HomeMy WebLinkAboutWELL-06-2016-073576.TIF 08/12/2016 07: 23 7048924705 BKWELLDRILLING PAGE 61
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5/ I1 ITI T.U.INATL(.PIONS
l 1'0111 well depth brlox I-MIdsuit-ace: 6.--S 10.) 24a. Fur All Wells: Submit dig louts wllhln 30 days til completion of well
,..r,..r y.•. '�. .. .r ,,pn l'L✓ , - -.I .Iru'pnll;'intppl Cunjr,ucUll'.IU the following
II.51/ne ssawr levet helos.WV of n`.1”::�SO _w fin Division of Water Quality,Information Processing Unit,
n..L .'In„h.., •.I••••._,,••I, 1617 Mail Scr`'rce Center,Raleigh.NC:27699-1617
I L Borehole rl i:unc err.
6 „ __lin.) 2db. For Infection Wolk: In nddilinn to s/ndine.Iiia ttirm to ilic eddrees in 34:1
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above, also submd a copy of[h5 form within 30 days or'La/maitre/1 of well
12.\611 cnlulruclilvl meilmd: Rotary :DII)trucuoll to the IDlluwin_
Division of Wale,'Qualip,Underground In jecdon Control Program,
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FO. \A'n'I'I'.H,S1' '1'n LA'W'I:LLS()NM: --- 1636 Nlatl 5ervicc Center.Raleigh,NC 99-
1636
mil 3 _ .Merhod r,'cat_Open-Flow 224c.For Wider Sunni.&brlecllon Wells t additionIll$onllln thef irtl 05-,:::o I'
I I-line IP.I the uddicssles) 'above. also Svbmrr 0120 0/my oI dui (aim with. 30i
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Chlor Tabs 1 1/2 Lbs coniD eI o, Dr wen e.orsl nu nt to the '20u"11? health d.pammmcn Dr the Comity
13b.Uiainlin t VI Aumunl.
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