GW1-2022-06466_Well Construction - GW1_20220519

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Oembermal(ileaoriwconffng SupPI�') Residential WatCo Supply(single) ft. ,•,1 yu'�
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Non-Writer Supply Wells tt, fr. ,,,--------.—_—i Recovery tl, h• _- •._.—
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Aquifer Hon 4'y.,.VI •AC. , :••:•:-:_1 ..umTtcntw"i
(lroundwaterRemedialon n .y_.? - 11�s lei pc.
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.n.Well location: �0ZD r.
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(livendindrine W(n$tisu sufficient)
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l.454 ir::ACi n2C_I1 i0r!ar 1SA NC/IC O2CJAM Wert Conx(mmnn ymadarde mil inns n
7-lit rids it repair to all existing well: Ma orAINn ,,rl,l,aims word hoRirra4 p►avkhM to(lil weft Mv1tr.t.
1,ntrod tin ryrn(r.,mint tsecknown t)or On
baolr;t insforhrn rnrrf rspiniu ih r ntrnc nl rhn a p' g=or additional wall rt tellst well ante details or well
rr'rnlr tinder s:t ramnrks secant)it do(tt:hart nf(h(.rfnmr. use(Ire luck of this pwwd M provide additional
Too tray ifneaessds?
R.For GmnrobeMP w r aosetl-i.rmp Ged er AI Wells
eUMBFing Ma ante corg.n/c.t nn details. You may also attach additional payea
t�nnsmrctien.anly I GW t is needed. l'nrlieolt Felt
9.''Rao le w depth Wow land BuriNcc:,,..
CQ�� ^._(4.) 24st, For Ai We t &dunk this foam within 30 days of completion of Pell
Per multiple wax iitr nfi(loft jdltT'ertnr ibcr+arph:-3!'TRIM owl:4l0dq crtnstruelinn to the Mining: ��Information RI'OCCts�Unit,
-_(ft•) iMvition of Water Resu, GTh Pr t_i
10.Static watercokra
vet below top of taatiag: - — ' i417 Mefl Service Colter,Raleigh,
�f a clef irmr!lc rrMry C(>{•Ini we" ° ( to addition to sending the Wm 141110 address in 24 n
EL 1Mrchnledlimrter: CSC / (in.) 24h.0.aen Submit' �p n f ad:
i tonn within f i r t iii odd of Well
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i.Welt con .cable, rent6pd; .` 1 � caostruetian ro the foIIOHinM
(i c.auac,Min.cable,Oren t phone.) DI 1I$ n ofwster RM �tlh Underground halet:tion Control Program,
1G36 Mall Service renter,R*leiglr.NC 27094636
MIA WATER,SLPPt.Y_IWELLS 4 IN: in Addition to sanding the form to
i'2 e.r• Woo r SMID ��FSIC'tT �'
13a.Yield IRI►n►) • Metiurtl of test:, _ / — - rile nddress(cs} above also submit one cope of thin farm within 30 days of
Amormt:• completion of well cr oston:don to the county health department of the county
rsb,1111srnrcatinn type: --�- -- where oonsrnienurt.
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