GW1-2023-02310_Well Construction - GW1_20230331

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. &Are aoprohciDET or Closed-Loop deathertnal Wello having the same You may use the back of this' Rya to provide oddities:I well site details or well
constrataion,only LaW4!swirled.Indisate TOTAL NUMMI dwells. commotion details,Yen may aLeo attach additional pages iftwoessary..
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%TOM/Fell t.,,'•.haw lend swam; • • • Ft4 .24s.Za_611__Welk Submit this faint within 30 days of completion of.wall
Itmittiplesser Midi depthsfelifitrata(etrawk4 e. Cr azuf Wan construetion in the Mowing:
gp„6,,t,.water level holm top(Maslow 14 6 Ota Ersufsfal Caroms.nesourcoo,.,0•ok-mooloo prosustoE unk from lea itabovotafis WIC"÷ '
1029 Nail Santo Couto)'''..VA NC 276,39416117 •
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IL Iliscer a le&mem 6 lit) 24b.For Ideation 111/,'At In addition to saddles the!mill to the address in 24a
. above,also submit one copy of fent milltiza30 flop of comptedom of well
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..,- __ _ _ • Division of Water Resonate.%Untlessmtind injection Control Program,
It ORNIIIATER SITOPLIFIVELLS ONLY: ltin• Moll Bart/ice Cents%Roletti,NC 27599-1;t2
.132.161eld'TA Lib • lide,,ed of test c a-ds4 lit -- • 24a.For Wahtr Snooty&Merida T,elk 1,addition to morligs ea tom to
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. •... „,• Q,„ the address(es)shove,sitesubmit we espy of this ibilli within 30 days of
.326.BiClerecti:an types:IA Tti'lb'zs, AMousg: (6 •,'''.2.- completion of Val g ovstenatiara to the county Stealth&pattern of the count/
ere constructed.
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