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GW1-2021-07431_Well Construction - GW1_20210921
_ �N Lam°®�d m3L� Far al s® L WeAContagtdm•f�tbnt Gairyi.Thornpson 441&A A I for W411CORNMOW t c l o TM Aqua®rill, Inc. . . CUAPM MO t Nand rneffon Fold LHUflr2l03 a 1 ' •, LLqdffgw sotila><wCwwI daoepMftRA=cm0aft room gal a ta. J a,�I►atl�(etaiekwell aaek � � �° As&Wtutal c3eAtata01welSogaa tgSttpply) . wateraq>p1y(sbtgle) t+ToII-wamrsupp�►Wdh. t �„ l ro M e n. &qWwSwW - �' �(imttadwatcrRemadiesan ' - x- - - au► y I1►�ettter 19 ttt0arTmt a: ialTroctmology 1313obw aascemw & rt. tieathatmal(acted Loop) 137know3 13eleun Other anaeraalltwnttrlm99 4.DAteweu(s)Qmphdeda3a- �,wdlal & o; Se..Wetl i neatlamr, 25IL Faeilt maerNtttae FaatlityIDSlYfeAA� ) ft, rL f f CIrr,�hcr�c�l� �, ©Mfg;\12 11C'_ 7`7t�ltS! 9L f `�— IL 9L �wr r+awlracttd8erttoaNt:tPlitn gstosn Oman Old,ttae1NNIMrstoo>Aade>u) CertlrtcoGlaa: &h(a,)dMiMR(e nent or m DOW 7.Bo poe sit tlepatr an $Ysr j;:%(Mspbm4 llrMSy tooaw de'ttte IN um{tray eomot m awaidmw ataftwa. Dyes or �o tNlb3ANCAC01C.0/OOorlyirNCAC03C.O1DDJiLIiQo glmr�mrr rattdl6pla �r6�etra,ytao-.J�oarl�m+c�rar�l�,�anda�ab+rhenaenetddm ��'4�rutsx�eeadn®ebemepevrafedaorke,exrtowmr. „e ,rn�r+atl,m�ntr,a�r,o,ea�3trd �tMa�sm M.Offs dta nuo,oraddla neBwalldatia0e: L For GeopmbetM or(led—pp Cmeamd Wdb 1-tavhtgt>ta same You mar use dw but ofttda pop to pra Me addidand wall site details or well cMwMwft only LOW-1 is needed. lodimte TOrALNUMM oNdb. consnuedon dstaft You met►do attach additional pgas ifnewmazyw.. _drilled:— t ' 96Tota1"depth below landsaafaeat_' `1�5 r UL FW All tlJtO Submit this ftum Wdffn 30 days of completion of well F&md*k wdk AnaltdVda pebw rompr&s@mswdj@Jwj tathefollawiOF 1tR BfaNc tavel below top oftmslag: 5C5 (Q Dlvtslaa of Water 18esonrr•as, an Pmcemtng Un% f/ht�aerlw.i/sadroveaerr�,a:a•+•e.� 1617A�5aIIServfaeCeutereHlaleigikNC27®4-1617 ' iL t$orehole dfmmetet: (6n.) 246 For Hnleetlon Weis: In addi m to nuft the farm to the address is 24a 1Z wen a tlon meffiod: above;On mft&one eapq of Mb fora%willdn 30 days of ampkft of%veil �� consnuation to the fallowtn� fA�.��dtnmp+uheral i Division of Wafer IIieaonrces,Bin [ hd adon Control Pngpm, FOIR�DATt3R ffii>PPLY WEli t�ONLY 1636 Matt Sarvlce Can m NC37M4636 13 L.Yidd(gpm) oc Ketiwd of t����"��E 38a�•ffM annaty At lniaetion�Idt� 1n addition to sending the farm to -�, the addrem(es)above, also submit one copy of this fluor within 30 days of .13L Dlelo6iegon typo A 0, A..b completion of vMl consoeuation to the county health depaAmem of tho cotnyy . wheretamsttucteL j FocoGW l NoalhtatolhtaDtof>invYeattttteamlQueliy�DivtsionaFlVaterYt�oueos I� I Reaieed2�l6