GW1-2022-00935_Well Construction - GW1_20220107

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WE CON�STRFJC ON DECO Fnr inlcr»ni Use Only:
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Wa ta-Snpp�jr Wcli:
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CIeCmlta1•ntal(ilcatiltg/Cnntlltg 8ttppiyj Rtzidentint Witter Supply(single) ft, ...._.ft, in.
indusuinl/('nmmareial Residential Water Supply(shared) al P -j tlai
Non-11'lftr inppk*V!'ell_ fr
ttaonifntin Rccavery _ u. _ _ ---..--- - — •�
Aquila-Rechpl$r, firattndwnecrRcmcdi+tiers 19.\NO VKLPA It -
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Aquifer StorageRnd Recnvcry' Snullity(intrim AROM
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Experimental Trchorli(}ty C:ontrat ---
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GeI he nal(Hea_ ti`n�Q(Cootin Rew"I Othar cx loin undat 71 Rggn L)_
Su.Well 1.0ralian: }�� ft. � � R• - - _.
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Nh.1,ntfindcnadlnnpltndeindcnren9lmivatrs/.atcnndsordreimnlfirgrets: -...----•---- -. --__
6 %welt Gelrt,oat 100nn+;in putnetrnr) A:?. fien[io
/s(arr.)the well(,q mantat or n1Trmpnrnry s tmntctt. �051ifi 01e) Contrnrxar Mile
l v•apnfnJ,•rAts t•,nr,1)Irmhp omtlhy(brit III ay.•llraj nvtr A,•M--,?)rrntrrtuderl Al nrrwrAn7er
1,thic a rrpnir to n n arisHn>;well, �" Vrs or No x:+r6 l.S,t.ti"C'A(.'n2C.11106 nr MA NCAr d9C.',I!?RO tYrtll C>•nrrmr�irpr 3lnmfarA.a rnuf rhm,:
Old,i.c»rapnir..�11 rn,rknm,m uvJ1.!na.tn,rtiwr ittfnmminamn cr#rlht the mime nlnc� tnplr r flldt rr:rnrd hme ht't91 prylr&f4!A10W.well n"fer.
.,.Vir rnrder A t rrotnr7rt.raete9l at Mr l/m Aar fi r+flA6r./<m°' );i,Site dipRram or nddidul>nl VWl dIICIt61
R.For Crnnrvr6ettA1'T or('lrrald-1,nap t;totherrRnl Wllllf having the saute 1'+>11 pray a rill hack of this paga to provide additlonnt well Oita dr+lnilS fir watt
,xlmIlmurinn,nnl�I GW-I is needed. hulietlto TOTAL NIIMSER orwrils con9tnirAintl ciclailR- You%nay RISO etteoh edll(l 11111 Pagos ifnect�aaary,
9.Ir Hal'Well depth bel(tw land surfiitc: �_ (R.) t,tt;t, y6CAU Nta: Submit Otis thrm within 30 days of eompirlinn of itlell
N,: A lelpl:went rpron4teprlrr ifdi,(rcrenr Jit?2or•nmd ar lot),) I'11naiTilt:iinpfo thy.fWiotcing;
11I,9lntit;wrdrrtrwel Ireton top of em ing- —, _ .-(ft.) 91vision of Warw Remuraea,laformatlan Prbtesmg Unll,
n,wvrh•r hn-,r/it•„hnvrr raring,ntr 1617 MItR Servile ICeiter,Raleigh.ltiC 9174"4617
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S S.Rrtrchole dtarnettm ---(in.) ;IAA.Par IllierHaw WAIS: RI addition to sxintting the fora+to the tt 01M in 249
17 Willt r.anumellan intltbnd: � mbnve,also submit one.copy of thin frmn within 3l1 days of complet)orr of writ
--_..._-._._____T_ t ousmlctinn m(he follorhnIr
(r c.nugr,mmry,etbM,direct pr1311.CIO
Ma Werra :Ppr.y ws I,r tNvt.u: - -` Dlv9sion of Water Resaums.1)1 dtrgrolwd Onjectlon i:ontiml Prnprnm,
7(i:16 Mart.4ervim..,rente,StateWit,NC 2740111 6M
l.ta-Yirtd(Qppl). �� Imethad of lest:N/t �.lC,�i t f SnDDl1 t1Ts rRi�j( a W!19: In udARion to rounding tht:thml to
-�"-- till: nddress(es) nhovo, also submit.pne copy of thiS than within 30 days of
0.1h,low—ilmdon"UP �^ Amnunr� nimpletinn of wets conatrurdon no tha connty homm depnnrnrm ar Site enunty
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