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23.Side diagram or add"itfoaal g en details:
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24.SUBMITTAL MgSTRUCTIONS
9.Total well depth below land surface: f A 0 (ft
Fosnsdnple>.dirt;,:aIIde�da ��v„nC ie_g(�200.mmi2�Ipp) SubmitthisGW-Iwithia34 days-of weUcompletioaper the fallowIng:
10.Stafic water level below top of easing: d (�) .24a.For All WeIIs: Original form to Divialm of Water Resotuees (DW4
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11.Borehole&metrr. G (m,) 24b.For lhiection Wells:Copy.:;to MR.Linda mt nd Meetica Control(IUC)
Pra�ram,1636 MSC,Raleigh,NC 27699-1636
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FOR WATER SUPPLY WM S ONLY: 24d.For Water WeUs producia�over IMOM GM.Copy to.DVAR CC=A
132.Xidd _ d Q Pam I'gpm,l61 MSC,Raleigh, —
(EPA Ivfnthod of test: �ti` ,
13b.Disinfection type Amount:
Foam GW 1'
N�athCmoliaaDepattaxat ofFsvnonmental Qm1$y-Dividaa of WatxResomoes Revised 6.6-201S