GW1-2022-00999_Well Construction - GW1_20220107

828-622-7241 P.1
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Well rolmornation INUMC-M TN
Permit I):. ft, In.
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DAgrimlittral (miallm bile
71C-Mll M11111(130thIgM.11TISSUpply) Residentint Water Stipply(slug1c) in,
—11nd"51fiall/commemial Residential WAInt Supply(Shared)
ntion
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KI"Offorin Recovery
Aquilh-Rtxbfjt$p. E)(irolindwnter Remedimkin
A qui fer Storage and k"'Ovary E]Snlitlity Ontrim
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1,A If I nd r.and iOnjtIj 11(It in deRroestmivatacJ.occartds or dr.ch"A I firg
(c,1VOT Gehl,one 110ong, 'r V
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­-W.-iiemmetar Date
h�(Rrr.)the well(9) ma"Ont or [MiTemporairy ed
I hart p cy0fify thill Me liv.41(k)w4r!War,?)mmmifted m mimfow.w.r
this A rrPair to Aix eximittlog writ: FIVP, or tr�No OXIM70 or MA M#-Ar.fi2(2.f1)11O IVO.11 SIRRI/aNf.4,717d that,:
P-7x Urvirder Or site ditagnm or pidditional WWI dMIb-
A.Plar GenprOwtarT or 0(m e.mi-toup GeotbermAk wellit boving Illslinji- ;,11 may Ilse.five back of this PARO to Provide addiflonill Ividl site delaik or well
I GW-I is nerded, I'sArato TOT Al.NUMBER(jr-wrils conitn](AMI details. Yen may also mmh 011119nal PRF1 ff nmeffiftry.
-well Imift tend surfiv.c e: 405 Ar—aft—wft: Submit Ifils thrm Ivitilin 30 days of compfcann of well
comiTlIVOI)II 11)the rollowing:
Ik StROR watrriftell below top arpswing- Division of Water Remurattt,laformuflan Pruemning tjnll,
1617 MAR Smilee Center,ftleigh.MC276".116117
'141s.Tar fallerflas WAIIA. En addition to Sending ft firm to die addrm In.24n
17-Wet;mminiciltln Mt!lbnd. tionve,also submit one copy of this form within 30 days of completion of writ
'
-A-,rotnrp-eme,direct r"1311.CIO c'
imNtrtictinn In the fallntvinQ
f"00 WATRP.q.,ppt.V Wr INvOlon of Water Rracurve.4,Undeirlground Injection Control Program,
7 636 roft ft SerVI M.C&nttir,RAM41h,tqC 2744W11636
t.1n.Vicki(g ad of rest:.pin) Imeth A-FRIJOgjap WAY9 In add4lop to Itinding the time to
jorlinfl-clion type" Amunt: On addrems(es) ahovn.- also submit one copy of'IhFF form whAin 30 days nt:
r.,impletion of well cov.,umcdon to thr'connty 11CM111 4aparlincrit or the m"111ty
'Imra wimmetr4.
Um North Gnmunn vern"Mmu. C,!x'11I1? Divislorp of woler Rag"Itucs
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