GW1-2021-00518_Well Construction - GW1_20211222

i
MGM M-2 PbrbImmdUsezw,
L WM CbataacforIWbramdoj:
GeeyThompain
WdCnwwNm 449�1 • • . i
t CwlIItmmlNdeel��
Aqua DdII, Inc. : . Affn '
M �.
I WaII camodospalwitttt�Q��d '
36 WeII�(aba�weII Weer . 0: Po 10.' .
alert WeII: 7' - ;.
Gaotltannel IHeaNagl�olfa$t)tgp�►) 1 weoarSnP*(sbiglo) a IL
AL
IadudrtelK7otnauaoiet aeiwatersoPph►W+
in
-30
tWaterSnpp��tetp. I'll r
IL v
hrledwpMeb
�cieo dwae�ltmnadial►ea 916 M
w y �lieli4tly8aaaer a
Ideff Ten
ftmwTabwojw 13SA aseCoatod err;
t3eatha mal(Closed JAM) Q1Ue V D G
l3�ermel Ratmn) CLcftLggLam nadoro ltmrrarlm) nt
� err
O.Dept well(a)QOmF t.� 1 7 A MM f�
Sa..WeIIlaeattoas . . R Po �
&loillyl0araastVmae �W>nYtiFappttastt]e) � � �-�: ,:5:
... •47,� I�'ri,'I ���rp `�,1 �I z�_ C c nY� ,(1G t�9 se a� t��A ,z
��rScJJh
mob' ear�lyd�aaea►aeaxa.t�un �,=-•�r:�.r-r�:. .
56.amfiludaand taa�ima:m de rmrm�Gealieronds os•deereml ere s �� '` �`•'', !r �;
(tFlrali ftetd.�ae tedtm�gia ateoq 2L CiMearlow
6rTKa�)Poowen(a rmaaeet or�'empomw SrBeeoaaeF well eeaetar Daro
7.Ietbtearap*IMnaashttagwdb Mai or 0 � NCACUIC.OJa IdAMCO2CA10D�iFd/ aw*#* . .
- .--�lldeaea�.J�a� ,�l�uame�ura�la 't�asaatmealdle ��YBINtesaeetdA®eBe�c�,alpenleWdedai�G�eua�ltl�o�.naeis
A .._Ii�i1A0{fP�lf� lal'tlpd�sdaa44iYht,fye,• �aSttadla�mora+ddlIIoaellydidataper _.
L Aw GaopmbdBff orqUd4,=p&oftnmdWdIsImftdion= You suey teas the back of tbta page to pmvhte sddidwd well dte details or wall.
Mdowfolowa*LOW-1 k needed. l iDTALNUMM ofwelts ooustmWo r daeft Hon may elan attsab additioud paw Iftwomy .
8�1C I depW below tend eeaPaees_ 965 i1L) Ua• Aft�!e>fss Submit dh himwAdit 30 dW of opladon of wdf
Pbj'+nah9tlemd$lataadop�sp near J@M-wd2@100jconsbw s
14 SteaewatwIwd below topofastog:_ .�•�,� (Ira Dhfdoofwatar�Ourees,ft&nm tenPwcw tab Un%
(JYraarrh�velaat'ravee�sae era■ �• �"'®® .
1617 MR Heave CoMwo RdeW NC 278961617
24L jtor Inkft In addition to s ouft too fmra to to addmsa in 2ft
above.ado submit on espy of am Porn�withia 30 days of ampietioa of VIMti3;waII ooas tea method: a ® emotion toga Nowioe:
(csaaesrarmgd�,d6setpuPo,easl '
FOR WATER APPLY WELLS mqLg Dhisfen of Waier ftworcoh Umkqpmd Inj[udon Cbmed lrogroah
`M.Yidd(gpw) lW l dhad of fth C�Ch�-T;tin 3<8.ft Walar ago*A Infection®Yeltss To addhion to soft the form to
13h.Dldnt3selfon e:_ ITN%O% the addrma(m)dw4 also submit no aopy of Ibis Porn within 30 days of
$'p Amoana.= 1Coe, n compledon eoasmauetd eonatrrrsthm to the health departmaat of dm aounw
FamGW1 xeght:amltaaDeparema4aF�viraaa►oatelt)uelip►eDlvlsleaeFlVat�lta mea8 Raulmd2�,1016