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GW1--04792_Well Construction - GW1_20240814
5. .. . .. Jr,Ni:f.... .,• ,..-- • myd... .mtiraaucilgamgg__LAyin G ,ii 1 1 orintenua Use Ody: 1.Wen Contractor InlbrusitIon: :77-0-t V.12a4"I na . 1-4&tioowa ,c-'Diicsirrgir7- ir- f--.7,K-377-Itt--,-)-.-_•:'4, '. - . , Ir_g_ Weil ce‘trter Niue* ft. ft. .— . ....... Ne....c............„,..Number iiiiEryst i I. 334 tIUDRA111,11010(UV Morgan Well&Pump,INC .FROM :10 Wiwi* — , ._ — -- a PvC IL 7 7 ft e iai is 041 Compote Komi .1.11;_,V.M.:-C../AffleartustizGistifild AVIA igaisz L Well Coastrasstiens Pernsit., Fillxiii_ki--03512.,______ 774..w ,ft. I° Litt oN eptioabir veil ottuo-krifot"'Mufti it.e.IJM i.:J.Ttely,Stast,York/two,do,? ft. It. • 3..Wen The(check ssell slaa)t ft. — ft. ler Water Sappty Wen: - IMSCRIOL "N ' . l••• •., •••'', •, '• .. imam* w, • ---—''. ft. .rr art hiero nowt ro_ . *Agricultural MunicipalePublic ft. la. ..... a Geothexhul(1-fehtio1P0aoling 3uppiy) Reaidentiel Walser Supply(single) 11 hadaahriaV•Cisitretatial DEIroide. :hut Water Supply(shared) itraour, ----,. ...,,- - t.• Irlit.011 TO 11111,11::::. 1 i.l.niAaBW:-"ort WIMP*aucigisT litia-Weiber&apply VitY-7— .- 1,,:s0.6 pounkt , Ilk.ManAtting i ff. ton,,_.._c_o_vory ft. ft. • ---_ t a!,errienc Weil: It ft. 01'Aqt;if P;e..atge ri G r a u n d w:i t, -Penv-itiation pur.1.f.ti-SALT-ago:is:al P.c....:::,erali D Salinity&pier From TO MA1721.04. zaar..carrialugaOrrainft ii:Ii.A c,nifcr Teat DStormsatitz Drainage fr31:4::::-Iriientai.iciamalou r3Sahaideocr Control tL ft. ..,....."(acaed Low) arnicer ..- -., ... MUM iti tuctr ate(osier,kadiavor.,inifitatictrpt„roil Nis,AO P',c!.,..looftatittfulentioUr4rmatit,LtRatuto) DOthet_Kexpl:lio under#2.1 Raoarks 0 rt. t z .01[)11 4,Date Wr4s)Courrhirien: r-2-. ."? _._,ILL Well 1110,..,„, C q fL 01 ft. 5(A, ‘ f24C , — -1-4 rzc. ..tiovx Titaitynti(ffappticable) ft. ' • ft. . --- farsiA A.46notz Cat,.to.1,41 0- ft. *...rripiallkli':-.-"...:--1,`,'•-•-=':.•:::.---7..--S.:.`..4.12'1.:-,,--Xs"..Sr,.=---'Cf-zr'r.-",4.0:-",',-..7.`:....."..7-:-.-'-.---'-;--.::,'"-.. ___Lzt_60 ,Z;k2,1A___ ' ___--_______— .', ilotwy Patoel 1.3.... .ifecalttn No(PIS) — ' 22%.1.,titiee react lmsgfar de fa de,,,trostudoorestaittottds or ticeirnal degrees:. qr.-1 .:-11,,enrc ittilool LI r.v.7..-lart) , 21 Certifies S..o , q .; 7g ,zi _ ---_,.-Tel.'? ' . .--- :. ‘lef,:ria)Cie syr1144,-OPerstorttl or alf,.sannurorg Sfratzto Vat ed Well C.onttactor -.1 Dido • • By eivtieg Air form,1 keray catte' tidt the lealteii war(wax)casigniesel be enurvidextt . 