GW1-2022-03379_Well Construction - GW1_20220314

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cOnstnrrtinn.once I GN'-1 is needed. tytdicate TOTAL NUMBER orhrns consumetion drtails• You may also attach additional pages if necemmy.
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9:7'ntal well depth flow land surface: u D� (R•I 244.1FQr-AD relic: Submit this form trithin 30 clays of complajon of well
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10.3tn8c water level belowtop of easingc o (ft.) Division of Water Rears rces,Information Processing Unit,
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o suction Wens: 1e►f this f m twit ing the days
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1Z Well const►uetinn inethath D above,also submit one copy of this form tvkihin 30 days at'ewnpltxltur of weal
G c-auk,mtup.cable,dir"I push.etc.) t nrt5truetinn in the fotlntvin�
inR WATFR St PPI V WpI,I S ph11 y, Division ofWater Rtanurra,Undergraand Injulkln Contra)!Program,
106 Mail Service Cenrrr'iRidergh,NC 27609.1636
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the addtcss(es) abovtL also subm4 one copy of this foun within 3o days of
t.iA.nistafeellon type_ ^, ArnnvaC eDmptetion of.vell conswction W!rho county hwdth depanmcnt of the enunty
whcre constmeted.
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