GW1-2021-01878_Well Construction - GW1_20210928

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WELL CONSTRUCTION RE •RD ,
NORTH CAROLINA
EnWronmental Quullty
•rm GW­1 Well Construdon Electronic •
DivisionNorth Carolina Department of Environmental Quality
April 1,2021
Submission ID#
G W 1-2021-01878
Are you submitting a printed form?* r Yes
r No
CONTACT INFORMATION
.........................................................................................................................
Contact Name* Email Address*
David Walker [e-mail]
Is this a revision to the form you have previously submitted?
r Yes r No
WELL CONSTRUCTION INFORMATION
..................................................................................................................................................................................................................... ...................... ....................... ....................... ....................... ....................... ....................... ................................................................
1.Who is installing these wells?*
r Owner r Well Contractor
1.Well Contractor Information:
Certiticate# Cert Level First Name Last Name Company Name
2629 A DAVID WALKER ROTARY DRILL SERVICE, INC.
2.Well Construction Permit#:
W10300457
List all applicable well construction permits(i.e.lvbnitoring Wells,UIC,County,CCPCUA etc.)
What type of well is this?* r Injection Well r Non-Water Supply Well
r Water Supply Well(includes irrigation wells)
3. Injection Well* r Aquifer Recharge C Aquifer Storage and Recovery
r Aquifer Test C Experimental Technology
r Geothermal(Closed Loop) C Geothermal(Heating/Cooling Return)
r Groundwater Remediation C Salinity Barrier
r Stormwater Drainage C Subsidence Control
r Tracer C Other
4. Date well was completed and ID#
Date Well Completed* Well ID# Well Yield

9/18/2021 (gallons per minute)"
5.Well Location
Facility/Owner Name
Brandon Pressley Facility ID#
(Required) (If applicable)
County* Parcel Identification No.(PIN)
Alexander
Physical Address* Street Address
224 Shook Lane
Address Line 2
City State/Prm4nce/Region
Taylorsville NC
Postal/ZZp Code Country
28681-8864 US
Latitude* 35.8603100000 Longitude*81.1955851000
Decimal degrees Decimal degrees
6. Is(are)the well(s):* r Permanent r Temporary
7. Is this a repair to an existing well:* r Yes r No
If this is a repair,fill out known well construction information and explain the nature of the
repair under#21 remarks section or on the back of this form.
For multiple Geoprobe/DPT or Closed-Loop Geothermal Wells having the same construction,only 1 GW-1 is needed.
8a. Indicate TOTAL NUMBER of wells drilled: 2
9.Total well depth below land surface:(ft.)
400 9a.What is the depth of the casing from ground
Formultiplewells Iistall depths if different surface?
(example-3@200'and 2@1001 in feet
11. Borehole diameter:
10.Static water level below top of casing:(ft.) 5.75
If water Iewl is abo\e casing,use"+" in inches
12.Well construction method:
r Auger r Air Rotary r Cable Tool
r Direct Push r Mud Rotary r Rotosonic
r Other
14.WATER BEARING/FRACTURE ZONES
From To Description
in feet in feet
15.OUTER CASING(for multi-cased wells)OR LINER(if applicable)
From To Diameter Thickness Material
in feet in feet in inches

16. INNER CASING OR TUBING(geothermal closed-loop)
To* From* Diameter* Thickness Material
400.00 0.00 1.25 HDPE
in feet in feet in inches
17.SCREEN
From To Diameter Thickness Material
in feet in feet in inches
18.GROUT
From To Material Emplacment Method &Amount
0.00 400.00 Sand enhanced Pour
in feet in feet
19.SAND/GRAVEL PACK(if applicable)
From To Material Emplacment Method
in feet in feet
20.DRILLING LOG
From To Description (color, hardness,soil/rock type,grain size,etc.)
0.00 80.00 Clay&saprolite
in feet in feet
80.00 360.00 Gray granite
in feet in feet
360.00 400.00 Blue granite
in feet in feet
21.Remarks
22.Site diagram or additional well details:
You mayupload additional well construction information here.
pdf only
CERTIFICATION INFORMATION
............................................................................................................ .................................
*PF By signing this form, I hereby certify that the well(s)was(were)constructed in accordance with 15A NCAC 02C
.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy of this record has been provided to
the well owner.
23.Certification*
Signature of Certified Well Contractor

Submittal Date 9/28/2021