Anchor Farms - Hydrostudy - GW2s

OWNER Anchor Farms, /nc. Hydro Study Well Lot # 1 PIN # 368280791000 9. State law requires submitting to the Virginia State Water conVol Board information about groundwater and wells for every well made in the State intended 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 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 analysis, and copies of any geophysical logs. Quarterly-pumpage and use reports are required from owners of public supply and industrial wells. The Virginia State Health Department requires a water well completion report for public supply wells. 10. DRILLERS LOG (use additional sheets if necessary) DIAGRAM OF CONSTRUCTION (with dimensions) DEPTH (feet) TYPE OF ROCK OR SOIL REMARKS From To (color, mineral, fossils, hardness, etc. (water, caving, cavities, broken, core, shot, etc.) 0 10' Residual Soils 10' 380' Schist 11. Well lot dedicated? ;Size fr. x ft. Well house? ;Distance to nearest pollutant source Type .Distance to nearest property line 12. WATER SERVICE PIPE: Checked under psi for Installer Date ft., Building ft. ft. minutes. Pipe size in. Material 13. I certify that the information contained herein is true and correct and that this well and/or system has been installed and constructed in accordance with the requirements for well construction as specified in compliance with appropriate county or independent city ordinances and the laws and rules of the Commonwealth of Virginia. SIGNATURE Groundwater Systems, Inc. (Well Driller or Authorized Person) (Seal) Date March 20, 2006 License No. W-0004 County License No.: Virginia License No.: