HomeMy WebLinkAboutGW1-2022-08287_Well Construction - GW1_20220526 ECORD; Per lot-ad U&C ONLY.
less"a"'m"we'grab"&muistle"rut
1.WIN Coattrounr VW-.7j j-':"r..
J!m .......1.
r2 C/ 1� I L tam
r�'WRIICOWW!t-CA41ficatiou W..A., CO Is 0,'AWs fle-
+
Camow
X We"CAM-11111-4110.Peciptale,0: -M T MAAIMM I TW=mr::1m1%MJAt.
LUF di Owirmwo talim"aftVm";;;j"I.,
J.WWI Ilse(clialljo.11 BA;. OV. Is
W.kCmM
aler ply Will;
Powlisr-W(Howr4cooling SWAY) lu,*qy(,talk) i Or. ft, it jai
:l(CallidentIll Wft!tl Supply(tlriee)74ti tan I!! IQ
MADE& • Kznmu Angign.
IL I I() i
Ohfartitor ft I IL
...................
ft I
CGCMMAJatcr RsModtagiOn VILLFACK(ML y:
Usslwly BAITicy
L1Aquil!crj-c3s ':;;PkmTUw%1a Lvainsp
fL V;
Claxporksmal Tochxiogy ranee cowoi
ricetr
CI(k*wmd(Clatiod 14x4j) 7 7:
006011lorms!(Haiti uwuw Return) 8'-'
4-ftill W&WO)c3mmovino: k
194.Well Lota*V: . I I ///k
AM1313P A-1-KA/1 ft � Ok
F-imy0waor Nmm
Facility
Physigat Addroo.1,C*Jly."4 74
Cow), rue*:
Sb,Lamade
4611 L489k"t in of&g1mal "do,7—
*1111111(11064 is sumckma) U.Cortl 31(De:
W
ofQ.ufirl .,I
C Is(6m)the OV141) ort"rxol or CiTt'Gror'ry Oda
fifflemur/AV Awm.I AW,.b !AW 111110%VU)V-700:W6fffj"mwwmd in
7.Is This a repair to"e,"log Wall: OVes or No
V#114i"Wr jV1 ow bloom voll of A kenpowelod on pV!,0~,
'P"i'10"if,0)11 MWFAS,R*&.0, C4401r.11118,411601V VOW 511e diigran or 3olditictual well dirsaft
1.14111115bor of wells constrweizel-. YOU:UIY use the back of this peg*%;provide additional W#U sits details or uvl&
'.a JfW
A-"drorde nVelim dr me'.6.,eed, co'lou'"C! A 49019. Ym'MY also 911sch B"Mer4l r*#u "attry
M&.PWmjtowxm. . OU SnAumndTtON9
!P.TvW will 411OP11111 bdo-Imed sarfeet: 0 _J(tT 34L it -Submit that Form wrtillil SO days uf cumplefiin at wc!
wr*at,@11 dooke Tk*,fa �Vw end;Q1 go-)
I a.Slade mrstar level twtow Np of calsiti:
//-Wvr Derision OfWawr QwAty,Twformatiots Prucc,s4mg L;qij.
I 1.11016"dlAv"Wr. a.
1617 Mail Sorwks'COU*W.R&1*b,J1qC 314WUL7
LgLa, aL_Wcr&: in 14640M to 11041olil*J%'f"CO It*11441441 iti:as
12.Well costarwgia I a eq., of .,a 31. N V omm days of Cmirlotimn of wC11
fit.Poser.may. C top OCIS A ktv%vhry."No.&—Speak..
3*�ATKA�VMLY�WjLLq�O-q V. "It' Q!W '_,1111111Y.
169 Mail Service Clouser,Raleigh,NC 374JI-106
13L Yield(gpjW Me.4#d 14 Um; AA7 11A LlewcAltlbi,," 11tiecder.Welk In'doitkirt to Noble OR rwm to
tlu fild4se"(06) above, also submit v.m sopy of this ram within 3o days 91
13h,Dislakettiels bpc:C L G r I h P Alienist: winpisum or well Conalruchun 40 the rAurtlY health dc*01um of IA CCA.Pri
where Coltsir"W.