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ACSA199500001 Other 1994-07-21
6 1 1RG0 COUNTY OF ALBEMARLE Dept. of Planning & Community Development 401 McIntire Road Charlottesville, Virginia 22902-4596 (804) 296-5823 MEMORANDUM To: Gary Rice From: Wayne Cilimberg�. Date: July 21, 1994 Subject: Well Conditions'on Route 684 in Yancey Mill As follow-up to our telephone conversation yesterday, I am requesting well record information and any associated documentation of problems for the following parcels on Route 684: Tax Map 55A, Parcels 1,6 and 13 Tax Map 55, Parcels 79A2, 79D5 and 90 If at all possible, could you provide this information by Monday, July 25, 1994. Much thanks for you help. • Fo n GW-2 COMMONWEALTH OF VIRGINIA 197e-10,000 WATER WELL COMPLETION REPORT •BwcM No. State Water Control Board (Certification of Completion/County Permit) P. O. Box 11143 SWCB Permit 2111 North Hamilton St. _ Richmond, Va. 23230 County Permit 1 Certification of inspecting official: County/City A l t.—-. -1 a r-I E This well does does not County/Ctty-Stamp meet code/low requirements. S. •Virginia Plane Coordinates N •Owner Date_ Valk,.r � 10 .� M For Office Use ._. - ..- E •Well Desi nation or Number a----1 `-'1 N r1 __-,.,s ic k, Latitude& Longitude ._. Add ress4,-0- 7_ - t, E---5?j/ N ' W r'-ir) c: t.- n �c _ �• � 1Q-'f�-�'N Tax Map I.D. No. _ . .-s w -- Phone 9 3 - 't ?)4 3 Subdivision •Topo. Map No. Section •Elevation ft. •Drilling Contractor(-- ] ..-,..t 1-,, J e^t 1 i % '-‘r ( C. s . Block__ •Formation' Address c ;�c �i 9 j Lot _ _ •Lithology . M '..--) z 1 YZ 3 ' t '7 Class Well I _ _ , HA , •River Basini :' Phone S'•74 -5 4 6 1 IIB , IIIA f _, IIIB •Province' IIIC _IIID IIIE •Type Logs , •"-'-^-'"'� WELL LOCATION: 4 (feet/miles 4 i direction) of ('\4.-1 1_ 3 Gam¢ •Cuttings and 1 feet/miles 5 (direction) of a.4 C,-S4 •Water Analysis • (I f possible please include map showing location marked) •Aquifer Test Date started l ` 3 -S)( • Date completed t - tv-- % 6 Type rig fNy,e --R . IZc I. WELL DATA: New V Reworked Deepened •2.WATER DATA •Water temperature_ __ ___ __ OF •Total depth 7.-6- ft- •Static water level (unpumped level-measured) _____ ?,y ft •Depth to bedrock a6 ft. •Stabilized measured pumping water level ___ tt •Hole size(Also include reamed zones) •Stabilized yield I j gpm after_ _ I hours • t!G inches from cr.. tog ft. Natural Flow: Yes No , flow rate gpm • (. inches trom g' to --(.5 tt. Comment on quality—_G-ai d. • inches from to ft. 3.WATER ZONES: From 15" ToI5I •Casing size (I.D.) and material From_,..l.4 3 To 2 j . From _ To • G r/4 in hesfrom es to ,`1 ft. From_ To . From To Material_ i)4/G 4. USE DATA: _ Wt. per foot or wall thickness ¶ (I, lie, in. Type of use: Drinking , Livestock Watering • inches from to ft. Irrigation Food processing_____ , Household Material Manufacturing , Fire safety , Cleaning_ Wt. per toot or wall thickness in. Recreation , Aesthetic_ , Cooling or heating _ • inches from to ft. Injection ,Other Material •Type of facility Domestic 1' , Public water supply Wt. per foot or wall thickness __in. Public institution Farm___- , Industry •Screen size and mesh for each zone (where applicable) Commercial , Other • inches from to ft. 5. PUMP DATA: Type _ 1 Rated H.P. - _ •Mesh size Type •Intake depth •Capacity at head • inches from --- — _�o ft. 6.WELLHEAD: Typc well seal - •Mesh size Type _ Pressure tank gal., Loc. • • inches from to ft. Sample tap , Measurement port •Mesh size Type _ Well vent ,Pressure reli,f valve • inches from to ft. Gate valve , Check valve(when required) •Mesh size Type _ Electrical disconnect switch on power supply •Gravel pack 7. DISINFECTION: Well disinfected _ _ yes no •From to ft. Date _, Disinfectant used •From to ft. Amount _ , Hours used _ •Grout ,---) 8. ABANDONMENT (where applicable) •yes no_ •From 0 to i-ca ft.,Type 1 <<, r d Casing pulled yes_ no not applicable •From to ft.,Type Plugging grout From _to ._material ..t,.-et Owner — — — BWCM No. — _— 9. State law requires submitting to the Virginia State Water Control 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 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 or 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. 10.DRILLERS LOG (use additional Sheets if necessary) 11. 12.DIAGRAM OF WELL CONSTRUCTION !with dimensions) ' DEPTH(feet) TYPE OF ROCK OR SOIL REMARKS Drilling From To . (color,material,fossils,hardness, (water,caving,cavities, Time etc.) broken,core,shot,(etc.) (Min.) ► e• a L\— ��t\PO21314�5ie -13 o •e-.)I`8•c,rP--, Pa .i ,_.:_ 17.e r L_ `tea Y R7� \2 ., i______ 13. Well lot dedicated? .Size ft.X ft.;Well house? Distance to nearest pollutant source ft.,Type Distance to nearest property line ft.,Building - ft. 14. WATER SERVICE PIPE: Checked under p.s.i. for State Water Control Board Regional Offices minutes. Pipe Size inches,, Moterial Valley Reg.Off. Piedmont Reg.Off. Installer ------ 116 Nortli Main Street 4010 West Broad Street Dot• P.O.Box 268 P.O. Box 6616 Bridgewater,Va.22812 Richmond,Va.23230 703-828.2595 804-257-1006 Southwest Reg.Off. Tidewater Reg.Off. 15. I certify that the information contained herein is true and correct and that this well 408 East Main Street 287 Pembroke Office Park and/or system has been installed and constructed in accordance with the requirements P.O. Box 476 Suite 310 Pembroke No.2 for well construction as specified in compliance with appropriate county or independent Abingdon.Va.24210 Va.Beach,Va.23462 city ordinances and the laws and rules of the Commonwealth of Virginia. 