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Form GW-2 <br />COMMONWEALTH OF VIRGINIA <br />WATER WELL COMPLETION REPORT <br />(Certification of Completion/County Permit) <br />~ty/City: Loudoun County <br />County/City Stamp <br />Owner: Anchor Farms, Inc. <br />Well Designation or Number: <br />Address: 7340 Wisconsin Ave <br />Bethesda, Md. 20184-2926 <br />Phone: (703) 932-9030 <br />Drilling Contractor: Groundwater Systems, Inc <br />Address: 3159 Mary Etta Lane <br />Herndon, Virginia 20171 <br />Phone: (703)620-2040 <br />Well Location: <br />PIN # 368280791000 <br />BWCM No. <br />SWCB Permit <br />County Permit <br />760084090001 <br />Certification of Inspecting Official: <br />This well does does not <br />meet code/low requirements. <br />S <br />Date <br />For OJ~ce Use <br />Tax Map ID No. 9//////4 <br />Subdivision Anchor Farms <br />Section Hydrogeologic Study well 1 <br />Block Lot I <br />Class We I _ IIA _IIB _IIIA <br />IIIB X IIIC _IIID _IIIE _ IV_ <br />Hydro Study Well Lot # 1 <br />Date Started : 03/13/06 <br />1. WELL DATA: New X <br />Total Depth: <br />Date Completed: 03/14/06 Type of Rig: Rotary <br />Worked Deepened <br />380' <br />Depth of Bedrock: 10' <br />HOLE SIZE (Also include reamed zones) <br />10 inches from 0 to 62' ft. <br />6 inches from 62' to 380' ft. <br />inches from to ft. <br />CASING SIZE (LD.) and material: <br />6 inches from +[ to 62' ft. <br />Material: Stee! <br />Wt. Per foot: 131b or wall thickness .188 in. <br />inches from to ft. <br />Material: <br />Wt. Per foot: or wall thickness in. <br />inches from to ft. <br />Material: <br />~t ~ E'er 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 to ft. <br />Mesh Size <br />Mesh Size <br />to ft. <br />GRAVEL PACK <br />From To ft. <br />From To ft. <br />GROUT <br />From 60+ To 0 ft. Type Pressure bentonite <br />From To ft. Type Pressure <br />Type _ <br />inches from <br />Type <br />2. WATER DATA: Water Tempature degrees. <br />Static water level (unpumped level measured) ft. <br />Stabilized meas. pumping water level ft. <br />Stabilized yield /S gpm after 2 hours. <br />Natural Flow: Yes No X Flow rate gpm. <br />Comment on Quality: Clear <br />3. WATER ZONES: From 270 ft. .5 gpm. <br />From 355 ft 14.5 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 />Public Institution Farm Industry _ <br />Commercial Other <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 />Electrical Disconnect Switch on Power Supply <br />7. DISINFECTION: Well Disinfected: Yes _ No_ <br />Date Disinfectant Used <br />S. ABANDONMENT (where applicable): Yes _ No _ <br />Casing Pulled Yes No Not Applicable _ <br />Plugging Grout From To Material <br />From To Material <br />