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9.ToW well depth below tendsubcot J�5 (CL) 241L Fer All MD Submit this fans within 30 days of completion of"e
Fer„,d*k dhkUm7dcpdegrdfibea construction to the fallowing:
it static weer level below top ofeming: (ft.) Div dm of Water Resources lID rmalloa Praeessin6 Unit,
1/avierind kabMeaffng are-< 1617 VAII Service CeWmr Rr fth NC 7.7699.1617
IL Borehole diameter. Lc (1m) 24h%or Taieetlon Wdlsa in addition m sending the form to the address in om co 2
LfA[�Lf �•` above,also submit copy of Ibis formthin wi 30 d►ys of comp w completion of
11 Well coastruedaa ateSwd: construction to the foUowmg:
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D(aklon of Water Resouri=i Undogrouad 101"011 Contra(Pregmm,
FOR WATER VJPPLY WELLS ONLY: 1636 Mail Sscvi ce Cantor,lWdgb NC 27MIEG
i3a Yldd(� Ieo Aethad of test:�r4rh-F T;s� 24e,For Water body&lnicefien in addition to leading the*M
a the addrew(es) above, aim submit me copy of thfs Sam adtllln 30 days
1361 r1 a type )" T76 ID Ameawb {(I l pletion of toil ugatwrin to du emmty hoaith department of the cote
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