703-628-5183 804-499-8742 / West Central Reg.Off. Northern Virginia Reg.Off. Signatur a ,_(�� �, _(Seal),Date tt -. G. — Executive Park 5515 Cherokee Avenue (Well dri ler or author z perso 1 5312 Peters Creek Road Suite 404 License No. Roanoke,Va.24019 Alexandria,Va.22312 703-982-7452 703-750-9111 d D1— -UB C SLc L NON-PUBLIC SUPPLY COMMONWEALTH OF VIRGINIA CC un19 f DEPARTMENT OF GENERAL SERVICES 07- ommunify ❑ �. DIVISION OF CONSOLIDATED LABORATORY SERVICES-BUREAU OF MICROBIOLOGICAL SCIENCE �( 1�1 NAMEOF REPORT ON BACTERIOLOGICAL EXAMINATION OF WATER 14 I 3-5-V`,• "6„,„ CITY OR • 1. TIME: 1'W COUNTY ��� DO NOT WRITE IN SPACE BELOW. DATE COLLECTED �f7'� Lj7c 3 Portion Bact. of. Portion Bact. of SAMPLE NO.C. J Of Sample Coliform Of Sample Coliform J NAME OF SUPPLY, f 4� �M S Tested Group ' Tested . Group - , va n 0 rSUPPLY OWNED BYY4-1 �C. K`� 32_ .0001 ml. - 10 mi. —=T 4d T"'' br= SAMPLE COLLECTED BY � .001 ml. 10 ml. E m SAMPLE WAS TAKEN FROM �!.Va. RECE ` ; PROVED TAP,ETC.) ml. 10 MI. �,,.� 3 -t (WELL IS SUPPLY CHLORINATED? YES CI NO�'� o 4 WAS CHLORINE TEST MADE AT SAMPLING POINT YES El NO El - Si o O REtS. CL. RPM. .1 ml. 10 ml. o 0-. . REPORT RESULTS TO- m "m t t COM LETED �n � ��, —� c I ml. 10 ml. `._ 3)/0 cV o c V � � _1 Z' \ Membrane Filter Coliformsper 00 ml. " m Q 'J\mil Ala . 72go � JN / = + Opposite Portion Tested Means Bacteria Indicating Coniami- 1.., nation WERE Present. x - — Means Bacteria Indicating Contamination WERE NOT Present. O See reverse side for collection information DCLS-02-078(REV.3-79) - I -. Commonwealth of Virginia Uniform Water Well Completion Report Owner �`. S ��ear .sr✓ Tax Map ID .S-,�_ L 9j 4,AP Address 3 ,,_fJ Gv ' VDH Permit,, ,_f z - G/P / C 4,,,/, ���-i ZfGJ VWCB Permit Phone 77_5 -o1:pp VWCB ID/o/— 77 - 72l yr Location . ',e ?o 7 County *Well Data * General Information ' Drilling Method ,6"/ Date Completed • 7 Z/gyz Total Depth of Well Depth to Bedrock 7_ ? Yield /Z (GPM) Length of Test Static Water Level Stabilized Water Level Natural Flow (Rate) �e 5- Well Disinfected (Y or N) Disinfectant Used Amount Used Casing From d to L7 From to From to Size g/ Materialx,r4,r7 c Size Material Size Material Weight/Schedule /,,,-, Weight/Schedule Weight/Schedule Gravel Pack From to From to From to Grout From © to z...0 From to From to Bore Hole Size — Bore Hole Size Bore Hole Size Type G'e.0,,-----7- Type Type Method,, 4,�7, ,,-„G. Method Method Water Zones or Screened Intervals From to From to From to Mesh Size Diam. Mesh Size Diem. Mesh Size Diam. From to From to From to Mesh Size Diam. Mesh Size Diem. Mesh Size Diem. * Usa Data * Private Well: Domestic Agricultural Industrial Monitoring Public Wen. Community Non Community Drillers Log • (Use additional sheets if necessary) Depth Description of Formation or Sediment Remarks z 7 f. L 2-7-3z- /9.COG..).v '72 .Sor'7 �a � ,b1 0111 of / .32 -/74 Z° . ,r) �,f G Li [ certify that the information contained here is true and that this well was installed and constructed in accordance with the permit and further that the well complies with all applicable state and local regulations, ordinances and laws. Drilling Contractor�,. 6-- Address „� Z;: f Phone 94 -/7 7 Drillers Signature Date ,c Lz2L Representing _424. Virginia Contractors License Number 3 7 2 o - .a ,1-.+ N �s ^ - ' ' 44. Biological, Chemical, and Physical Analysis of Water/ Air, and Solids; � Bioloqiml and Chemical TretabilityStudie; Flow Measurements L�F-.c C-3 F-7_7 '-'I-C-3 F� 1 F_—_:E3 � 1- r'-J r—: .P.0Nm 4006 : Charlottesville, Va. 22903-0841 � Phone (804)295-1716 CHRISTOPHER. H. CHAPMAN, 1 1 /20/92 RT. 1 BOX 248 CROZET, VA. 22932 BACTERIOLOGICAL ANALYSIS REPORT . TOTAL COLIFORM IN DRINKING WATER JOB NUMBEP: T07827 ' SAMPLE NUMBER: T07827 DATE RECEIVED- 11/19/92 DATE REPORTED: 11/20/92 ` IDENTJFICATION: ~ CHAPMAN WELL, SR - 17' WEST OF CPOZET 11-19-92 1 : 45PM ' � ~~ SAMPLE MEETS S - FOP,DRINKI TATE STANDARD F� COLIFORM BACTERIA ' RUN BY THE MEMBRANE FILTER PROCEDURE. /1 COLIFORM BACTERIAL COLONIES PER 100 ML. OF WATER. To MEET TRE STATE STANDARD, FOR C0lFORM/ DRlNKlNGWATER SAMPLES RUN RYTHE MENBRAME FlLTER PkO DURE MUST HAYE LESS THAN ONE C0LlFOKM BACT[RlUM PER{OV ML., AND NU �O8[ TH4N 2OO 8ACTERlAL CUL0W}[S ON THE MEMBRANE FILTER. 7Hr SYMBUL />' SHOULD BE READ 'GREATER 7HAN' THE SYMBOL /<' S9OUL8 BE READ /LESS THAN/ AOUA—AIR LABOR TLY TES R,EPORTED BY ` / � � ~ ` � ^ C2), ie Commonwealth of Virginia Uniform Water Well Completion Report 0 Owner BUJ �mr-\g, LL, ?, A c,` ax Map ID Address . L x ii 5 AI. lie DH Permit l'ililio P—_, /)14 , I 9.3 VWCB Permit Phone 0 I VWCB ID „} ) Location (,0. 7 ,, ,I i' ?L ..`'. County N 'O 1c ira()_, )QJ 'Well Data * General Information ' Drilling Method (t. CZ, Date Completed ) -, a-c-1 a Total Depth of Well G cl, Depth to Bedrock •✓.o Yield 60 (GPM) Length of Test Static Water Level Stabilized Water Level Natural Flow (Rate) Well Disinfected (Y or N) Disinfectant Used Amount Used Casing From 1' 1 to From to From to Size to` q Material �, Size Material Size Material Weight/Schedule Weight/Schedule Weight/Schedule Gravel Pack From to From to From to Grout From 0 to ,-.) From to From to Bore Hole Size /p Bore Hole Size Bore Hole Size Type Aft.B ai-IC , -r- Type Type Method j,, L, Method Method Water Zones or Screened Intervals From '7O to '75 j9,Jf77 From J°() to f q 5 ri .JP/f7 From to Mesh Size Diam. Mesh Size Diam. Mesh Size Diam. From ibn to J[;. 7 4'1'rn From a P 0 to ,7 R 1 36.8P m From to Mesh Size Diam. Mesh Size Diam. Mesh Size Diam. 'Use Data ' Private Well: Domestic Agricultural Industrial / Monitoring Public Weil. Community Non Community ibN Drillers Log (Use additional sheets if necessary) Depth Description of Formation or Sediment Remarks • O— /a 18)0uV1) CIUL 1Q - 3119 &zit c 3/-305 I certify that the information contained here is true and that this well was installed and constructed in accordance with the permit and further that the well complies with all applicable state and local regulations, ordinances and laws. Drilling Contractor C.R. MOORE WI l DRILL ,,,r; ro , .'tom. Address ROUTE 13, BOX ";5 CHARLOTTFSvil t R VA _220g1 Phone Drillers Sign ur Date Representing 41)412 Virginia Contr tors License Number 2 ry: . i'keX.•_n++, ` ` - - COMMONWEALTH OF VIRGIN • - �` Fo• nr-w-? - F. .,-agaa-t o,000 ,. ;I,,, ; ,,, WATER WELL COMPLETION REPORT •BWCM No. stet•Water Control• Board (Certification of Completion/Co• unty Permit) P.O.Box 11143 . 