GW1-2023-02927_Well Construction - GW1_20230420

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or anhaf tG a,eu rrptatnttwtietitimofllra , cuj Vf'thts,Otn+dh +btwtps Wd,dwthastillono►.
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( a.For CoaprobeiAltl' i oo)i t1N! ssrtatl Wafttnrttitto Ito cammy use th°wait of alto i to pi vldo additional oil,tiro dateite or watt
t cotntrualion,only I GWaI Is aided. Itndicate IaTAL NUMMI%afwolle ooninitoalon retails. You um oho nob vdditional pope 1Pneaeuty. •
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1 9,Tail woll diet belawha whim (ii,) tia, Submit Ns am within 90 days or comptotion or watt
POP inufgpto 00fl t(lido?*If utter Wow. Rod i ,,.,�,.,., construct on Sowing:
I in,Italie water Mal Meow trrp ptattlall . 1`'`0_-_._ ._ (it) Division of Water Ittriitlratt.Inf rsoolloa pr�tlty Until
3 (four tesni It ubotb ouhi.toe"t 1617 filtdi 0orcloa VARA Raidsit,NC 27699p48IR
rt 11.©oreitoto dlelnatert,.,.,,,s�,3..,,,�,.,,,.m.(In•) • 94%,Egadotioaalkt lit addition to sending lira Mon to tit°address In 94a
a a nbavo,n coot t ono copy of thla lbw within 30 days or camptatiun or well
19,Welt c013biCilel(�nlstirt► / onnhtnIuliatt oU the Ibltowit{llt
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i3p.viola(Ip 5 Meikad at test!n ( � $40o � �} { In addition to sondhuy tho lbnu to
�{a ai►) a va, a eo eub,in►ono agpy of title faun within 8t1 Jaya of
13h,iNettthotton typo; � Amounts �as p: • catttplattan at wall cot►stntctic�to dip county health deportment of rho Bounty
+sittnro avllttcnataxl.
�° Notthectollnt papatttttsttl of UtwitanmintU aunty•Divwianot%s it nUieeu Rovlcs+t a a2.2016
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