar��a�pt�«3�aan•f z@to�y consttuedonto the fattosaing:
it Static water level below top ofcasings �;Z-Z> (tie) Dividen of Water Res•Pw etr.HtaB'artntkL Usaif,
(�awtertercitroaaveaasAf�use"+" IQ7 iwall service center,a3msh,NC276991617
11.Borehole diameter: (1n) Ze.ZjLbjjj9nMW. In addition to spun t4i form tc trf,edej-oaas in 243
r above,she submit one copy of this fbm%viftr 31l d£ys of camplsaan of well
12o yi/e11 cattstrnetiam methods L`b
construction to the faffowing.
Division of Water ter Resources,Undalro'und Injection Control Program,
FOP.WATER SUPPLY WELLS ONLY Im Mall Service Center,halei$h,WC 2769-1wfi
13a.,Yleld(Spm) metbod of testy (-i'n 7AP-Fat'�fi/Jat M Min*A Imeee�lota�Pe9r- do addition to sending the f�to
addresses)abova6 also submit one copy of this fattm tdit 30 days of
13h.Dislnfecdou type: D o� Amount: i 6'/-z- complatlon of wall constwtios to the coil health deparpntent of the county
whew consweted.
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