2111 North Hamilton St. , " • i SWCB Permit . Richmond.Va.23230 County Permit /�/�s Certification of inspecting_... - �!v-'.i✓ti?� G. - a p n9 official: ,County/City '` '' Th;s well aces does not_ a.r-,, meet code/low r-- *•' County/City Stamp requirements.. . . •Viry;niaPlzre Coors nstes - Date N , •Owner_ . /":-.`I• _____ - • E c Well Designat or .'umber f For Office Use Latitude& Longitude Address 1 N t1 Tax Map ! L.) No -------------_- w Phone- _ ____ -_ _ __, SubdivAton •Topo. Map No. -- - -- - ----- 1 Section _ - _-_____ •E ovation ---tt. •Drilling Contractor 2•► ,4 _ ,4 _ i Block - --- •Formation Address ewe.--4 c-7__ ---- - --- -.1 Lot - - -- • •Lithology -- Class Well I _ _ I!A •River Basin Phone 1!3 IIIA III f . •Province I IIiC.._ ____!IMD - . PIE__ _ •Type Logs WELL LOCATION: - (feet/mites - - direction) ot_�__ • •Cuttings and __feet/miles (direction) of - _______ _ *Water Analysis (it possible please include rn shoW g location marked) •Aquifer Test - ' Date started ,4, • Date completed / 3r",-__Type r feide f -,42ze I.WELL DATA: New Reworked Deepened 2..WATER DATA •Water temperature • "Total depth- 9� __�__— _ ft• - --,•Static water level (unpumped level measuied) _ .3,,' - ...... _•Dep-h to bedrock___ . _.._ __ _ ft•_ . = . .!Stabii zed measured pumping water level °Hole size(Also include reamed zones) - --• •- -.Stabilized yield gpm after _ - - ho O 7- inches from p to _ 3_' ft. Natural Flow: Yes _____No .__ , flow rate g! o 6inches from PX"_ to 9 __tt. . - Comment on quality • inches from - - to _-_-_ ft.• - 3.WATER ZONES: -From__ _ •Casing size (I.D.) and material From ToFrom_To-__ _ From -- To • rp %✓ inches from _3._-_ to _ iter: ft From- ---__ To From Ti.,Material -- -- eLLi.--------------_ 4. USE DATA: • - _ Wt. per foot _ or watt thickness_ 4_ __in. Type of t.se Drinking_____ . Livestock Watering -_y- --- • -inches from to _ ______. ft Irrigation ___-Food processing . __ , Household ____-- Material _-- _-_-- _-._. _____ Manufacturing______•• Fire safety Cie:+rnnq _____ Wt.per Toot _- or wan thickness —_- -____•_in Recrear.on _ --,Aesthetic _ Cooling or heating _ _ •---inches from _-- to —•__-___--ft. In eetion - Other ____ . . - ---- -. Material _ _ - __ _•_- _ •Type of facility Domestic __•. , Public water supply --_ Wt. per foot---�_or•wan thickness-_______ _ ___ in Pubic institution -__ , Farm . . , Industry _ ---• •Screen size and mesh for each zone (where applicable) Commercial _ . Other • inches from to --- ------_ft. S.PUMP DATA: Type �!t.,terf H P •Mesh size___--- Type ----_--------- •Intake depth 'Capacity at head • inches from ____________to _-_____- _____ ft. 6.WELLHEAD: Typc well seal _---------- Type --- -----_- -- _ __._ Pressure tank---- gal• Loc. - ---^ - - -- _ _ 0Meshsi;e ------� • inches from to-i____________ft Sample tap•_ _ , Measurement port • Mesh s(ze --_ype --- -__-- Wei vent Pressure reti_f valve - -�_ __- o inches from to _ _-----_ ft Gate valve ______ Check valve twhen rertuired) __ _ Mesh size Type ___ __ -• Electrical d•sconnecr swi•ch on power supply ____ •Gravel pack 7. DISINFECTION: Vvell c isinfected _ _ yes no 'From to ft. Cate -_ _ , Disinfectant used ------ _- From to _ ft Amount , flours used __ 8. ABANDONMENT(where mplicab'e) •yes no •Grout --- ---- • • om _ to ft., Type -�_-_- - . Casing pulled yes---= no• not applicable_ ( c From to CI • _,ype • Plunging grout From_ __.fo_. - _.:_-__material `0VER • • • e--- rtttst .• , .o eke f3r"t ter; - BWC!lrrh%^ .. ~-• e . s • Owner 'c .it•.';_.), " f.,; '; ; .. 7, '..' ' ,•.•;«, .-43.State law cequi,es_submrtt'a9 to:fie'Virginia State Water Control-Board roformaLlorti about,groundwater and wells for every well made in the S,a:e • ,,intended for water. or any other non-exempt well. This information.most be_-ubmi•led:w`•eth_r the well-is completed, on standby, of abandoned. '�ttforrnStiOn required includes .an accurately and cone e[ely prepared water well oomp'etion.report;full data from any xtu+'•et pumping tests,drill �etett,npt:-rtsken at ten foot interests (unless Pxerr?`•rt:n :s?:ecu*-d!. the resutti or--any chemicaGanafyses, and copies of any geophysical logs. Cuarterly �, pu npa a and use reports are required from ownr,rt of public surr,i'y and lnds.Stra', vv"tls.COJ:Ity or State oerms s to d :'I may t•e required in some parts of ..s.tre.state.-Some-ceunttes sego ire sub:7issior,,stf„kv+3+•' well u.rriplet!1tny!ePoet: TheAti.irg is itvte 1-tealth.00Pa' meet requires a water well completion report for public supply wells. _ T 12. DIAGRAM OF '.Y::L. W. JnILt GRS.OG use additional Sheets if necessary) 1' ;11 - CONSTRUCTION--- -• • ;2; 7 ! Iv.rth din-tensions) __ T TYPE OF ROCK OR SOIL 1 1?E/KARt 5 Q'itfing- QEPTtf(feet) -- t --- ' iwatet,cavrrr.cavities, Time ^, �- ` From 1. To I wetor.cnaLet,al,'o.arls,hardness. _ — becks.,fair._stto!(etc.! (fyc.n•1 , 1 / t! .71,i , i • -, -5— 505 •4 • 11 ii I v ! y a -If a- t ;�( i � fi C j <_dLGrtK .. µf f r ' ''.fir. - t 1 .`err 1 i . • • I 4 j 1 L... --- --.----- 13. Well lot r!edre.ted7 _ ___ ,Size _ ft X•_ _ f t ,filet!house' Oistanc a to nearest pollutant sou•ce ____ , •-__ It . I ype - bstance to nearest property fire • _• __ ft ,Building ft 14 WATEf. SERVIC► PIPC Checked under _ __ . ____ p s , for - StateWaterControl Board Regional Offices 2.notee" t'•oe sere -. _-__ :nch.s, Moterro:_. . — ____ — Vattey Req Ott P,.:tmont Reg.Off. ,,rtenar — ._ —__ __ _ 116 North Main Street 4010 West Broad Street ^c to ----- P.O.Box 268 t' 0 Bea 6616 aradgewater,Va.7:812 R,thmond•Va 73230 703.828 2395 804 237-1006 Southwest Req,Off. T,Cewat.r Req Oft, 15• 1 certify that the information contained herein is true and t.Mrrer-r .iitrl that th.,:Nett and/or syrtern has been rnstalted and constructed in accordance with 'he ,equ,rernents 408 East Main Street 287 Pembroke Office Palk for we'f eunct•uctton s;,ec,hed in compliance with appropriate county or independentAbingdon.Va.24230 Va,Eicacn. P.O.Box 476 Suite 31C 4 N .2 city ordinances and the laws arc! •ules of the Commonwealth of V,r.1,n,., V Va a 23462 • e '� 703.62E ,-S153 604.499 8742 P / • ,+ West CM n trat Req Olt- Norther V,rs•n•a Reg Off Signature.