HomeMy WebLinkAboutGW1-2023-01373_Well Construction - GW1_20230208 9 '
T1e w tv tsel Jltrsm*o t4 Mwhsle eeelh per Let.•1d Uet:ONLY.
1'WIN Geltort:r
Wea'•;r•ebN+-+r "ter 1 •��..� Eta�.._.-.._.... .. -
� 7� •. /<�ri . ��PvYi
M
K Well Coearm:!.C'46ee16;w
�
LL97
`mil r �
.. _ t:A/M R
gyp
7 Weft Qa PO / A16- r ram'
arrwAe�Tenon/:w »uat.
rL/d�gpiNwW yrrraMpr•��tiirr/1.c rvwr. --
J.WIN the Wwrli teal -
aler J1. Cil V — eurerru .; uy
_is�•�._:_.w'\M: r• R t� is '�
�dar%l+ten+a►(Ntrsur 1 -' 1
��y+`�`i��SvD'vly) ;Z�tcttder•tttl ct!accr 9ctsply(;ioi(p) t «• h. !, 1st
QIndV�t....vKVRrifal Cittssldtntlet wA!tt Y
$yp 1 I 1
'JLti tan F
NN WalvdteA.M WrSh _V_h_i-
QAsonleor - _..GRecortry ..
.. _ I
ft
OAluihrRwh rjs
Ot7r0u.�dv►�tcr Romedlat,on ViL! N• i !
QAsti�r Stttrtlpe,tnC F..,,,y Ustdio)ly Darrur
eAgdkrrm n. Ki
� C;Plurtawatar 13eeingo
i C3Cxperitcodd TacJr,,wa I QSLb►;tsnce Cotwui a A i
O(kgOwmd(C)nod Lea,,!) l7'racer +tt aJ '' tM if e,
040o— ther—ma((Z(Mtl ' pe OUs,cr ca lun tavJrr r2!lcamarlul h 016
lisp WWI)CS•ap4 CNd: °�3-acr-tt h
So.Wei)1-0ulfer: ¢ w cS 0.in 4-
��' -
C-l-e,
n,ewyrAre.Nw -..---- 4L"• 1�p fa "(Ate
F•t>iliy tDY:,r,.aFc.et.l i
Cee.y � atitree::Je„e.i„eti.Ne.
WWI _ t •..`I, •__.` ��-' V � 2(l � '
�-
Sb.Lrrlffsdf and lwagittr�c is�edereel.ai.steyeeetiae or tkriwl I• .([roil Eel4 ooe 1ftAey u wt8ek.a) dermas: 11.letT shoo• i� t ,+r,r,<.• - a;;:;� :r,;t
------`"
Wit")the weigh) Ctraneteeet or GTttaporrry ofCwn,fe/ �trruearror Deco
4
7.Is IW A pat / Ibnrp'seeltp�Arr d1 svUftr Myer;eer.J QMW'W.d 1A dMMAJO.e
pair N u esiNiag well: QYu sr
GNp r►M/J fK C 0?^.OrPb w/lA dC'tC'IX,'Q7pp lLtrt.,alrurrrwJAfA,i,rbw(,::u a ytArr N I f y,Ary,�!/oe0 rJtlorrr Yelr oOH+rs.S1p1` r r1►�'of•y+eeori atr Mrn/rw/bI q fAe wr;o+wr.
n/.,il�/n r.+wo/J.Ir<'eM Y M..e te.J w•1� �n rwu ey�ofn dk,morn R/rb
2).Silo dlegrame or sdd3liolial well deteW:
1.Notaber of welb coutre,eud: You MAY u►e Qw book of iWit page w provide addlricval wou site d4wis.or wotl
Awr"•hole$"elm s r...w.r sr c*eulti!.on d"Ji. You.:.y duo abate a0dltinnat tygu if tserasnry
Y r� trelb dWr_T r/f4,Ar awe cwaw+aw..you aerr
r UPC 'JAL Ins -MONS
�.rw11 we)hpl below I.ea..rt.r.: ��d
IFNAVAfW-VAVi4,d/N,wA#(fftrry,u e,n , (hj 71L rsr All ►yi: Suit this ►iMrnt wtiiila 1C days Vrcumv leiiin nt
f role••W�'.n���,t/oo•) const:s;cl�on w tJr ldlavini
1a.31alle•oterlevel below top )rw,Jttg: J
//"ebr lwl4 ai"..r;.e We - iRl Drririoa of Ws¢par(�trrUry,irtforw.lioa Ttviceesttag gait,
1r►17 asaA gor.ica C..aw.AaMlgti,NC 27Nf�lil7 11.But"dlatretar: `r rtia.)
sb lt!£i' rL�eiitt in addtt"an to K'WMg he:o•m to l!tt iQCreli 1n:ae
U.Wa0 toatirectLte tw.�_. / `we a. I tv'.af . cq. j,of „r par. , u w1a .' days of cotnpjgem of wou I. _. _! /f^ L
eeter,tatry.hWe,�•.epWe. 7 - Q-/ let�`� a n1 ,e;, a 1► t'o:towtn,'
pORWAtYl1Yt)rlLY WZ(. - / tJ,7efr o!w..
L. O*r1:Y: •attrY. 'grr--. rselioaCoatrsitfcornw,
106 Mail Seeriee Cw4r Rolelgh,NC 27011.163d
13a Yield(gpaa ;, r
Nle.:iW Null:�OL1/— rlU wh 2k.Fir Wa v d air.� e iet:liy Wel
the tdbcis(w) abovs. also'submit w.w y*y f thion to towAthi tlst Cum to
13L Diaialtetln bpe: L G�^I h P Aneoaut I�' Q Z uv*plsuon of we11 eonshtiotlon to lbe w 7 0!this form want 3C dacc of
r
where'Cocau,tcled. I. i tM health depaiatw-nt u, Ise:cw�r
trJhCen:/.:Dryan-.r�.r7sWMt.:.•. � i
�.1 Nd.wt aeewn..• r.
r ��