GW1-2023-02470_Well Construction - GW1_20230404

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NE Well Eastrauer Eartination Number
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if I fperimenml Tidmoingy DSubaidenco Comrol ft. ft
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7 i.l His t repair to a6 By aloft this form.1 hwrhvovt0Om!the w l(4 inv Grand A in aienwe
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8 For Gcoprobe/1aPT or L! 23.Site anemias or additional weltdoanna:
4lmimcelen•aNY I GW-I is needed, Wines TOTAL NUMBER t n/ellg the lss c Vett may use C0t191rUctinn(Retails.he Y mayalto attacof Ms pap to havide addltionatt page well site details to well
ddlterl: __ Pages if nexxssery
9r Twat 1 1lefeav land sulfaca §vilM17TAIa 1N TRII not
9, wat w 11 drob hdo Jar CO%� ` (IL) 24e1. Iron Alt
trdgyerene r� -3Qa mre.4tJon? Wolin wing:Submit this Oros within 30 days of completion of veil
ip,Static construction maw follotttag:.
(1Rotel.los! na level eg. v of owing: ( )
ctrs►n8.water me".~ , Division of Weisz Rei.ure lydbrm Processing ation Proe Udi.
ti.Borrt►otrdiameter: �� 1617 Man SavieeCenter,RetBBh.NC27b99-in7
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L �,, r 7Abh or.IAter^ow t L,,dption to tending fiat foam to the addout in 24o
IZ,Weil construefloa_L..... VO 1 O. .� above,abo submit one copy of tills forma within 30
days!i s,new;m4ry,eabk,di:od .ow ---... . constmeban to the following: of completion of well
Division of Water Blooms.Underground injection COAlftd
On.Yield(gpn) 163tiINailServleeCenter;leetetdtyNC276934636 PiingiAm. •
i WATER SLppr V WELLS ONLY:
Method anew: 74c For Wafer Suggiv&ittFccnoa Welis-
13b.DtbillfCCtloA the add 1ti addis id sanding 0 days of
to
Artttnaal: wion ofs) olso submit talc copy of Mb farm Within 30 d
------- t ► well n:o the county fasatth ehpantarrn of the�uitoty
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Owner: 2020 Poo l cLe_ S NewWell:
,Address+2-13 t---d P l Le -
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Peri tll~ 26Z
I hereby certif3r that the above referenced well vats grouted in appearance in awidanoe with
all County Well nile .
well Dxjtter -14— KcadoLosSued:_. ��----
certificate: 'Z 1 v Dt Gr acted- :.,2-` . „?e.
Construrdon: C4tout;
Total ; (1) Type:
Cash*Type: �v C° Thickness: . pY cv_f/. _
Casing lam: W 6
Diameter: CQ $
Weight/Thick
Drive Sloe:
GPM: '