�a %,/_. _.• Y lSeatt.pate .� 2 . 3 .- -_ - • Leacutiw hark 5515 Cherokee Avenue (Wet driller or authonted persO.1" • .. S512 Peters Creek Road Suit.404 • License No - _ Roanoke,Va 24019 Ale.encr,a.Va.72312 70S-9C2:7432 703 750.9111 r. r • 'Ai*°• r.. & t'r, .r ' " • A r . + ,, °• {. F v _it BIOLOGICAL, AND PHYSICAL ANALYSIS WATER, IDS; BIOLOGICAL AND CHEMICAL TREATABILITY STUDIES; FLOW MEASUREMENTS LAlO1 AioltiLU, INC. 627 DICE PHONE ST.04) 2•9S-.O.6BOX 4006 • CHARLOTTESVILLE, VA. 22903-0841 • Cwr L. C1zrk-ti t* 1., Box V5 Crczowt vA Z2532 BACTERIOLOGICAL ANALYSIS REPORT TOTAL COLIFORM IN DRINKING WATER SAMPLE NUMBER : 1'2692'1 DATE RECEIVED : /17/17 DATE` REPORTED ,;//V r'> I DENT II F I CAT ION : Clark well water SAMPLE MEETS STATE STANDARD FOR COLIFORM BACTERIA IN I, ,. DRINKING WATER. • SAMPLE DOES NOT MEET STATE STANDARD FOR COLIFORM BACTERIA x IN DRINKING WATER . 4 X RUN BY MEMBRANE FILTER PROCEDURE. 2 j COLIFORM BACTERIAL COLONIES PER 100 ML. III BACTERIAL COLONIES Too NUMEROUS To COUNT. APPROXIMATELY TOTAL BACTERIAL COLONIES PER 100 ML. CONFLUENT GROWTH. To MEET THE STATE STANDARD FOR COLIFORM, DRINKING WATER SAMPLES RUN BY THE MEMBRANE FILTER PROCEDURE MUST HAVE NO MORE THAN ONE COLIFORM BACTERIUM. PER 100 ML. , AND.NO MORE THAN 200 BACTERIAL COLONIES ON THE MEMBRANE FILTER w_ RUN BY THE FERMENTATION TUBE PROCEDURE. ;,,,- --fe!tvet*max., TUBES POSITIVE FOR COLIFORM BACTERIA PER 5_X.10 ML. SAMPLES. MPN COLIFORM BACTERIA PER 100 ML. --To MEET THE STATE STANDARD FOR COLIFORM, DRINKING q. WATER SAMPLES RUN BY THE FERMENTATION TUBE PROCEDURE } , `- MUST HAVE NO SAMPLE TUBES POSITIVE FOR COLIFORM OUT .4. OF 5 X 10 ML. SAMPLES. -� �». > = GREATER THAN, <. LESS THAN ' '4. �.��.� .�. t 1 iT1.0 J Y '� � ' � f' ��f� �f`� � AQUA-AIR LABOR TOR ESQ! I C, O REPORTED BY : \ sinceisTz F., GW•2 -OMMONWEALTH OF VIRGINIA 1)18-10,00o WATER WELL COMPLETION REPORT •BWCM No. State Water Control Board (Certification of Completion/County Permit) P. O. Box 11143 2111 North Hamilton St. SWCB Permit Richmond,Va. 23230 County Permit County/City alitiinGak../ Certisicationof sinspectingofficial: This well does does not County/City Stamp meet code/low requirements. S. •Virginia Plane Coordinates - )a.A Date N •Owner ' E •Well Designation or Number For Office Use Latitude& Longitude Address N Tax Map 1.0. No. w Phone Subdivision •Topo. Map No. Section_ •Elevation ft. •Drilling Contractor • ct , �.. 11 - i--- Block _ •Formation Address } 1i "� �u7t yaa.1 Lot _ _ •Lithology (' .. ;t tOO o • J( . a.a:10 I Class Well I , IIA •River Basin Phone IIB , IIIA _, IIIB •Province IIIC _11ID IIIE •Type Logs WELL LOCATION: 1) 4 (feet/ /J direction) of a�"� •Cuttings and LiJ(direction) of 1dROLIJOS0; //6 _ __ _ ___ _ _ _ •Water Analysis (If possible please inc •.e map showing location marked) •Aquifer Test _ Date started • Date completed Type rig I. WELL DATA: New .Veworked Deepened 2,WATER DATA •Water temperature _ OF •Total depth /ss • ft. • — -- ---- Static water level (unpumped level-measured) _____ 0 _ ft. •Depth to bedrock (,/O ft. •Stabilized measured pumping water level_ ft. •Hole size(Also include reamed zones) _ •Stabilized yield gpm after hours • 8314- inches from O to 4IS ft. Natural Flow: Yes No , flow rate. (....Z gpm • inches trom to _ et. Comment on quality • 6, vg inches from 14S to 1 5 J ft. 3.WATER ZONES: From 70 TQP/r) •Casing size(I.D.) and material FromL3J' Te?SW . From __ To • Ip 14 inches from 4-1 to L�S ft. From_ To . From To _ Material_ c `U0._.- 4. USE DATA: Wt. per foot or wall thickness in. Type of use: Drinking Livestock Watering • inches from _to ft. Irrigation Food processing _ , Household Material Manufacturing , Fire safety __ . Cleaning Wt. per toot or wall thickness in. Recreation , Aesthetic_ . Cooling or heating • inches from to ft. Injection ,Other T/ Material •Type of facility Domestic / Public water supply Wt. per foot or wall thickness — in. Public institution Farm , Industry _ _ •Screen size and mesh for each zone(where applicable) Commercial , Other __ _ • inches from_ to_ _ _ft- 5.PUMP DATA: Type _ ♦Rated H.P. •Mesh size Type •Intake depth •Capacity at head • inches from to ft. 6.WELLHEAD: T ypc well seal T •Mesh size Type - Pressure tank gal , Loc. • • inches from to ft. Sample tap , Measurement port • •Mesh size Type Well vent _ , Pressure reli.f valve • inches from to ft. Gate valve , Check valve(when required) •Mesh size Type Electrical disconnect switch on power supply •Gravel pack 7. DISINFECTION: Well disinfected _ _ yes_ no •From to ft. Date _ , Disinfectant used_ •From to - ft., Amount —, Hours used •Grout 8. ABANDONMENT (where applicable( •yes no •From D to al ft., TypOlfilfit Casing pulled yes no__ not applicable •From to ft., Type Plugging grout From _to __material OVER Owner --- — — — — BWCM No. 9. State law requires submitting to the Virginia State Water Control 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 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 or 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. 10. DRILLERS LOG (use additional Sheets if necessary) 11. 12. DIAGRAM OF WELL CONSTRUCTION (with dimensions) DEPTH(feet) TYPE OF ROCK OR SOIL REMARKS Drilling From To (color,material,fossils,hardness, (water,caving,rig.cavities, Time broken,core,shot,(etc.) Min.) )b Pt) c�►i$'. )o 40 low, 13. Well lot dedicated? ,Size ft. X ft..Well house? Distance to nearest pollutant source ft.,Type Distance to nearest property line ft.,Building ft. 14. WATER SERVICE PIPE: Checked under p.s.i. for State Water Control Board Regional Offices minutes. Pipe size inches, MOTeriol Valley Reg.Off. Piedmont Reg.Off. 116 North Main Street 4010 West Broad Street Installer P.O. Box 268 P. O. Box 6616 Dote --Bridgewater,Va.22812 Richmond, Va. 23230 703-828-2595 804-257-1006 Southwest Reg.Off. Tidewater Reg.Off. 15. I certify that the information contained herein is true and correct and that this well 408 East Main Street 287 Pembroke Office Park and/or system has been installed and constructed in accordance with the r P.O.Box 476 Suite 310 Pembroke No.2 for well construction ase specified in compliance with appropriate county or independentt Abingdon,Va.24210 Va. Beach, Va. 23462 city or.: and the laws and rules of the Commonwealth of Virginia. 