GW1-2022-06977_Well Construction - GW1_20220725

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lit-perimentai Teetomlogy �Suhsidcntx control
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.rib.I.Atitntlo Dart tanpittude in dcgreeslnilmttcslsecands or iWmaI degrees: 112.C
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rcmvlrrm4er Gtf remOrtKxex tf4h Drnrf fltc b(u�aft6ix farm. g3.s"e cynRram or rAmona!w
l'oa may use fttc bnek of th'tspogd to pravido AddifionNl well 91ta detalls or well
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eonminirtion,only I OW-1 ie needed. l'ndiaata TOTALNUM13FR(Ji"rlls ��)��
drill-ed. __---- - -
�,7Porar,y¢cl acptA ttielow Mud surlNcs: �� M) 24A. snr AO W&g, 9uhmft tltia forts xvltlAt 30 days of satnplalion of�re(i
J%nr nexlrlplr wrltc list ale d.!ptl�s fd0jar lnr{pe{rmp/�3tFiT?OU`nad sellaQ7 Con9lrnClI(M to the IllllDl
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ti.Foneltolediptnetce• v ��n) ygp,*^-e�Mnt:na WCt19: in addition to solo ft tim form to lltG txldf l ill 24n
a)Aove,gtso submit one eapY ot'this form within 36 dnys of ccmpictltm of well
AZ%Vgl;construetios maftd; ___._�t v UM)smotion to the fotlaxingr
(i r..m,g(r,rntatp._blo,olrlm posit,etc.) Dlvulon a!'Water Brea m,64 Undargmwld jujactlon Control Program,
tl(ftt WATER SI.,ppLV VVE11-Y INVLY: i G361HYil sut•vioe Ccntd•,RAtelgh,NC 27094636
Metiloq of test: lac r Ntatrr enntlly&IRFWAlon Wells; to udditlon to sanding the form to
t�3a_1flrttl(gpm) 1 the nddr4ca(cs) jbovcc, also Submit one eapy of IM form within 30 days of
Atnoiml: eomPWon of tvdi coos ucrwn ibc cgtmtp hettith&Variment of the county
t3h,pllsttofecttan type-. where constlneteQ.
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