GW1-2021-02440_Well Construction - GW1_20210521

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WELL CUNS"TRUCTION REQURD per bst-W Usc ONLY.
ilia 6M ass W last iwaib$W n atuititie"Oita
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411.
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ater ailpply Well, .._....._... . — auwerarl
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M Latitoda sail Leasgkv4t is dt>tiK[dasisetca+escaMds or tltcisel dwlrsas: �,l trh afloat _
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You:uay u►e the bank of t)sis pep*U provide sdditi&W well tits dseeile or welt
I.,lviebw of wills eoastrutud: 1 e."tnres:on ditsrlt. You may Ow utsoh edditie"I porn it W,aswy
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++i.:'vrrA M. OU 1!'AL 1MSTIAMONS
!.?opal will MiK below lead asetatr. rt i , "_ j
Ifi 7aa r AL Welts: Subniii if1:r hrrnl vrttiilil SC darn v!cusnDlsiiin or .n for>rruArr,swAhWrN,rf.+vAr1(rUwyu(e,vq,r-1gpao,enr2411W) const-lerlionto the following
19.Stalk stout lovel tNlow top of caking: d �rft) Dmis:oa of Witerr Qw illy,Titformstion Processing tiois.
01.sre+6r e,0arf,o..ewing we-r.- 1617 Mad Ser.ica Coute,96641l NC 37N4.K11
It.Dotsisais diioester: �. `r_ .. ie.! aft Z WM jL.Wejk1 in&dditbn to estrdrng J16fWM to life WOrsAs 0:ai
11.We0 tonslrnttfp nt A:, i a it fo lam of .re z<. v sww , days of tamrls ion of welt
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TOk WAT1tit VUIPPLY WLLt,41 ONT.V, / 164 Mail Stn+ico Ciaiser,Rslefgk NC 114MUM
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} Out sdtrs, (ao) abort, also svbmit are dopy of this toms withi r 30 days of
13A Disinlitties Pypea C �—�+ P I h f5 Anronirt de D 2 wniplslian of well conswidjun to Ow courtly hcoltli depsitim t wr 4-A tc+.my
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