GW1-2023-02386_Well Construction - GW1_20230404

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Nitre)the wdf(a)ppernsaeent or 1:31TntelmrarY
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ftlafris� Irairtopnp� plies orVflo ByAWN3Mb.fora,lkeettp. yyovrrJWr
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s.8.For ode, D1Ta• 23.Slite diagram or additlmm/wtil
For Nana he I TOr lQated- p w'asal Wells lining the same Too may use the bock of this page to provides tzinal drilled'
needed. 1spdj TOTAL NUMBER ofuclis convtruclmtldam7s. You may atm additional we11citnd�ulrorwWl
`� ! n Y ofleclt additltmal AtlBes if ntaccssary,
9.i'ote Well depth i)alawland maraca t lV . 1 f17TwT tt1SiR_ TI(17�t1
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1Q_&atiQ baol dlrFltt f er�rfe0SYS -.10200 41 n°7 (�) +1•!4[AR►Yalu; SQIS:• fhb tun)I+d4tun 30 daps of
I "�r+�velba!totvtapafcatsiagc "+c+9tmWon MC MOMS:, eompTalion of well
lxnlar ni %R n'I me „ ` 00 Divttina of Water Reswtr
1 i•Ilorodoiediametca: !� l(►IT Mall Service lalbruatJon Prod Upit,
fin•) Center,Raleigh.NC of 69-1617
I2 WeR construction me /� 2tb.Etnr t■trcrroa /a w In addition to sanding the form to ties
It a ate; S: .dean Puala.M l �l�l���.,���� above,alto submit ane eoP3.of this farm whithi 30 days oft pl o addosin f yv�Ht
+:attstlt►astim,m ute folroaring
rolt WATER f+IV WELLS OivLY: Division of WrAter Reawtues.11n i
I3at,Yield(RPar) i636 Matl8ervlaae Ca dcrgroltnd infection Conn/Program.
Method of test: ',Ram.NC27094636
qggiin 30 days of
136.Dtaiafcction Intl2.1t.Itar►Ilhfer Q »olr•&iaFaett.�� Ill+tdd#1an fD sanding the felon to
Antonin: a11thess(es) above;. aiso submit one copy Or l ig form compete/ion rifec0A199aeta3d well constonsion to fhn county hcaUh dePtmens of the ,ay
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