GW1-2023-01440_Well Construction - GW1_20230208

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constriction,only 1 E3W. P z@otherttla➢Wells
having
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drilled: 1 is waded. hidicate T®TIA1L g the same you its OG additions➢well decal➢s:
a_ 1,R)MZ13R of wells y u y use the back of this page to
-1 .111,1➢eve➢➢de s action details. You may also attacph additional
page well site derails or well
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(�®i'saainge _� construationt o tWhe following:it this form within 3A
'in°L O•GspO➢e�1¢a =_ days of completion of well
1 Division of Water
— - `=-�m 1i1�°9 tFo891Vf RHourcea,Information lfroeeas
V.mgel'1*o©seraetiOn method: ROTS aft ScrIfte Center aging
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(i a.an�Ci;i'ON Mille ��l' 2-fb. ®r ,Ra,l8lgh,WC a96M� 6H9
•'gtpr+sh, above, ° !•t In addition to sending the form to
�y .= also submit One co
_U— - -- _— �g =- corlshuction to the following: of its torus within 30 days
�e address in 24,
PTLY V✓1EI.g,S®RII.Pl:Ilia.Field ��-�-=s g Ys Of completion of well
6sprta) �_ Division of Water
ytesottre
z lwegutOd of test: AIR ROTARY 96S6 Mail SetvBeo� enter,�atld.t 82h^IDl©i6tGeetial . �Y14 a ➢elf � 0a Control_ �'Pe. 1 —�- 24s. e�laeea su gh,NC 37699�g636 rant,
Amounts 1x, the address es 1 d` c
above, also submit one! Yn addition to sendinMft
g the fonts to
North Carolina 13eparhncnt OfFnvironmcntalvhC1Leonstructed. the count rfr within 3U days
Y health depattmen¢ of
Of the county
QUality-Division of Watoritesoureus