703-628-5183 • 804-499-8742 West Central Reg.Off. Northern Virginia Reg.Off. Signature 7I )0a� (Beall,Date 5515 Executive ParkCherokee — e erokee Avenue (Well drIer or authorized person)5312 Peters Creek Road Suite 404 Roanoke, Va. 24019 Alexandria,Va.22312 License No. 703-982-7432 703-750-9111 BIOLOGICAL CHEMICAL,AN PHYSICAL OF LYSIS H u - AIR BIOLOGICAL,AND CHEMICALT REATABIL TYASTUDIES• F OWRMEASUREMENTS SOLIDS; 627 DICE ST. • LABORATORIES, INC. PHONE (804) 295-10.6BOX 4006 • CHARLOTTESVILLE, VA. 22903-0841 B.E. Creasy BACTERIOLOGICAL ANALYSIS REPORT TOTAL COLIFORM IN DRINKING WATER SAMPLE NUMBER : 124910 DATE RECEIVED : 7/9/7 DATE REPORTED: 7/10 /07 IDENTIFICATION : Doug Gentry well water N SAMPLE MEETS STATE STANDARD FOR COLIFORM BACTERIA IN DRINKING WATER , SAMPLE DOES NOT MEET STATE STANDARD FOR COLIFORM BACTERIA IN DRINKING WATER , X RUN BY MEMBRANE FILTER PROCEDURE. I COLIFORM BACTERIAL COLONIES PER 100 ML. BACTERIAL COLONIES Too NUMEROUS To COUNT. APPROXIMATELY TOTAL BACTERIAL COLONIES PER 100 ML. CONFLUENT GROWTH. To MEET THE STATE STANDARD FOR COLIFORM, DRINKING WATER SAMPLES RUN BY THE MEMBRANE FILTER PROCEDURE MUST HAVE NO MORE THAN ONE COLIFORM BACTERIUM PER 100 ML., AND NO MORE THAN 200 BACTERIAL COLONIES ON THE MEMBRANE FILTER. RUN BY THE FERMENTATION TUBE PROCEDURE. TUBES POSITIVE FOR COLIFORM BACTERIA PER 5 X 10 ML. SAMPLES. MPN COLIFORM BACTERIA PER 100 ML. To MEET THE STATE STANDARD FOR COLIFORM, DRINKING WATER SAMPLES RUN BY THE FERMENTATION TUBE PROCEDURE MUST HAVE NO SAMPLE TUBES POSITIVE FOR COLIFORM OUT OF 5 X 10 ML. SAMPLES. = GREATER THAN, < = LESS THAN AQUA-AIR LABORAT R IN , REPORTED BY : Fo„n GW-2 COMMONWEALTH OF VIRGINIA ,see-,o,000 WATER WELL COMPLETION REPORT •BWCM No. • State Water Control Board (Certification of Completion/County Permit) P. O. Box 11143 SWCB Permit 2111 North Hamilton St. - Richmond, Va. 23230 County Permit ^ 'Ilx Certification of inspecting official: County/CityZ IUt1C Ii This well does does not County/City Stamp meet code/low requirements. , S. •Virginia Plane Coordinates ��� u� Date_ N •Owner For Office Use E •Well Designation or Number Latitude& Longitude Address N Tax Map I.D. No. w Phone Subdivision ®Topo. Map No. �y�� j\` (�! Section •Elevation ft. •Drilling Contractor Q R. W vL % . `1.J»c./ Block •Formation Address c 14- q as Lot •Lithology C.-ir,\I (l_Q , 0 l'- aaCl0 i Class Well I , HA , •River Basin Phone ) IIB , IIIA _, IIIB ___ •Province 1 l JJ IIIC _IIID IIIE •Type Logs WELL LOCATION: /U (feet W direction) of ±2,Sb •Cuttings and 7� fee•`�''Il_es `J"C.I.) (direction) of (' 7 6 4 __________ __ __ __ •Water Analysis (If possible please incTu a map showing location marked) •Aquifer Test - - Date started ji.'aa-y,q • Date completed a Z3- d c' Type rig 4 I.WELL DATA: New " worked Deepened 2.WATER DATA •Water temperature__ _______ _ OF •Total depth 14S ft. •Static water level (unpumped level-measured) ____ cQ ft •Depth to bedrock I(e ft. •Stabilized measured pumping water level____ ft •Hole size (Also include reamed zones) •Stabilized yield gpm after hours • IC inches from Q to 10 ft. Natural Flow: Yes No , flow rate. S gpm • ty__Inches trom to tt. Comment on quality _ __• Inches from aQ to 18S ft. 3.WATER ZONES: From To— •Casing size (I.D.) and material From_ To From _ To • to II- inches from -I-I to c O ft. From_ To . From To Material_ P O( 4. USE DATA: Wt. per foot or wall thickness in. Type of use: Drinking Livestock Watering • inches from to ft. Irrigation Food processing__— , Household Material Manufacturing , Fire safety __ Cleaning_. Wt.per toot or wall thickness in. Recreation , Aesthetic_ . Cooling or heating • 'inches from to ft. Injection ,Other - T _ Material •Type of facility: Domestic ,Public water supply Wt. per foot or wall thickness __in. Public institution Farm___. , Industry •Screen size and mesh for each zone (where applicable) Commercial , Other • inches from_ to ft. 5.PUMP DATA: Type _ 1 Rated H.P. •Mesh size Type _ •Intake depth 1 Capacity __at head • inches from to ft. 6.WELLHEAD: T T ypc well seal •Mesh size Type Pressure tank gal., Loc. • • inches from to ft. Sample tap , Measurement port •Mesh size Type _ Well vent ,Pressure reli.f valve • inches from to ft. Gate valve , Check valve(when required) •Mesh size Type Electrical disconnect switch on power supply •Gravel pack 7. DISINFECTION: Well disinfected _ _ yes_ no •From to ft. Date _, Disinfectant used_ •From to ft. Amount , Flours used _ •Grout 8. ABANDONMENT (where applicable) •yes no /� •From O to `mod ft.,Type` .QJ(j Casing pulled yes_ no__--not applicable •From to ft., Type Plugging grout From to __material • - ., a }. Owner BWCM No. • 9. State law requires submitting to the Virginia State Water Control Board deformation 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 waters well completion report, full data from any aquifer pumping tests,drill cuttings taken at ten foot intervals (unless exemption is secured), the restates of any chemical analyses, and copies of any geophysical logs. Quarterly pumpage and use reports are required from owners of public supply and industirial wells.County or 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 fcr public supply wells. 10.DRILLERS LOG (use additional Sheets if necessary) • 11. 