GW1-2022-07178_Well Construction - GW1_20220729

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-6.bort)the welt anent or DTemporory .rrgrrlafj hrnel,,v red/j,Ihar the lurft(4 u y Aofixr)MALO> aecvrrAatcr.
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7-Iy tlliz a repair to as exitd ag well: cr,P1,nfilds rr!r./,nl Nos baA1 pro10W 10 rlas will!MwIrr.
6I'011-i-k v repair,,frl►ow known wall uonsin,ellnn i*I- lfan mrd rsp/nirr the rrnnnr nrjho
�1 Mee tHApratn or ltdditiottol well aelili9:
rr,mir render All remora a wstlnn(jr mt rin:harkof►hrs,nrnr. 11sc plc back of this pale to provido additional weil site details or well
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R.For Geoprobe(111PT or C wvd4LQnp Geotberift)WAIR having the sane con9tnlctitxl ttrtails. You may Also tt wh addi(ional pages
aMainrctian,onlY I GW"t is needed. Pndimoa TOTAL NUM13FROf+�Mls �tRR,�t�grRLl(TiQNB
.7rntat well*PM tteloly land sutaNcGo --tR•} 241a. her a Ids tt ifs tome within 30 day9 of emnpletlon of��elt
9.rats" lc r rrto l:zr ari d.!ptlar didbr,mr(rsamplc.3 94A•oust�Id lntr'1 ennstnictttm to the foit"Jing:
!0,static tvtNer 1cv41 beMw top of casing:,_ --<fc} Diviaon of Water Restwr"&1111%TmAdOn Pt w1'Ss<+ volt,
AfrI7 iYhfl Service Center,Roth®q.NG a9k94-161h
I/'x are r fan:!!x i+hnve caslnp,rrte"•"
^ I lei adon to&ending the lbrm m due ttddralm hi 24n
tt.tlarcnottdiamettr. --(in) 24t,FnrJefcsii!?BYP A-. oPtliiR fimn WiUrin 30 dW, Of comF1e0(m Of wdl
above,also submit one copy 1
t2.Well constnietlon mallbod! 1 el)ngtuction to the following:
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I1 nuycr,rafiry,cnNk,Qlrgct pltah,ttc,l Division orWater Reemtm.jUtidCt ground><gjettlon('patrol Program.
iYf111 WATER 8[PPLV WELLS F)1VLY: 1636 MAN Servi x Cenw,ptateo,NC 27# ?636
l�� 11it!Llund of test• a�.eely&iaiet:Hoo Wefis: In addition to aondfllg the tbem m
1Ja.Vivid IRi►m) the ndQr4ss(cs) abovo also subrah one copy of this form within 30 days of
1)I.sinfecttnn t Arrtorme: comptetlon of+vdl constaudion'Co the wants health depattmeM of the rAuftty
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1`0011 Gw-1 NarrB C`nmlinn I�aparlmonr.of tinvlrlinmr:o9nt f�uallty-I�rvisron of Warcr tiatlal,rcalr iir!utlfOli.2 Z2 10i d