GW1-2021-03714_Well Construction - GW1_20210823

828.622-7241 p.1
Feb 1619 06:43p GlealwaterWeli Drilling
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Physimtl Add .a,City,and Zip z1, AR 3t C.qr
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Elves as No n•r1h)M NY-AC'02l.8/04 en 19A�YC.AC.02C.-0200 Well Cmtgrmreart Slaurr/adG rmrt rhm er
7.to this a repair to awniydag wdl: rofgr nfllrtr na»rrl haaebre°P1nrMeAlnlh+t wrlr mvlW.
lrtld.�is n ralaolr.jilt eutbtnwn ntsB•onstrnulnn i>dprmaltunupraDf
r,,wir under a:t remit*xcow nrtM rlrc had Of1140arni. ; u diatleam or nddldoatn!Wctl dotWO SM
8. you may USO fltc ba&of ibis Pw to Pic
f nr Ceoprobe/llPT or CIM2d j Anp Geolbertmrl Weise having the same ci nitruction ttrtaii du MV also aMb ad Onslwide �p n9l IfnMMMY,its rn well
MITIOntction,ant%I CAW-1 ir.needed rndicatn TOTAL MMSER(jr-milst
9. �3,3`J ( .) ilia. Enr Ate, 1ft. Submit this fbIM tYillnn 30 4MS of completion of well
7rotat weA depth lmluw land surlitsat
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(ft.} Division of water Rewurees,lniblemadon Pracesa�little,
ill.glade wat"leret b&w top or"Slop 1617 Nbe115atviee Cegltal,041ftb-MC27#"-1617
1/'11 nldr IM,If e+hne caring JAC
fit addition to handing She ibmt toOf�� f a 1
Il.Iloecltotrdfameter: O r�-�{�n') +sfooy4 g�submit one copy of thisifwm,Within 30 deys
12.WMi Canrtraetlnn Mtkade y+ "'�" cAaMcf,an m the falinwiV
ti c,mg=,romty.rnnk,dirm-tP sh.6tc.) DivUlon ofWater Rta4 Mem Uidergmand lgfeetioa Com M Programs.
FOR WATER Sf Pi7 V WEi LR ONLY' I636 Mail SWAM Cent-,tiatelgk,NC 27096-106
t: 2iC ' ialeetlon Welly In addiction to wading the tiam to
sr vdstcr S.ta�L
13a.Yirld(Rpm) MethnU of test:______�_--- the nddlyss(cs) above, etsA submit!one copy of this fomn wrihin 30 days aP
redl cons"gedon to the cmmh health depamocat of the COwMY
13h.Utsinfecteon type: ,AmlotroC ution .v
who onternw
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