GW1--06382_Well Construction - GW1_20241025

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FROM Ttl DLAMETEI ..TFr1Ci�,{SS' MATERIAL
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4 Date Steli(�)completed 9-23-2024 .Wc't tli SVE-106 •
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$b taititude and 1 ngitu4c sex degees/miriut&cccond9or decimal stcgrets,. 22 Certit"tcatttraI
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r4ii;.. 4-02:1 t ro ks cFcJag,r'i'jIli'th.Lofih4s•faait 23 $itc`diaxrkiit addtionalntlikail r Yo nii u eti�Uakofh pagetopmtideaddtnon se stedeailso eil
•• •• c • d. 1- - eonsttucotttetails Yottira}also Rttech'additio•nal page•s tf t essan.$ IAuultrerof 0rtMe Farm.ialii(c 1r1/ 4trt vF lkkii4 a a rlt4 s 1s OMVLY)ldrlti„mrrostruloo axatcia t . -
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24r lint All Walt Stibnut ibis`fonll:t thrn 30 dims of COtit ICtian:at`well.
9 Totn1�Ctl itetitb hlaIIInd Sur(acie: 15 ..... (t't� ' p
Forr rrdlttlrlas urlls"1fsrtrllrirtaths tf drfiiei7ai(cxmriplt,€200 aaaJ2G I00C3; constnictiOn to Use f'9 11on'tn
• 10 Staticttatet,ia�iei betix ofixt top. inlr:NONE.:... - (tti,) Ds Isrun of�Wau.rROourccs,Informati00T.D#esging•Unit,:-'
If it 1,i:M.'l is a .;p#iih ..-1,ac sr«+"•' -- • - •• •'•1GI?111atl;Scn ice(a nfcr,R.1hka NC 27Q9 4617;:Borehole dia t tineter.i0 5/8° r(tp) 21b J+or iniccdon\yells ONLY In addition to sending ttie fowl to the address in
3a aUa a alsta sobinit a-apt of tlua fonn':tsrihu► lD ria}� of eoOiplelioii csf well
1' Wc11 eanstmctlou method AUGERS' 0 mini UOII to the following. II
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Dfvfs(on of�VaterRtsouires,lrnderground ter}ectl6n Co itrolProgram, .
. FOR 1' .a�'i'RR$IJPPGY•WELLS O'LY : • • • • • • • • • ice Center.Rillcute,\*C 27G99403fi' : •.
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ttiso snUnitt oI►e tills f ititli
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' l onstnichn to the eansn hoaith dep�i tm nt of ttic eosin!}♦then :'
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