GW1-2022-07599_Well Construction - GW1_20220817

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Page ttach a tde onaltio, well site details or well
g.Total wen dep6-below land 2 7 You�Y also attach additional pages lfnecessa:y,
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1'e'Serlic wStI awr�eer/6elm top of e"I".. �� conatntcti llo-%b t this form within 30 days of com
pletion of well
11.Borehole fsmeler. Division of Water Resources,YDformaffon P
fl3•Wen contraction ROT (in) 1617 Mai(Borrlce Center,Ratelgb,NC 2709.197 meessin n�
(i.e .,contraction dod: ARY 24b.Eor 1n _=+ addition to sending push,eta) above.atso submit one copy of this tbnn within 3p fO to the address in 24a
FOR WATER SUPPLY W 60nshuction to the foffow(tig: days of completion of well
EL)�MY:938.Yield(Win Division of Water
Method of test:AIR ROTARY 1636 Man sa ddee Con rSUnd Ijefta Centred Pragrap4
13b,D •6R�elgh,NC 2769.fl(,Disinfection type: HTFi •' at $tUppty rot
Amount: 2 yp the addnomte6) above, also submit LINE- m addition to ae
completion of well conetructton to one copy of this tbrDi within �to Forni OVU-4 where consitucted. the CDunty health department of ou of
North Cantina the county
Department 0MVIM1tmm11ml Quality.Division of wate,n.......___