GW1-2023-01701_Well Construction - GW1_20230213

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1.'Wolf Contractor InArraMttent
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Company Not" �1
1.Weft Cotutnaellon Periolt Nt_ (A)
LUF ali tW414obk aril coivImmtorl p,vrn rr l.r,111r, un to,.nr ants r R,
3.Wall!floe(dhoek well aeo)t
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Agriuulutrol FRO"w"O'llittil
l3Oo hamul(MoatlnylCoollog fttfppl)jnl Water Srtpply(eit►ylo)lAdu4trioUCommetew al Woter 31"ly(shated)fim --- '
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AqulAr lieohnr@cdrottntlwater Kemedlsdon ..
Aqul fbr Stomp and Rtwovory $allnity harrier IN I
AqulArTes► Iltwlttttfese DMlnNjv 11 R. S 5 t• l l t. Oou^
SxpurlmunU)ToolincloSy Soubolddive Contmi p. tt.
Coothonnal(Closed I.aop) Molitor
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60,Will Localloal R' l) Ib
FeoilltylgwnorNams !'�v(ifa(rpiWebky R. �
Myrkat Addrora.City.and Lip
rcunly Plawl MaMtflaKirM hM.t,(PIN)
Ilb,Latitude and lo"Node In dyt1etfs/ttftMutoo/eoeando or decltnnt tlegr wt - --------- —��...-----
(it well Ibld,onu Ial1kmQ Is$ulfloNfm) J 11,Cor fiMHow
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0.Igo re)the well(p drtfutet!nt or C)�wovpfdfa
not a "" wwor '•`�
!d 4wnt rhlr Jb a,I Arm*trrf(Q tha►!M lrwh l uw Aron)Na ovew fir MotA Iva
7,111111110"pit to Ma aulstlitp nadir No u1lh!a MCC 42C.01A9 a /1,1 NCAC(""0.i0r wAg1 Q"low"M on,ill IN sad that a
(ftMr I,r o wpolr,�lll Oal knouts twNp>Ktlnfctlon t)16rr 1100 fhe>Hrirwr tythr 6oP1'(dl'thtr rororrl bas Errat WarVdorl ro the ue!1 p,rrrov.
ropntr alum,fill rrnvett,literhul or a,rin bm grthlr,lbM.
23,alloe rdtUli►7ut1 or adtittlonat we"1I CGelb,.
8.For.GooprebrlDPT or Cloved-L,ory1 GootaMlMl Welb hwhlS lbo now Yat my wo tho book of thlo pays tc provide oddlllonal twll silo dmfia Of we'll
ctuntractlon,only I GWi Is neatlell, iodivativ TOTAI.NUM9811 of-welle construwon dsudls. You may also aatnair odds lonal paocr ifneoanatry.
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9,Total well depth bokw land owh►cat ,,..„..,gift,) Mo. submit this Atrm within 30 days of complotlon or wou
F'r,r rntahlphr nvf/x frl nlidrprbr((ri(prewrr iara ,h i r I 1 liOnM(ruoflgn to 1 llowlnl:
ID.f3lotte voter level betorr top of fnIlitlnl,.., ..v,.,_..,,..w,w lR�) DM*"to Wow litdwono,II Ibmation Promint Unit,
U'nnrrr frivi it dviv nuhyl,fire"t" 1I1 7 Mom"lee(.'odctlrr,Naldeb,NC 170001 17
i 1.q trehok dlasaatart. g�►,. ;wh. ;(� t In sMitlarn to rending the tbtn►to the wdt�t�t In 1,1is
R�, ry nbnva,afro rtt toff to
espy ur thbr firm withEn 30 Heys of enmplatlon of wall
11,Well eottetrt►etlon rna4bWt , ........,,. uonMruwton to the Mowing:
(t,e,nyph retory,,oahls,dGoc►pwh,tna,)
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i 13a.'Ylold(;pot)—LD � .�5 Molbatl of leas,4�,f,, �.,,�„ 1do.j?yC��INK.�11 111111�N Not in B"llon to wttdittp the form to
_ on "wro�oo) a om also eubm 1 ono ropy or this hmn whbw 30 days of
13b.Did"600nTypal Atnot►nif" complolioo of wail amintetion to tiro courtly health do"Mytoot of the oounty
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Form OW-1 North 4mlitw t)rptntnonl orenvhomnrnitl Qwil►y-vivis►on or walsr Itoaourrroa Rarit�J 1•t3-1016