WWIN-1972-0030 (Abandoned) - Laserfiche WebLink

COMMONWEALTH OF VIRGINIA WATER WELL COMPLETION REPORT (Certification of Completion/County Permit) State Water Control Board P.O. Box 1143 2111 North Hamilton Street Richmond, VA 23230 County/City Loudoun ------------------------- Virginia Plane Coordinates N E Latitude & Longitude N W Topo Map No. Elevation Ft. Formation Lithology River Basin Province Type Logs Abandonment Cuttings Water Analysis Aquifer Test ------- ------ --- -- - -- - - -- City/County Stamp Owner Post, Todd S & Alene M Peters Address 30 Cedar Dr. Sterling Virginia 20164 -8600 Phone Drilling Contractor Valley Drilling Corporation of Virginia Address 9172 John S. Mosby Highway Upperville, VA 20184 -1723 Phone (800) 582 -9355 Well Location: Rt. 7 East to Cedar Drive L #30 (If possible please include map showing location marked) Date Started WELL DATA: Abandonment —%� ft. Total Depth It. Depth to Bedr k Ft. ft. Hole size (Also include reamed zones) Inches from to Ft. Inches from to Ft. Inches from to Ft. Casing Size (I.D.) and material Inches from +1 to Ft. Material Wt. Per foot or wall thickness inches Inches from to Ft. Material Wt. Per foot or wall thickness inches Inches from to Ft. Wt. Per foot or wall thickness inches Screen Size and mesh for each zone (where applicable) Inches from to ft. Mesh size Type Inches from to ft. Mesh size Type Inches from to ft. Mesh size Type Inches from to ft. Mesh size Type Date Completed D 1, .r. V Y 1V ass BWCM No. T20275840002 ------------------------------ SWCB Permit County Permit Certification of inspecting official This well does does not meet code/law requirements. S ' Date For Office Use ------------------------------- ------------------------------- Tax Map ID# /81/A/32A//31/ Subdivision Richland Acres Section 2A Block 2A Lot #30 Class Well 3-C ; -- --- ------- --------- --- ----- -- Type Rig WATER DATA Water Temperature 56° F Static Water Level (unpumped level measured) Stabilized measured pumping water level Ft. Stabilized yield GPM after 3 Hours Natural Flow NO Comment on quality CLEAR WATER ZONES GPM @ Ft. GPM @ Ft. GPM @ Ft. GPM @ Ft. GPM @ Ft. USE DATA Type of Use Drinking Type of facility Domestic PUMP DATA: Type Rated HP MAKE & MODEL PUMP Intake Depth Capacity GPM @ WELLHEAD: Type well seal MAKE & MODEL PRESSURE TANK Pressure Tank Gal. Location Sample Tap Measurement Port Well Vent Pressure Relief Valve Gate Valve Check Valve Electrical disconnect switch on power supply Ft. TDH Gravel Pack DISINFECTION Well disinfected YES From to ft. Date 4 -27 -12 Disinfectant used Chlorine Tablets From to R. Amount 1.5 lb(s) Hours Used Grout ABANDONMENT (where applicable) YES From to ft., Type Casing Pulled NO From to ft., Type Plugging Grout From 0 to 100 ft. Material Bentonite State law requires submitting to the Virginia State Water Control Board information about groundwater and wells for every well made in the State indended for water, or any other non -exempt well. This information must be submitted whether the well is completed, on standby, or abandoned. Information required includes an accurately and completely prepared water well completion report, full data from any aquifer pumping tests, drill cuttings taken at ten foot intervals, (unless exemption is secured), the results of any chemical analyses, and copies of any geophysical logs. Quarterly pumpage and use reports are required from owners of public supply and industrial wells. County of State permits to drill may be required in some parts of the state. Some counties require submission of a water well completion report. The Virginia State Health Department requires a water well completion report for public supply wells.