12.DIAGRAM OF WELL CONSTRUCTION (with dimensions) DEPTH (feet) TYPE OF ROCK OR SOIL ,(REMARKS Drilling From To (color,material,fossils,hardness, (water,caving,cavities, Time etc.) broken,core,shot,(etc.) (Min.) o I (9 ax- m s<c • • 3. Well lot dedicated? ;Size ft. X ft.;Well house? Distance to nearest pollutant source ft.,Type Distance to nearest property line ft.,Building ft. 14. WATER SERVICE PIPE: Checked under p.s.i. for State Water Control Board Regional Offices minutes. Pipe size inches, Malone)! Valley Req.Off. Piedmont Reg.Off. Installer 116 North Main Street 4010 West Broad Street P.O. Box 268 P.O. Box 6616 Dote Bridgewater.Va.22812 Richmond, Va 23230 703-828-2595 804-257-1006 Southwest Reg.Off. Tidewater Reg.Off. 15. I certify that the information contained herein is true and correct and that this well 408 East Main Street 287 Pembroke Office Park and/or system has been installed and constructed in accordance with the requirements P.O. Box 476 Suite 310 Pembroke No.2 for well construction as specified in compliance with appropriate county or independent Abingdon,Va.24210 Va. Beach,Va.23462 city ordinances and the laws and rules of the Commonwealth of Virginia. 703-628-5183 804-499-8742 r ' West Central Reg.Off. Northern Virginia Reg.Off. Signature_ 4J� (Seal),Date 11" 2Q ^ O�j`� Executive Park 5515 Cherokee Avenue (Well Iler or authorized person) 5312 Peters Creek Road Suite 404 License No. Roanoke,Va.24019 Alexandria,Va.22312 703-982-7432 703-750-9111 . .v " nr.4.n r.e•;.... ' �(�111 Al it 3IOLOGICAL,CHEMICAL,AND PHYSIC ANALYSIS OF WATER,AIR,AND SOLIDS; Iti1 UU BIOLOGICAL AND CHEMICAL TREATAistL1TY STUDIES; FLOW MEASUREMENTS IAWof TORIES7 INC. 627 DI (804) 29CEP.O16BOX 4006 • CHARLOTTESVILLE,VA. 22903-0841 PH1`..r♦ &-. I-rs s `c4 y Ps Gentry - :itd 1 lox 359 Date Received 11/1/8 x'O Zet t Vk 22932 13 / �8i4 Date Reported /�� Sample No. 1,078 20 Identification nil l-I n.m Frestor4 Gentry Well ,.:' ter Sample No. Identification Sample No. Identification Sample No. Identification Sample No. Identificatior. l Sample No. LU 8 7 Sample No. Concentration Concentration ACIDITY(AS CaCO3) mg/I ALUMINUM,TOTAL mg/I ALKALINITY(AS CaCO3) mg/I ANTIMONY,TOTAL mg/I BOD mg/I ARSENIC,TOTAL mg/I CHLORIDE mg/I BARIUM,TOTAL mg/I COD mg/I BORON,TOTAL mg/1 COLIFORM, TOTAL /100m1 1 CADMIUM,TOTAL mg/I CYANIDE mg/I CALCIUM,TOTAL "mg/1 FLUORIDE mg/I CHROMIUM,TOTAL mg/I HARDNESS,TOTAL(AS CaCO3) mg/1 COBALT,TOTAL mg/I NITROGEN,AMMONIA mg/I COPPER,TOTAL mg/I NITROGEN,KJELDAHL mg/I IRON,TOTAL mg/I NITROGEN,NITRATE mg/I LEAD,TOTAL mg/I NITROGEN,NITRITE mg/I MAGNESIUM,TOTAL mg/I OIL&GREASE mg/I MERCURY,TOTAL mg/I pH NICKEL,TOTAL mg/I PHENOLS v g/I PALLADIUM,TOTAL mg/I PHOSPHORUS,TOTAL(AS P) mg/I POTASSIUM,TOTAL mg/I SOLIDS,SUSPENDED mg/I SELENIUM,TOTAL mg/I SILVER,TOTAL mg/I _ SODIUM,TOTAL mg/1 SULFATE mg/I TIN,TOTAL mg/I SULFIDE mg/I • ZINC,TOTAL mg/1 TOC mg/I TURBIDITY NTU - 0 oo N _ 00 Q ' :r�A ay # :,'- • a.+f +z.: �.$-sts-r,y+�.k,�yt�s+s.wk ' "',..z -k S "' #•m c , -� * 7 ,i r Yt ?rr,',*� ,+ „..;:,,xi tv kv�t� era r .+, > A�- �o �t tis A +1` ' y a�a� �a;t ,1zx ri.7° TE .�,�AV;^'3 . a - .x Vim' *�r, s .,,.. The Commonwealth of Virginia has set a limit for drinking water of 1/100 ml total,-colifo Sample Z0 S 20 miu$�s/-does-not-�meet this safe drinking water standard. , : 7 ^1 e;,,, t REPORTED BY _ ' , • Commonwealth ofVirginia Uniform Water Well Completion Report Aocr �Ip t tr� •1t V �� Tax Mapl0�5-"gc -1.)4 YOH Permit 1 Ot"-9.-off Lo L4 1.4- 1'()lam,-, 4N11.,.A, CvAtL3, cciC,t VWCBPwTnE Phone • Lxation dk lf�t kint Cou nty 1 810 (:)..T , • 'WallData• • Ganes'Into Doling Me o+oa7 j `Ci.- Date Corn d ) -cj� Total Depth of Weil ol�� Depm to Bacrod( •ti YAW ►Cs) ' (GPM) Length of Test S aric Water L.wel - Stabilized Water Level Natural Flow(Raul) Wed Dlsknteced(Y or N) n I DisWtaxsktt Used Amount Used Casing From i To r From To From To Sae Cobb-" Materiel Size Material Size Material WeightSc.,ecJe e. Weight/Schedule WeiphUSchedule Gravel Pack Torn To From To From To • Grout • '.o,,, (--- To ?C2) From To From To Sue Hots Siz i /C Bore Note Size • Sae Hole Size Ty Po C 114.14_1 a Type Type mae,od�x�-)ry ,I. r3 t i✓ Mathod f„tam water Zona/ or Scrs.. .d intervals From To From To From To mesh Size _ Diem Mesh Size Diam • kWh Size Diam morn To From To From To mesh Size Diam Mash Slze Diam Mesh Size Diam eUse Datae Prnrata Well Domestic .X T Agricultural. ltt¢tutdat Monitoring P u t t c Well Community Nat C ern ty Bored or Dug Weds • Wella ethic than Bored Wells :aung Rrrncvad.Y or N?: Casing ramioytid.Y u•N? I v•Dept, c which casing was removed: It Y,'Depot Iti MNGti caiinp was removed: De pot and T.De of Fit if app�icabie.dspth(s).and type'ol prifnilsand 01�'' Sa:rca of Source of gravel or sand; S entonite P4t.:s:From to_ From to Cement:From to_ From to Mee,od of •',lgnendy marking locators: • T' • 39 c elr� `1 (01—c13— �• b (! • R ?_� -Otilar . a. ' Dec s Deaaipdon a Formation a Sediment Remarks • • -- • r. _ •• _ - • -• - • • • • ... . • • . • . (User sddlti ai Sttle.ig ass y) cant it ha R1a:on contained Hera is true and that this waif Maj sd C aaDic ... state and local rpu(atjoris,ordinances and ::,:; oruryuGigd In'accordance with the permit and further that Uw weal cornpliea aY a WELL & PUMP COMPANY INC �HART•OTTF4V • Phone , . Drillan. Repr y ' +Dnp�'O s t e r a utnp O vim"" nraa s Ulan.µumy 2705_,_015945A 40 a P1_J --int I FR t Biological, Chemical, and Physical Analysis of Water, Air, and Solids; Biological and Chemical Treatability Studies; Flow Measurements !_ f F_='A-T-iD F-:' I , 3 C: _ P.0 Box 4006 : Charlottesville, Va. 22903-0841 t Phone 004)295-1716 1 Virginia Laboratory ID # 00015 CARL FRANk::L IN & SON 07/21/9O 403 ALLEN DRIVE } N ARLOTTESVILLE, VA. 22903 BACTERIOLOGICAL ANALYSIS REPORT TOTAL C:OL I F OR'M IN DRINKING WATER JOB NUMBER: IUO7112 SAMPLE NUMBER: U07112 DATE RECEIVED: 07/20/93 DATE REPORTED: 07/'7)1/93 IDENTIFICATION: L'I RTI EY WELL 7-20-93 I 0: _ _AM SAMPLE MEETS STATE STANDARD FOR COL'FORM BACTERIA IN DRINKING WATER. RUN PY THE MEMBRANE FILTER PROI=EDURE. :: 1 I_OLIFOR•M BAl_TE''IAi_ _O1_OH.!IES PER 100 MI . OF WA TES•. TO MEET THE STATE STANDARD FOR COL IFURN, DRINKING WATER SAMPLES RUN BY THE MEMBRANE FILTER PROCEDURE MUST HAVE LESS THAN ONE GO1 IFORM BACTERIUM PER 100 ML., AND NO MORE THAN200 BACTERIAL COLONIES ON THE MEMBRANE FILTER. THE SYMBOL '>' SHOULD E READ 'GREATER THAN' THE SYMBOL ':' SHOULD BE READ 'LESS THAN' • Commonwealth of Virginia Uniform Water Well Completion Report Owner Th(J ' ,—} --Pas—tor-5 Tax Map ID Address qcS )4114_:m v.ii_ �,kv-t__ VDH Permit CI\0.