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05/13/2002 12:54 <br />Form GVV-2 <br /> <br />SINGHAS AND MICHAEL <br />CONlZ1'~ONWEALTS OF VIRGINIA <br />WATER WELL COMPLETTON REPORT <br />(Cartif cation of CompJetion/~Counly Permit) <br />Cauaty/City: LDUDDUN <br />County/CIry Stamp <br />Oavaer: B'ur1o2 ~ H¢rbert Bank ~ Trust (Chia fi¢!d-Taylor) <br />Well Deslgpatlon or NmrtDer: Tear well Ito <br />Address: P. D. Box 268 <br />Alexander, VA 22313-0268 <br />phones 308-228-4869 <br />DrWing Contractor: 3INGHA$ & 1VII'CAAEL CORP. <br />Address: 16S Liadey Lana <br />Berryville, Vnginia 22fi11 <br />phoises 540-955-3582 <br />WaA Location: 690 south of Pstrc¢17vllle, right on Paxson Rd (72S} <br />on right acroaa from Black Oak Rd <br />rout na <br />BWCM No. <br />SWCB Permit <br />County Permit 100 30 Ol FTW <br />CartiScation of Inspecting Official: <br />This wen does does not <br />meet coddiow requirernnrna. <br />S <br />Date <br />Fbr O ai Use <br />Tax Msp ID No. 43/SS <br />Subdivision BLACK OAK <br />Section ~ <br />Block Lot 3STiF'>4 <br />Class Wall: I _ IIA ,_~ _.~- ._ <br />TI1B X IIIC _IIID _IIIE _,. IV <br />Date Started ; 3/8/02 Date CarnpleRed: S/9/02 Typo of Rig: Rotary <br />1. WELL DATA: New X Worked Deepened _ 2. WATER DATA: Water Tatnpature 34 degrees. ~ <br />Static water level (unptunpad level measured) <br />'Total Depth: 600' Stobilized meas. pumping water level ft- <br />after 3 hotus3. <br />1/1/02 <br />m <br /> Stabilizedyield <br />SP <br />- <br />Depth oY Bedrock: 20, Nature] Flow: Yes No ~~ rata ~m <br /> COrClrnetrt On QualYty: <br />HOLE SIZE (Also include reasntd zones) <br />WATER ZONES: From 100 ft. 1 1/2 gpm. <br />3 <br />!0 inches from <br />- 0 to 81 ft. . <br />Fxartl ft. gpsn. rom 8.. ~• <br />inches 8ntn <br />~ 81 to 600 ft. <br />ft From R ePm. From ft. ~ <br />incases ftrm to . <br />CAKING SIZE (I.D.) and rnaterisl: <br />6 inches &am +2 to 83 R. <br />Wt. Peer fbot: 13 or wall thiclmess .188 ia. <br />inches from to ft. <br />MaDeriel: <br />W°t. Per foot: or well thiclasoss in. <br />inches ftarrt w ft. <br />Material: <br />Wt. Per $oot: or wall thiclm~s in. <br />SCREEN SIZE and mesih Tor each zone <br />(where rappllcsbte) <br />inches flrosn to ft. <br />Mesh Size 'Type _ <br />inches from <br />Mesh Size Type _ <br />inches 8orrs <br />Mesh Size Typo _ <br />to it. <br />to ft. <br />GRAVEL PACK <br />From To ft. <br />From To ft• <br />GROUT <br />From 0 To 78 ft. 'Type Pressure EENS1iAL <br />From. To $. Type Pressure <br />5409559548 <br />4. YJSE DATA: <br />Type of Ueo: Drinking K I.avestock Wateaing <br />~~~ Food Processing Household X <br />Manufacturing Fire Satiety Cleaning - <br />Recre®tion Aesthetic Cooliuog m Heating ,_, <br />Injection ~~' <br />Typo of Facllltys Domestic X Public Water Supply - <br />l'ublic Institution Farm Industry - <br />CommeTCial ~' <br />S. P'iJNIP DATA: Type ,_ Ra'md ~ <br />Intake depth Capacity et head <br />6. WELLFIl~AD: 'T`ype weQ seat <br />Pressure Tank gal J..oc <br />Sample Tap Measurerneat Part <br />Well Vent Pressure Relief Valve <br />Data Valve Check Valve (when recpsired) _ <br />&lectricel Disconnect Switch cm Power Supply <br />7. DISINFECTION: Well Disinfected: Yea _ No- <br />Date Disinfieetant Used <br />8. ABANDONMENT (where appli,cabkr Yes _ No <br />Casing Pulled Yes No Not Applicable _ <br />Pluggirsg Qrout F"r~'-1 To Material <br />Frnrn To Mate~lal <br />