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Parcel: 462705079631, 3532 OSPREY CT 1in=60ft
TERRELL, 28682
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the Independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents,and
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Copyright 2023 Catawba County NC
03/17/2023
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NaterSuppls 1Nrll: iT.SCRFE� 111 tltllNttl.
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0 Vi ti:ult'.nal ❑Municipal Public / ft. 1 TI, I in
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ptiiV:"crn',all teal mg Cooling Supply) t'sldcnt1a111 arcs Supply!single) ;CI--ft i in. I
pindustnal C oninicrcial �Rc'idential V.ater Sarpl!I shared I 1
I Ia.C:ROLT
nlmcah.•n i fRrist SO s1alfNlal. aMei t(tslte Ma111t1Da %t101'it
Non-►Paler Supply►Nell: rt. ,1 D, + 4
ONlondonng QRc.OVerY
ft. ft.
Injection Nell: L_-_
0Aquifcr Recharge I n. A. i
b �Liroundwatct kcntcd,alwn _
Q Aquifer Storage and Recovery alim 1 19,SAND GRAN EL PACK(if applicable)
❑•S r Barrier ` iliutt 1. 7o I it ill Slit. tNPla TWO'MEI'HOD
QAquifer Test 0 Sion:water Drainage I ft. ft.
I
DC•xi erimenlal Technology Subsidence Control ft. I ft.
[]Geothermal(Closed Loop) ❑Tracer 2e,DRILLING LOG attach additional sheets Haa+cessa
LGeothcrmal(Braung'Cooling Return) ❑Other(explain under 021 Remarks) ►wu�+j1 id
®) Di.ccw tto,KgI,rw„r,.senior►i+Pe.g..l.+r,..�r>
4.Date Nell(s)Completed:a�r13/ Nell lDN 0 k g R• rst✓r7 ,/ Jf i
Si.. •
Well Location: f J �j f� W ft. ,>l 46,/ / 'J/+//7 f# 5.//L
N[5r4/m5 tYL . Osprey. 5,U. Itr n. rt. /8"r�� �/S.( o1VJei,1
Facility)bent Name Facile ID of applrcabk) Y�1i• fl. 5 /7' , ` J. f
_353,z OspreyUvr 71irell/A. .900 - Y ft. ,,, ft. 4n yi '411Y'
Physical Address,Cuy,and Zip/ I h• ft.
Cita,ib4 car ilk; aSo)pi 21.REMARKS
County Parcel ldcMifrcanon No.IPINI .•t- e / .+' a. if l .I
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field,one latlong is sufficient) 22.Certif anon:
if
N W / _ --
6.Is(arr)the well(s)ZPermanent or Temporary 54: um ofC'nine sll Cbn r for if 9-03
Bi .rgning ihi+)arra, IIterrht swift'that die watt'.as“wale)rlmstracred or accordance
7.Is this a repair to an existing well: �YCs or o nob 1S4.VC'.4C'u:C.i lfdl or lid.%'CAC 02('d200 IIen Cowin,lion Standards and that a
If this if a repair,fill out known well construction rnfitrnraiwin and explain the rlaturr;it the copy al this record leas been pr,n rded lu the well tallier.
repair under 021 remarks section or on the back of this Jorrn
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional Well site details or well
construction.only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMIT!Al,INSTRI ICTIONS
9.Total well depth below land surface: 34J (fL) 24a.For All Wells: Suomit this form within 30 days',of completion of well
For multiple welly het all depwhf ifdtf/er-era trsample-3 i:(10'rtrrd:ua(Mr) construction to the following.
10.Static water level below top of casing:40 (ft.) Division of V.ater Resources,information Processing Unit,
If sorer le+e!is above casing use 1617 Mall Service Center,Raleigh.NC 27199-1617
11.Borehole diameter: 6 1/8 (In.)
lib.For Inirdinn Wells: In addition to sending the forAi to the address in 24a
Air Rotary above,also submit one copy of this form within 30 days!of completion of well
12.Well construction method: eonstruilion to the following:
is e.auger,war).cable,duvet push,etc.)ro
DilWats of Water Resources,1 nderground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY:
/n/ONLY: lb0b Mad Settler Center,Raleigh.NC 27499-1636
Da.Yield(gpm) Sal Method of test: /f/r1,fr 2 rc.For N Bier Cupuh t Inies-lion N ells: In.ii,lition'to sending the form to
the ad.:rtss(csi alxrtc. also vlh:tier one cops of this f. within 10 .ins of
13b.Disinfection type: Chloe Tabs Amount: 1112tbs completion ai well cot•sr.•.ic:t,ni to the county health de amnion of the r,..nrs
where constructed
form(,W-I \anh Carolina Depann+enr of Lnsironim niul hall)\•IT\-iOn at wJrit R;s,.un:. q,,,,,,. :