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t <br /> -5'G 13 :48 PROM :WESTON NC' ID: 510GO37901 PAGE 3/5 <br /> 4 <br /> i <br /> W:urt Is the depth to groundwater? <br /> 3p - �7`0 �f' <br /> Describe the sourec Oflnfnrnndlon: <br />). Are there ntay water wrlls on 00.1 parcel ',11111Jnwit-prnpertles, Yfi5 1 ) NO ( ] <br /> 1 ` <br /> Tyrie OY WELTS `rANCti TO TANK.l•(S) <br /> Pub11e Wc11 R. <br /> PCIVnte Well 1 <br /> Irrlgntion Well R. <br /> Monitoring Well 1 �Other <br /> 14. <br /> R. <br /> I , <br /> 1A. Will (Ito lunk(s) pendhtg closure be rept tl 0 with nurnlri>vcgm+++td ttY uudrrt;ronnd slororr hunk(s)? Yrtfi1 ] NO( ] <br /> Is. I11dlcute the rrsponslWe party to be bili or nddllionnl I'115.1:Ift) shirr❑me expended beyond 3 hour minhmm� <br /> permit payment per tusk Ir the pnrty l granted below Is different thin the penult nppllcolt, c.{. properly owner, <br /> lhu party must ockuowlulge this rez1rnn 'I 111y for the billing by sli;nnh,rc and dole bttuw, <br /> Nome GJk� ll <br /> d ��7�� " � <br /> Mulling Address SOA �' : f I'rfrrrLt.r,r ltiYE /SKS. —Ale—w-0 �J � 7-0• 2���Q <br /> Duy phone Number <br /> { <br /> Sigunlam Dolt. <br /> I � <br /> k <br /> Pogo 6 <br /> i <br />