✓ 1_Cflk,o.ti11. , Vnq QaGt'A VWCB Permit Phone cqt_i, -S 3 3L� VWCB ID Location — &L. i_f;- .41 County L,{; 1LA_ * Well Data * General Information Drilling Method--R_ Date Completed S -I'i- ci I Total Depth of Well Depth to Bedrock 2' Yield i _ (GPM) Length of Test Static Water Level Stabilized Water Level Natural F1riw (Rote) Well ni5!„fncte d �(Y or N) iv Disinfectant Used Amount Used Casing From LD to 02 ci From to From to Size (p'hi Material—i VC_, Size Material Size Material Weight/r5le -!v Weight/Schedule Weight/Schedule Gravel Pack From to From to From to Grout From to Z u From to From to Bore Hole Size i L Bore Hole Size Bore Hole Size Type cs-�- - Type Type Method ,�c1.-, Method Method Water Zones or Screened Intervals From to From to From to Mesh Size . Diam. Mesh Size Diam. Mesh Size Diam. From to ' From to From to Mesh Size Diam. Mesh Size Diam. Mesh Size Diam. ` ' Use Data * Private Well: Domestic Vy Agricultural Industrial Monttoring Public Well: Community Non Community 1 uruiers Log • (Use additional sheets if necessary) Depth Description of Formation or Sediment Remarks • • • I certify that the information contained here is true and that this well was installed and constructed in accordance with the permit and further that the well complies with all applicable state and local regulations, ordinances and laws. Drilling Contractor FOSTER WELL & PUMP COMPANY, INC. Address 3V05 DobleAnn Drive 'Charlottesville, VA 22901 • Phone (804) 973-9079 Drillers Signature t. 1/4 I.. ' 'tU 4 4S Date 'S - i5 `3f Representing FOSTER WELL & PUMP COMPANT, Virginia Contractors License Number 2Z05001061 2 D • V ;..:.. 'l<C - Biotechnology Laboratory Lab State ID #00163 Snits 202 340 Commonwealth prlve. . , chartouesville . (8U4) 973`-9740 1=Sx: 804 :9 3 08 :...::.:.:;. :..:.....::.:..::.....,.. ..,.:.::, :.... Date: January 26, 1993 David T, Pastors Project Code: 1140 'AT 1sok 159 ro C s on JB syst tact: G Crozet,.VA ...:.:... ..:..,.:.,. . • Results Sent' 1/26/93 - • :.. . . : Results Phoned to Client: 1/26/93 Sample Location: RT 1 Box 159 Crozet, VA 22932 - Test Requested: Coliform, drinking water Results: Conforms absent If you have any questions as to the meaning of your test results,please contact me or the Biotechnology Division Laboratory. Please let us know If we can be of any further service to you. r'7 • J` L . PhD ,�s� Bell Fa,n GW-2 COMMONWEALTH OF VIRGINIA 1978-10.000 WATER WELL COMPLETION REPORT •BWCM No. State Water Control Board (Certification of Completion/County Permit) P. O. Box 11143 SWCB Permit 2111 North Hamilton St. - Richmond,Va. 23230 County Permit - - Certification of inspecting official: County/City aikiiitA, This well does does not County/City Stamp meet code/low requirements. S. •Virginia Plane Coordinates � � Date_ N •Owner For Office Use E •Well Designation or Number Latitude& Longitude Address Nftir 0 n Tax Map I.D. No. — W Phone Subdivision__ °Togo. Map No. � Section_ (�•Elevation ft. •Drilling Contractor c • , Qot (�n,._ LP,II .•1++dt\S Block___ _ •Formation Address // i-9 ��py Lee Lot__ -- •Lithology l�h'h.QQA. O1' 22-q.01 Class Well: I , I I A _ , •River Basin Phone IIB , IIIA _, IIIB _ •Province IIIC _IIID _ IIIE •Type Logs WELL LOCATION: 2c O (fee miles 1.C direction) of "— i- to ___ •Cuttings and _ • ,miles 5 (direction) of CR-1-. (99 1 ______-__.. _. —_ •Water Analysis (If possible plea include map showing location marked) •Aquifer Test p Date started a 5�— 83 • Date completed r 7 " c25—Q`_R Type rig /• 'A . I. WELL DATA: New Reworked Deepened 2.WATER DATA • Water temperature__ ___ OF •Total depth I o. ft. •Static water level (unpumped level-measured) ____ CO ft. •Depth to bedrock L} o, ft. •Stabilized measured pumping water level_ __ ft. •Hole size(Also include reamed zones) •Stabilized yield gpm after_ hours • 8 3 1( . inches from ( to t-} ft. Natural Flow: Yes No , flow rate. /0 g pm • inches from to tt. Comment on quality_ __ • (.r., inches from 45i to 1 a� ft. 3.WATER ZONES: From (o,S"-To ' - •Casing siz (I.D.) and material From_ To From- To . • to 5'$ inches from ± 1 to 4-S ft. From_ To . From• . To Material_ puC_ 4. USE DATA: . Wt. per foot or wan thickness in. Type of use: Drinking , Livestock Watering • inches from —to ft. Irrigation Food processin g__''•; Household _. Material Manufacturing , Fire safety Cleaning'_ , Wt. per toot or wall thickness in. Recreation ,Aesthetic Cooling o' heating , • inches from to ft. Injection_ ,Other Material •Type of facility Domestic _,Public`waigcsupply: Wt. per foot or wall thickness ______in. Public institution Farm___- , Industry — _, •Screen size and mesh for each zone (where applicable) Commercial , Other • inches from to ft. 5. PUMP DATA: Type _-- 1 Rated H.P. -- ' •Mesh size Type •Intake depth ,Capacity at head • inches from to ft. 6.WELLHEAD: Typc welt seal T •Mesh size Type _ Pressure tank gal., Loc. • • inches from to ft. ' Sample tap , Measurement port •Mesh size Type _ Well vent _ ,Pressure reli:f valve • inches from to ft. Gate valve .Check valve(when required)__ •Mesh size Type _ Electrical disconnect switch on power supply •Gravel pack 7. DISINFECTION: Well disinfected _ — yes no •From to ft. Date _, Disinfectant used_ •From __ to ft. Amount _ , Haurs used _ *Grout 8.ABANDONMENT (where applicable) •yes no •From Q to 01O it.,Type Casing pulled yes no --_not applicable •From to ft., Type Plugging grout From _tO ._material Owner BWCM No. 9. State law requires submitting to the Virginia State Water Conuol 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 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 or 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. 