GW1-2022-09889_Well Construction - GW1_20221028

Feb 1619 05;43p ClearwaterWell Drilling 828-622-7241 P.1
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nstnlctinp,at11r i CsWt is nerded. i'ndicato TnTAt.i�I(IMBF1t of�+Wife TOR meY use the i nek or this ppge to Provide additionUi Welt aitn detnile or wort
drilled. U con9Wctintl drlails. Yell mayniso III addif me?patter if aocematy,
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Ili,Stacie"M 1-91 below top of rAglagr.� O constriction to the following'.
11'MnMrinr+JA�rihmrrcm7ng,uae ^l G ---^----( ) Division afWa(erResoure IaihrmtMon Processingntt,
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l O 161T ORA Smvice Center,iftiNgk NC27$99-1617 Cn•j
A„ 2(h For Iw rfigp ts: h)audition to ernding or,Arnp 14(h4 addrM iu 24n
12-weir enn32nielinn method: toJ � xipove,also submit one copy of this form within 30 dlayc Of cptnp(Fyo>t of Well
(i c,P11� r.Mtaq•,M le,direct push,oto,? cmutructim(to the fotiotving:
[V�OR WATER SCPi'l Division ofWAter Rraourm,Underglvnnd injectiop ronrrpl Program,
134.Yield 7636 Molt Servhx�cnmrt IRAIQjgth NC Z76P9.1636
it;Dm) Method of last:
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i3A.liisinfertlan type, 14 Alf udtlfllon too sundIng the fbml to
.Amotmt tilt aletion of) above Also submit 0tic Copp of this farm within 30 days or-
Mmptction of well cnnstruation to the coantq health dCpptttpont of the connty whnr4 corlstmctea,
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