Laserfiche WebLink
12- 14- 09 ;09:13AM; <br />1878- 10,000 <br />00 � / 7 6 16 4—j2 2 <br />State water Control Board COMMONWEALTH OF VIRGINIA P.O. Box 11143 WATER WELL COMPLETION REPORT <br />2111 North Hamilton Street Certification of CompletionlCounty Permit <br />Ricnmend, Virginia 23230 z`or� <br />County /City , �l� ); �.1 c] <br />Count)4C/fy Stamp <br />• Virginia Piano Coordinates <br />N <br />E <br />• Latitude & Longitude <br />N <br />W <br />• Topo. Map No. <br />• Elevation <br />• Formation <br />• Lithology <br />• River Basin <br />• Province <br />• —ype logs <br />- Cuttings <br />• Water Analysis <br />• Aqulter Test <br />• BWCM No. <br />SWCB Parma <br />County Permit. <br />Certification of Inspecting official: <br />This well does does not <br />meet code/low requirements. <br />S. <br />Date <br />• Owner r For 00117ce Use <br />• Well Desi nat.or, or Num r <br />Address `7 <br />Tax Map I.D, A' <br />Phone Subdivision <br />Section <br />• Drilling Contractor. Northern Virginia Drilling, Inc. Block <br />Address 11356 Industrial Road Lot --12 <br />Manassas, VA 20109 Class Well I IIA <br />Phone: (703;, 361 -6859 IIB __ - .111A 113 <br />IIIC IIID IIIE —. <br />WELL LOCATION: (leeVmiies direction) of <br />and feeVmJos (direction) of <br />(If possible please Irclude map showing location marked) / <br />Date starte. • Date ccmpleted_ //Q9 Type rig 11 <br />WELL DATA: New P cLtr,Qd Deepened <br />• Total depth C%CJ tt. <br />Cepttt to bedrock h <br />• Holes (PI Include reamed zones) <br />Inches from— d to /00 <br />inches from to ft, <br />inches from to ft. <br />- Casting size (1.0,) and material <br />inches from to ft. <br />Material <br />Wt, per foot or wail thickness in. <br />inches from to ft. <br />Material <br />Wt, per toot or wall thickness in. <br />inches from to ft, <br />Material <br />Wt, per foot or wall thickness in. <br />• Screen size and mesn for each zone (where applicable) <br />inches from to ft, <br />• Mesh size <br />Type <br />inches from <br />to ft, <br />• Mesh size <br />Typo <br />_ inches from <br />to ft. <br />• Mesh size <br />Type <br />• ,,,•„^^ inches trcm <br />t0 ft. <br />• Mesh size „•` <br />Type <br />-Gravel Pack <br />• From to <br />• From to <br />- Grout <br />• From to ft.. Type <br />• From to ft., Type <br />WATER DATA • Water Temperature <br />• <br />• Static water level (unpumped level- measured) <br />• Stabilized measured pumping water !oval <br />• Stabilized yield gpm after <br />hours <br />Natural Flow: Yes No flow rate: <br />gpm <br />Comment on quality -- '; <br />4'3 <br />3. WATER ZONES: From To <br />From To From To <br />From To From To <br />USE DATA: <br />Type of use. Drinking Livestock Watering <br />Irrigation_ Food processing— Household <br />Manufacturing Fire Safety Cleaning <br />Recreation Aesthetic . Cooing or heat ng <br />Infection _ _ Other <br />• Type of facility Domestic _f Public water supply <br />Publ.c institutior —_Farm Industry <br />Commercial _ Other <br />5. PUMP DATA: Type • Rated M.P. <br />• Intake depth • Capacity at <br />head <br />6. WELLHEAD: Type well seal <br />Pressure Tank gal. Loc <br />Sample tap Measurement port <br />Well vent Pressure relief valve <br />Gate valve Check valve (when required) <br />Electrical disconnect switch on power supply. <br />7. DISINFECTION; Well disinfected Yes <br />No <br />Date Disinfectant used <br />Amount Hours used <br />8. ABANDONMENT (where applicable) • Yes " N" 0 <br />Casing pulled Yes No Not Appl! IhIA <br />Plugging grout From fto _materla <br />OVER <br />