1.7.4 Z.tg lirvilmar gy*se t-„tliting weii: Cif itm or LINo wit%1.1.4 NOW 0.2C.1)100 or LSI NO C 02C,0200 Well Coutruction Simaitsh awl Ow a ,- 1., .. . l'ask)rk a i npid,, oist hors"00 erseteutAid 1412-24...1,2,1 c..,1 ro1/19,tin matare of us*; th'' n'Y'cuTlh°3 boon Phvidgel to the wan oullo'• : rink marren ratarb 04V.+1.7S V'OX K .,Itsei-tzft4:17,fa-Es. ,2 23.Site diagram or additional will detail= 'feu may use the Mack of this page ta provide additional well site details or well -1 '''' ' 3,gee‘,4=Tefineornn or Oka.11.1,3ep'. iikefiserm.1.;‘`-,-•Ola having tha atme .1. i.,,,.1101ERAI,,x,r2„4 calstracase dctsil.s.YOU may also titre*additional pages if neceasmy. _,:‘, '.1. . . fAt011galK'i2)Y!4.14N4 ri'ae•=4,14 01. ' • - .4'-' 01/0.A:-..,44_ ' —....-4.4.44...4.4.4-, . F3AMMILIIMRE31QM , '. .4;r4e414,kh i,lkgvAt4A*f*..'...;-_.. . _C.. ) V&Ega ja Wtillt Submit this Riern within 30 days of complettou,of well 4. !fre,,:r';,,,60-,-1„:g,,t/4e aiter figiriattleusirpia, ,.VW'14--f WW1 ncrigtixr.„:tina in the ktilowigiv. - , ,W'4 4'•4'l.t io..,..P,-1.f.0e-•=.:i1 41f,l•0 1•V1-•'9' '.)-g'',• , .4-• --01,' —' ' ..--, ..—. --.4.&) • DkviaI t(oio eMf Water r vRea Strrom l afaormati on Processing Unit,nit, 4, ' ; - ll ceOder,Reigh,NC27699-1617 ,..:,•...-..,- .., ,....,I.,4,-,,,,444 ii&,,,,t-aw.,t..4 , .....„,,„,;1, , ,,, ; , •---...,' .,,:,.:,...4.:.,e',,-... 7.4b..farlt5i, pi.„21..41: in acdillon to scatting the form to the address ._,.. raterv' ' :: ,-,' alarm,abo traamit coo mign,at Ids tics within 30 days of completion of , '.•;.,......, ..-,.:•--1.'.',..'Arai is1W• raleirercP4f1.•,,,,,...,,,,,n '' '', - '''• - . --- ••4- enrigradirat lis ti.n Palkrialuz 7.'04'al..4"17t•‘49.to wis..,,,,,r,,,,,,:t.,,,-.4,-,--:. , -•- - , •••••,. ••._,______,. .....--,,,••_-...;•..„. ..,.,_••:••, ,....,........., - .•.• -s.-- —•••......... Thittriest E.,71iVitta Recant tali,lindergound Inlettlaii Control Program, ., '';1 POR WA:Mit Etwisi -,11,tx.wrAvi , , . ---I' - , .. 163,6 flail Serttlea Ccater,Reieigit,NC 27699-1636 -1/4,,r,..), ' - - 11,1-,It4 of(cot/ . 444.g,S01.1,Ei'...10.7,Zii3Lifit,A 34.22-74.- let!duIg ::,,.'''' „. '•'. • '' '-.-- ' ''''-7,,....7-' -"-""---,,------„, oe 5-tti,7. ) iN.IVO,11 ,0 a itt,i Mt Cfqrj, cf this foon vitthin 30 days of ..:1-' ,'-'.Mile x-1-• rias i,ileis:'.fr.--4411-''''')°"., ' . ti,p.v.,.m.vii , .1,4 •i 4# tok., tompitt- 'n,-.,r.£*04...i ctelststsati;z t4 thk..r4tV°Y, heAdth department of the county . Nun f , ' ' - ' ''''''" ' ''' -' ....Mk/ails-7..4A ug:„.414onaac eglencirol,trlitil 0,--iii4ty-Pil,-teilin "atatarreew my!. , laviald 2-21411011 ,.,