GW1--05029_Well Construction - GW1_20230804

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W L CQNSTRUCTION RECQRR ' Per aa'f.l vac ONLY.
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• . ,00eothermal tarins/Cuttlus;Aouan COaicr(c.p(sum tauter 121 ltimulu) ft. ft
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(if rill k.14 col Whoa is sufiei.r) C.r..d.d ..I(:.ne actor Deli
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AC d}^.o/oo w ISA AIC:4C 6X.'02007 troll CnlInrrka.laoesJonmb uoll.i.v'o
7,Is Ibis a repair to as ezisliag well: ("Yea or 0No ropy of dm x.wd tar earn perms/w me rob err.
VIOW all/ywr,fill reo Iwo,,,well ooWr..Voe iglbrnwian x.d crylot.ma,,air,.Q/As
'v./oh vn le 11/'ware,els4.4.r..w a.ri w,imbibe.. Z .Site Jl.grus er additional well desalts:
You:uay use the boots of this page as provide additional well site deceits or secu
I.Number of welb cosatrscud: c xstn,ct.on 4eta,ls Yd.may also utsoh additional papas if or.Maery
Ir.r..daN..ryrce,,.n.wee...W.wjy+well,OM_Y riA this Saar gnaarv+aw..you w,t
mni,oi'o../4.. I1101C1"l"AL IMSY11(TIONS
f.Total wall lapel bellow lead MUM /'© tftj 11a. rer Ail Wells: Submit th:a tom wttiw6t SC days vI cunpl.tian of ..•...'
forwrld/ie war aft NI&o►s((Nrt'rrwt(emetsde 6200'end 2(rl/Po') coast:'. lion to the following
I I.Sack water level below top of caries: /_7 i(t.t Dmisioa of Water Quality,!nlorwalioa Primulas Vats,
1yewow.mewls,Okra~lug kit-•.- 1617 Mail Sera c.Ceuter.le,Wgb.NC 274,4.1417
11.Dore►ois Ramon: `r_.. ia.) -.sb r Lairs , c11: In sddit.on to sending lie Arm to Iha ildisia u1 14e
/J •o.'t a. m Hi Ai' a col. of ..c vs. N V sw.o .• days of Completion of well
l _ __ ll 1.We0 toiletry:Aso eo.. _ S" IA j r�-— c n, ,c:, •r .r. falowlrt,
(i..iarr,raart facia.dir•t goal V. ) -
_ mrvu w k o! .. . ..auty, '•..gat... _1<clio.Coalr.lPrograma.
i FOR WATY* JPTLY WILLS O'fi:Y: / 1634 Mail Service Costar,Raleigh,NC 3749f-Mild
I3e.Yield(sprat) /S M..:..d al u :a.L ar. coW tl/ W h Ras,Lr W aiy dmt v, to sscN.r.W ni In ad union to so iu t,maim Coma ono
r tru addrau(a) above: also submit one sopy of that forts wuh(n 30 days of
. 136,%a ikidos types:C It L O r(I,P Amooup / d e completion of well construction to Ow cotaoy hcsla+ dcpai n ont c f'le count,
Moire cwstrucW.
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