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9.otal wdl d@P belt wmnd aarfecer_ .24&Fermi Submit the four within 30 days of completion of well
�P �dlB�+e++r fie-9®20Do®d2�1009 construction to theibllowbng:
it$talk water level below top ofeasiog: a�� (R) Divtston of water Resources,Information Proces ft Unit,
j/bvherlarKlg atioreostro ore"+ 1617 Man Service Center, teletgh,NC 27699-1617
11.Borehole diameter. a (to,)
UL For Infentton Wens: In addition to sending the form to the address in 24a
11 r above,also submit one copy of this fonn within 30 days of completion of well
wen construction method: `QCr consbuctiarh to the following:
Division of Water Resources,Uu d Inflection Control Program,
FORwATSR SUPPLYwF,LLB ONLY 1636 Mail Service Center,Raleigh,NC2769MG36
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the addraWes.13b.Di9talhellon Wpe:�TN�/o gaunt: _J�Z Completionof)vdeli conshuction todw aimtthee health depmtmem of theurt4yf
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