HomeMy WebLinkAboutGW1-2023-01142_Well Construction - GW1_20230126 BM622-7244
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R.t nr G rnhe/pp(or Qta+ed-I.e►rr Genlpu runt Were having the ct+alc: Voo may,m tiac Mack of IMS pegs W P Dv,do additional well site det/11.4 crr well
,xmanlctiraa,nnly i CW.i is needed. Indium4 T07AL NU14BER Ofxvclis
comtrwAinn cklails. Yon ropy also MWII ndditicTmI pages if necessary.
1' 1"Itmt TKII dkpth baiow(Rltd 1=1IRM.^__ 9uttirtit thiv ibml irNhin 30 days of eamplrllon of well
For ncuhlpfo wa),liyin/id yrr!tt ifpl�farant{rranrnlu- 1MR++ads r�ttna l am9lNC60A10 the T0ltQS*E:
tU.Btotic wFkMrIMCI below top of Mgirrg: _ —_ -- (1t.) Div1161?n(Watertvee[eem 11 =1111t llin (t9p-1 i7)nil,
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1i,1)orrllotedlalnrtcr: l-'-�� f ! �(in.) 2®�Rae 1■ierti/l waL1a< in addition io r�ndllag the lbttll Iq lt1E tlddfalet m TAn
rlbovC,gbo submit one Copy 4P this form withinall days Of e0fn}Irs}tttt of Well
17-WMI1 conOrlel(ao m abod; i ra,nsinidion to the f4firmlliti
ll�.nugc•,mhtry.oahle,direct Itt1,dc,) T �l�l orWrate 8te0it1iY3r Uniergtoand iejmflon Contra)Progra(13,
Il0+R WA I'RR Rt PdI't_Y VIVELL S ONLY. � 1636 Man Servl"C't mrr,Ratcfga,NC 174IW106
Kam{ 2rM. Ilor WBl'r�rtIDlf&Irtimtlotr W} : in udditlen to sanding the ibnn to
I3a.Yield(riper) 7 i►it!thad of te81t
the eddrass(cs) -1130Wi also sumnu one copy of ihi9 faun within 3G days of
13A.Iilsietectlna type: Amnrmt: _-f— WmPtation of,veil corm etion to the county health dellatltTlelit of the araurin'
._...—_- •••"•••�••�••••••• wlxttr_co7Nnrrated.
F—I(jw--I 1JartL C'.nmlinnDaparimnnt.lf li,rvlrrinmimtal Qunllly-INUNIon nr Water iincoarcas Redlled2-22-2M 6
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