GW1--05074_Well Construction - GW1_20230804

a.
nix CQNSTRUCTIS?N RECORD *w imam:Utc ONLY.
Ilia be N$is tiled fr Asp or ioultith wells —
1.Well Csstroci:r.afa s►lfor.. _.. ..... .-_--... .........
37 r r1 3G- Z_"L `.." ,3'4-'i1 !�`_-- r s "'"•' _- - _ . .--_ 1
Ws,:Well Cc.eecc•bitiflcatise Nusekee. . • 4�s^teg'M:» K +•• : .i1 't Biel Ai H
t s �(J (yL4taYlil I III
f
vi c°r ►':.. .. 6,L.c. tin LL 4_ :r 1 �-I t ;ry` �/� fJ
Compute Noo. / I t•.lltrtlbl Cairn,$Rtr!iy� ts�ot it )
Lli stf au..,1 .
2.Wen C..esr..l.o renal r:w t' D g R• ta. j
LiudlgplYlrJW war iaMagrocoon/er.irr,1 0. .ry.Saw,easwnv.sir,J ft. - - ----
l.Weal Use(6414'1,41 er,,e; llamas17.>< itK -•-
r wtl.r fwisply Weil: _ -....._.....-... �--- :,f— wourvu uW
; o ►uu 71� slrl cia )us,t .+"er f
OAyisulagl •.11M';."�-i;At \•M:• h. !! its a- _ y
(IO.,hsrmal(HSeUr. Vocho Supply) Rfaaderbst ts)..tc•9ctaC4Y(5t I`•) ' N. [t. 1 as
Otmlustrsal/Commorcui ittasidcntlst tL'R.'Ct Supply(deatca) I
_..,�`i•_ urn,•tn, •. ., .r to:`]'.
• Oki tan
M.♦Weser leR:h rrg ' 010 ,(
R • ••R• - '—
Qldonitue O Racov.
.•..--..- . --- ..__._. . -. ry. .-.
at ft I it 1
-
OAltihrRacherpt OJcoursi•wstcr ftomadu;ort YSLrd tra" tea.)
'OAatiihr Sturan.eta.'.1n,Novcry' USalinity BarrierA.
� Wttia��aa )
R
OAgdfa T'em �'a alasmtrtn �Drnesc a A
Olixp.riee.olelTseh•.rioay OS%-twitanceCotgrvy l -
, tt, • L Zati .Lida ai it a m4soIrY• • ••
I Olkotl+ertnal(C1aod Ux.y:) U'rlca recta it} � 7l�lGsie�swar.nseww+trip%row to ns' _I
i • ,04eot)wrnul(Mntlev/Cu ti ts4eum1.�1OUexr(cap)stn tevlar►t2t ilstaarlu) F h �1 . fl' / !
a.Asa W.II/e)C�►nasal: 7¢7 ".�`5w.t,e� _ R L Si ra 0—fact j .
jre.r�� R. IL
ract)ay/tlu vNv. . PadW)'IDY:ef.pt:u6le) W. it. � —. .I
4/-57 Dot1E l-10Z4s r. 1 •:>?`o h..... h l r
`Messiest*Meese.CAI,•.A Co a . _rj_. . - U13 ill4, 4 3 7
/ync r1I1n 1-/oY initra zgic•1 Pr;,^_c .:.! ur.•-
` •
tr ro.::Ja�.md...ti..sit trot, D4�+`Gi';�3� `
Sb.Limited.sod L.aSit.ds is&armthu seta✓weards or tkcias•1&erase: U
.cullaltos:
(if mil MK ear tautens u sulL.te.a) /
. C o.2 cr s<�6 e N 77 ° VA SAYS' W / C 2 2��23
1 eemi.1 .t recesses Dots
6.L(an)the mnli(i): yiPwtaiarai or C7teoprsry fO r farm !Moray ssrt*rM.Its svUr7J vos:VOW r a.ntetr/a a,saAbn..
4C or'.ono w I SA nc:41:c,:ow rdt Cnnlnortdrt Stoo 1rr6 trot t.e•o
7.Is this a repair to as faini*Y evil: f7 Yes or ONO ny.•of sto+mood tar ken p..Wbal o)1M roh two,rr.
rigs•r i row?..lMl oar brown Mods ooterrwinip+:)tbrwarirn..ti a yloln the,warn y/IAs
',polo tnairo111 rs w,Ls.erww s+...W Mee..r,wi./►r.n. 23.Site dlagrar.ss 2dilflola1 welt details,:
You may at Ne book of this papa in provide additions)well site deceits or.eta
I.Number Owens contracted:• cxsvuat.on details You may also stook additional peps if omensiy
f.w Words urartew,nr ara-wrsr pjy*rods ONLY wets dr tray cnntow•sw.)ow oar!
clear IONfr.. J 1111,14B riAL INSYli(T1ONs
P.Tali wall depth below lead tomato" / �v tnLT 7/a girt' All l'c((a: Submit di:3 form within 1C days of uunpisti.sn of vc.'
forrwlrpewile itn.# h#((/f0*v/a(.rrsyl.•W one'7(efln0') coma:z:lionto the following
t 0.State water level Mtew tap of casias: 540 - i R) Derisio■of Warr Quality.Information Proemial Coil.
ry...,rr test it sio..~i.e.are-.•- 1617 Mail Semite Couto',Aal.(gb,NC 3741fr-1617
11.Betels*daaatar: b t`.. ,:ia.) '•lb.gi (a((£• jotdi: In addition to umndtna:hc.foin to the Mdr.ts to;at
/f 1 v)vt I. t W..ai' • cot., of ..a )m. V two .' days,of Comphtwene of wc
12.Wass cosstrrctl.a m..___., _,__f f /��/ jet �-_ c at Ali •v 1s fottow•tn,
fie.soerr,rain.seep,dig:•t peal G. )
)tviak o!We. .silty, '..rj't'... ._,.coot Clause rco=r.ac,
I FOIL WATYit SUPPLY WILLS ONLY: / 163t;Mill Serried Cowie!,Rahlgh,NC 37f9f.13
13a Yhld(spun al 1 M.:..d ei t+tt. °Li/ t(4 f.i!r� 24t,Lr Weir Sumer th Wader.Witt (p Minion to soadu1Z tlw Curtis io
W adttau(M) abort. also submit one copy of this form anthin 30 days of
•
. 13i Digs1Kf[.a type:C 11 L 6 r 1 At P Amount (Sr C Z. torwpl.Lott of well construction to the totally htahh dcpaiontnt of'lie cowry
wltue co atttcleU.
..ct•io. r.4110os.r.:Dr.a nr.,:•f:swa m:..•.tr.lNet.w)Leswt.,• r; I'.