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It)t•Ip,Qaa <br />~ut• wanr Conuol Bond <br />1. O. Boa 111x] <br />21 t t North ttanulton St. <br />Rrchrrtasd, Va. 23230 <br />WATER WELL COMPLETION REPORT •swcM No. _ <br />(Cenilication of Completion/County Pfrrmitl <br />County/City L c_:~ ~ ~l E ~;~ ,ti <br />Co <br />• V vgrnri Ptarte Coordlnaus <br /> N <br /> E <br />• LurtsWt 6 LOrtg~tude <br /> N <br /> w <br />• <br />Togo. Map No. <br />•E4vauon ft. <br />• f ormat~on <br />• ~~lnologr <br />•Rwtr Burn <br />•Prov~nca i <br />• Tres Logs <br />•CutUngs <br />•Waur Analrt+a <br />•AgYrltr Tttt <br /> 1. wELL DATA: New X Rewake0 Oeepene0 <br /> • Total Otlptn ~ O O ~ It. <br />rr •Oaplh to Otarock j O II <br /> •MOIt tr2t (AIfO iK1YCN rearrled sOrtfal <br /> • / ~ irlt:llet Iron O to 7 3 ft. <br /> • v ~nenet lrom 7 3 to G e o rt. <br /> • rrtt:hlf from to ft. <br /> •Catlrsq srtt 11.0.1 and materul <br /> • ~ 1ncMs Lan b to 7 3 It. <br /> MaunM S-~ n ~~ <br /> wr. per loot _,~,~~ or wall tmcknw .n. <br /> • utchet Irani to ft. <br /> Mater NI <br /> W I . per IOOI Or wall thlt:ltMft ~~ ~n, <br /> • ~nChtf Iron l0 It. <br /> MattrYll <br /> Wl. par foot Or wall Ihrcknttt -~~n, <br /> •acratn Brat arW meth la tech tone (where apWlcaWel <br /> • ~nchM Irom _ to _ 1t, <br /> • Mesh tut Type <br /> • ~nchtt Iran _~o ft. <br /> • Math uze Type <br /> • rnCht3 )rpm IO It. <br /> • Mesh sue Type <br /> • rnchtf from t0 ~~- It. <br /> • Mesh srre Type <br /> • ~iraval pack <br /> • f rom to It <br /> •from ' to ft <br />- <br />- <br /> r <br /> •Grout <br />•From '0 to SO ft.,TYW __}.~~2Y•'t"~Q-SJl <br /> <br />~ ` <br />•From to h.. Tvoe <br />unry/Gry Slwop <br />•Owner L r} tv G~ C O tv C t ~TS <br />eWNI Otspnauonor Nwnper <br />Address 11'71 Y : own.a~ G rcc~• rt~C <br />c~~--~ v Z L OS ~ <br />PhorM <br />G~auzl~lwater. SYSTEMS INC. <br />eOr~llinq Contractor <br />Addreta 12329 WASHIN .Tf1N ART(`1? R~ <br />_ FAIRFAX VA.2~~39 <br />Phorte (703) 620-2040 <br />SWCB Pertnrt <br />CoYnty hrltit <br />Ce-tllicauort of inpglrp oH;ciN; <br />TAia wNl does dOw got <br />m«t eode/lOw rtpnyMtwL <br />s. <br />Oay~~ <br />Tan Map I.O. NO. <br />SYhdivltwn <br />Sectlort <br />Block <br />Lot_ 7 _ <br />Clan Wall: 1 , IIA <br />IIB ~ , I IIA . , IIIf1• ~~~ <br />,WELL Lotr-r1oN: n«t/mw. dutwtloM a <br />and f«t/nMlet Idireetlortl of ---- - ....-- <br />(l f poaslble Weay incksda reap ahowirp k>ICatiow marked) - --.. • ... . <br />2. WATfi11 OATH • Water terrlpaewre __ _ <br />eStatte MNtN level (Y1lpunlped level•rtstaauredl..~ <br />•Subdisad rrrersred pumpup water lave) G n«_ <br />•Stahllised rN1d ~~ gprtt alter - .1. r <br />NeturM Floslr: YM. No x , IlOalr ray. _ <br />Camntent on quMltr L (c i} 2 _ <br />3. WATEfI ZONEt: Front Z(,UTo ZG/ <br />From - To - From _ To <br />From To from TO <br />s, usl[ OATH: --' <br />Type of uy: Orwtkwp Lwsttock Wawtrq <br />~~ <br />Irrpatlon food proctsslrp. __ . Itoslseh010 <br />Marwlacturlrp . f rr0 Mltty _ . Citarsrq - <br />Recrearrort , AestMtlt __ . Cotllrlp o- Itaetwq_ <br />Ingxtwn__, Ocher ---- <br />•Trpe o/ farWitr~ OamwtK . Pualt water tipple <br />PuGie institutan Farm-_~ , Iltdttatry ~~ <br />CannterelN ,Other _ <br />i. -uMf• OATH: Trpe • Rated M.P. <br />•Intakt depth • ~~ <br />C'oa'Ity -__..~_ x~~ Ix <br />•. WELlMiAO: Trpt wNl tale) . <br />Prtttavra tank gal., Loc._ <br />SampN tap . Mtaturement port <br />--~~~~ <br />WNI vent , Pretaure rNlsl val•O_ <br />Gay vales . t:l+eck vahre lwratn ngtlredl <br />Electrrcal dseorYlect svwtch on power tippr~ <br />7.OISINFECTION: 1hNlOglnlecttd _ _ -_ rw~~ <br />Oett ~__ , OrunlKtant used <br />Amount ~_ . -tOYrs ute0 <br />•. ABANOONIMBNT IwMra gpllt:atslel eyes rt0 <br />Caalrp puwe0 rM-_ no . _ __ not apWeatw <br />Pluaq~rp grout From to motel <br />Oay started ~- ~ S - S~ • pay ~pgyd U - z O - 5 ~ Trpe rp 1 IZ 4 v <br />OVEfi <br />