GW1-2022-01122_Well Construction - GW1_20220107

828•-622-7241 PA
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R.I%nr OmPrubrtOPT or t`.traed-t,nnp Geolhcrmnf Weltit hAvimt+he cnw7c 1',>u InRy III ilu:Nick of this page;to provide additianill well Rite defnik fir rveil
,:,)npmn:rinn,only I GW-I is nreded, indianlo TQTAI.NUMBER of ucltc rtmstntrAinn tictails- You they also mtach adtiitit►nai pA)dCS if tlect"aaary,
drillui:_,_�: �rntlutry,�,�,�„�1TAfw itti tf[�UM1t6
`'•lrntat wotltkp�bRlAw land surtke-1J�� � Submit this'fbrm iviti n.30 dBys of comnidn of well
f*-1'1eaprCircift fill M:drprhrfPffrru»r{erne d(nD1+1rd.o•100)
rgllBtgtt:iinn to the fdloicing;
t[I,4tntir wMrx level below top of cr1>iilige 5. ,v _V__(ft.) Afvl;inn of WsraYr Resouraea,Information Prot Unfr.
!!e•+rh r 1��ci Jx,rhnox anrcng,to(- 'n 617 MAR Setivilee Cil"ter,R>ttdgh*NC274"•1617
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in addition to 5amtttng the fitttt to We gQAafi+rt Ni Zen
f?,Well rnnstntcitnn method: ni>nve,alto submit oar copy of this firm within 30 days of completion of well
-•— -- constttietinn to the fallowing:
(,c.nugn!•,rnmr}•.r,+Fk,d'ircct p,alb ctc1 Y�-
f)Ivislon of Water ReSQUrees,Underground Ordection Control Program,
tYNt WAT[R St;PPI`V F.U-4 tNNIN: -`T -Y--- MOM b"IF 4ervicr Ccnrr,RAtelp,NC 27094636
132.yield($nit) 1 �. talerhnrl of leer, --.--- 24t., ;r-Sanely,-19 rpiccnon we ft.- to uddRion to;tanning the bm to
tilt: nddress(es) Abovo, also submit lone copy of thfp tbnn whilin 30 days (if
t.tn,i>IHnthrtim,i type �, Ammrnt: _ r:�mpiction of tivct!c+roatrrr,xlon to ilia cotntty haute depanrnrnt of the minty
V-t (`WI North CnmtinnMitimmmu.ofi!n..•trnnmrrtoi).,);,silty-DivislnnnPWillerRnynlitaes 12ru(teA224_2AI6