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I , Form GW-2 <br />Counri•/Ciri~: <br />BWCM No. <br />COMMONWEALTH OF VIRGINIA <br />WATER WELL COMPLETION REPORT <br />(Certification of Completion/County Permit) <br />Loztdourt SWCB Permit <br />County/City Stamp County Permit 740089/80001 <br />Pin: 622486667000 <br />Owner: Neverte/1 Farn:, LLC (EGGI) Certification of Inspecting Official: <br />~~'ell Designation or Number: /HS-1 This well does does not <br />' Address: P. D. Bor /960 meet code/low requirements. <br />Middlebiu•g, Va 20/!8 S <br />Date <br />' Phone: 800-279-4425 (F.GG/) <br />Drilling Contractor: SINGHAS & MICHAEL CORP. <br />Address: 425 Jack Enders Blvd. <br /> Berryville, Virginia 22611 <br />Phone: 540-955-3582 <br />Tax Map ID No. <br />Subdivision _ <br />Section <br />For Office Use <br />85.~9D <br />Block Lot <br />' Well Location: Rt 7 W to 1'urcel/vi/le, Rt <90 .S, Rt 61 / S, To .St Louis, Class Wel I: I _ IIA - IIB - IIIA - <br />Rrghl at Newlin h9ill Rd, site at intersecton of ,Nei+~li~~ Mill and Rt (! 1 IIIB ,Y IIIC IIID IIIE IV <br />Date Started : 10/29/04 Date Completed: /0'29/04 Type of Rig: Rotary <br />' I. ~~'ELL DATA: New X Worked Deepened _ 2. WATER DATA: Water Temperature 54 degrees. <br />Static water level (unpumped level measured) 60 ft. <br />Total Depth: 260 Stabilized meas. pumping water level ft. <br />' Stabilized yield 20 gpm after 3 hours. <br />Depth of Bedrock: 25 Natural Flow: Yes No X Flow rate gpm. <br />Comment on Quality: Clear <br />HOLE SIZE (Also include reamed zones) <br />/0 inches from 0 to 78 ft. <br />G inches from 78 to 2G0 ft. <br />inches from to ft. <br />CASING SIZE (LD.) and material: <br />6 inches from 2 to <br />Material: STEF_L <br />Wt. Per foot: l3 or wall thickness <br />inches from to <br />Material: <br />Wt. Per foot: or wall thickness <br />inches from to <br />m. <br />ft. <br />Material: <br />Wt. Per foot: or wall thickness in. <br />SCREEN SIZE and mesh for each zone <br />(where applicable) <br />inches from to ft. <br />Mesh Size Type _ <br />inches from <br />Mesh Size Type _ <br />inches from to rt. <br />Mesh Size Type <br />GRAVEL PACK <br />From To <br />From To <br />to ft. <br />ft. <br />ft. <br />3 WATER ZONES: From //0 ft. 20 gpm. <br />From ft. gpm. From ft. gpm. <br />From ft. gpm. From ft. gpm. <br />4. USE DATA: <br />Type of Use: Drinking X Livestock Watering _ <br />Irrigation Food Processing Household X <br />Manufacturing Fire Safety Cleaning _ <br />Recreation Aesthetic Cooling or Heating _ <br />Injection Other <br />Type of Facility: Domestic X Public Water Supply <br /> <br />Public Institution Farm Industry _ <br /> <br />Commercial <br />Other _ <br /> <br />5. PUMP DATA: Type Rated HP <br />Intake depth Capacity at head <br />6. WELLHEAD: Type well seat <br />Pressure Tank gal Loc <br />Sample Tap Measurement Port <br />Well Vent Pressure Relief Valve <br />Gate Valve Check Valve (when required) <br />_ <br />Electrical Disconnect Switch on Power Supply <br />7. DISINFECTION: Well Disinfected: Yes <br />No <br /> <br />Date _ <br />_ <br />Disinfectant Used <br />8. ABANDONTIENT (where ^pplicable): Yes _ No X <br />GROUT Casing Pulled Yes No Not Applicable _ <br />From 0 To 73 ft. Type Pressure /3F.NSF:.9/_ Plugging Grout From To Material <br />From To ft. Type Pressure From To Material <br />78 ft. <br />tan m. <br />ft. <br />