10.DRILLERS LOG (use additional Sheets if necessary) 11. 12.DIAGRAM OF WELL CONSTRUCTION (with dimensions) • DEPTH(feet) TYPE OF ROCK OR SOIL REMARKS Drilling From To (color,material,fossils,hardness, (water,caving,cavities, Time etc.) broken,core,shot,(etc.) 0 4a. owl r C sp • • $g10 112/� col 1„k —sr,`• of g •? .7l?5Zi1-ti6 'l 13. Well lot dedicated? ;Size ft. X ft.;Well house? Distance to nearest pollutant source ft.,Type Distance to nearest property line ft.,Building ft. 14. WATER SERVICE PIPE: Checked under p.s.i. for State Water Control Board Regional Offices minutes. Pipe size inches. Moleriol Valley Reg.Off. Piedmont Reg.Off. Installer —. ---__-_- 116 Nortn Main Street 4010 west Broad Street P.O.Box 268 P.O. Box 6616 Dote Bridgewater,Va.22812 Richmond.Va.23230 703-828-2595 804-257.1006 Southwest Reg.Off. Tidewater Reg.Off. IS. I certify that the information contained herein is true and correct and that this well 408 East Main Street 287 Pembroke Office Park and/or system has been installed and constructed in accordance with the requirements P.O. Box 476 Suite 310 Pembroke No.2 for well construction as specified in compliance with appropriate county or independent Abingdon,Va.24210 Va. Beach,Va. 23462 city ord. nces and the laws and rules of the Commonwealth of Virginia. 703-628-5183 804-499-8742 West Central Reg.Off. Northern Virginia Reg.Off. Signature Q R (Seal),Date 3 ���-� (to Executive Park 5515 Cherokee Avenue (Well d Iler or authorized person) 5312 Peters Creek Road Suite 404 License No. Roanoke,Va.24019 Alexandria,Va.22312 • 705-982-7432 703-750-9111 • •-- s w N. ri COMMONWEALTH OF VIRGINIA PUBLIC Y NON-PUBjI-hC„WPPLY EPARTMENT OF GENERAL SERVICES • ommuni rLJ DIVISION OF CONSOLIDATED LABORATORY SERVICES-BUREAU OF MICROBIOLOGICAL SCIENCE on-Co . lQ ` NAME OF c-�k - RESORT ON BACTERIOLOGICAL EXAMINATION OF WATER W CITY OR I� Vv���Q DO NOT WRITE IN SPACE BELOW. —~ DATE COLLECTED TIME: COUNTY + _ < GJtJ"'( "' Portion Bact.of. Portion Bact. of, SAMPLE NO. • • Of Sample Coliform Of Sample Coliform ,., " c. V`C� Tested Group Tested Group NAME OF SUPPLY , �/ # r $sL!, H 1 , 2 93 .Oool ml. 10 ml. _ 0 SUPPLY OWNED BY ` I • 5 .001 ml. 10ml. - � ' SPIE COLLECTED BY V, t ` • r 1 ZS• AMPLE WAS TAKEN FROM �/l t J� '� RECEIVE b (WELL;APPROVED P,-:� _ .01 ml. 10 ml. "'�....' 0 3 HI£S4.1PPLY CHLORINATED? YES ❑ NO ❑ 0 m Z W CS CHLORINE TEST MADE AT SAMPLING POINT YES ❑ NO ❑ f •o p 0 RES. CL. RPM. 1 ml. 10 ml. n N �°-� - REPORT RESULTS TO• :,,,, 121 W '‹ •� . ' .��. ��OMP iED 1 ml. lOml. g ( Cre I— J o . \ -7 Q Membrane Filter Coliforms per 100 ml. W ),,k, \.....)"K),..A._ , )..)s. . 2 N 1.. Oppos,ite Portion Tested Means Bacteria Indicating Contami- J = / nation WERE Present. ~ O See,reverse side for collection information - — Means Bacteria Indicating Contamination WERE NOT Present. u ' DCLS-02-078(REV.3-79) . Fo GW-2 COMMONWEALTH OF VIRGINIA • t97ta-10,00o WATER WELL COMPLETION REPORT •ewcM No. State Water Control Board (Certification of Completion/County Permit) • P.O. Box 11143 2111 North Hamilton St. • SWCB Permit Richmond,Va.23230 • County Permit . • ' Certification of inspecting official: County/City . - .. ALBEMARLE This well does does not County/City Stamp S.meet code/low requirements.'- •Virginia,Plane Coordinates Date_ N •Owner ALBEMARLE HOITSTNa TKPROVEMENT PROCRAM - For Office Use • ' E •Well Designation or Number BLAIR—WHITE JOB Latitude& Longitude Address 409C East High Street - N Charlottesville, VA_ 22901 Tax Map I.D. No. w Phone Subdivision —_ •Topo. Map No. Section •Elevation ft. •Drilling Contractor_FOSTER WELL COMPANY Block - •Formation Address 2885 EARLYSVILLE ROAD Lot__ •Lithology EARLYSVILLE, VA 22936 Class Well: I , IIA •River Basin Phone (804) 973-9079 IIB . IIIA , 1118 ___ *Province IIIC _HID ' IIIE •Type Logs WELL LOCATION: (feet/miles direction) of • •Cuttings and feet/miles (direction) of _ •Water Analysis (If possible please include map showing location marked) •Aquifer Test Date started 1/89 • Date completed 1/89 Type rig Rotar• I. WELL DATA: New X Reworked Deepened 2.WATER DATA • Water temperature _ _ _________ OF •Total depth 225 ft. •Static water level (unpumped level-measured) ________ ft. •Depth to bedrock 56 ft. •Stabilized measured pumping water level _ ft. •Hole size(Also include reamed zones) •Stabilized yield gpm after, _ hours _• 9 inches from 0 to 56 ft. Natural Flow: Yes No flow rate. 10 gpm • 6 inches from 56 to 225 tt. Comment on quality _____ • inches from to ft. 3.WATER ZONES: From To •Casing size (I.D.) and material From_ To _ From To • 6 i inches from () to 56 ft. From_ To From To _ Material_ P1 a sti r• 4. USE DATA: Wt. per foot or wait thickness in. Type of use: Drinking X , Livestock Watering • inches from to ft. Irrigation Food processing.___ . Household X Material Manufacturing , F ire safety __ , Cleaning Wt. per toot or wall thickness in. Recreation , Aesthetic _ ,Cooling or heating _ • inches from to ft. Injection _,Other Material .•Type of facility. Domestic x ,Public water supply Wt. per foot • or wall thickness __in. Public institution Farm___. , Industry — •Screen size and mesh for each zone (where applicable) Commercial , Other • inches from to ft. 5.PUMP DATA: Type 1 Rated H P. •Mesh size Type •Intake depth 'Capacity at head • inches from to ft. 6.WELLHEAD: T ypc well seal •Mesh size Type Pressure tank gal.. Loc. • inches from to ft. Sample tap , Measurement Port • •Mesh size Type _ Well vent , Pressure reli4 valve • • inches from to-- ft. Gate valve . Check valve(when required) •Mesh size Type Electrical disconnect switch on power supply •Gravel pack 7. DISINFECTION: Well disinfected _ _ yes_ no •From to ft. Date _, Disinfectant used •From to ft. Amount _, Hours used •Grout 8. ABANDONMENT(where applicable) •yes no ... •From _ 0 to 50 ft., Type cement - Casing pulled yes no__ not applicable •From to h., Type Plugging grout From to _ __material OVER -owner AHIP — — — - _ BWCM No. --- 9. State law requires submitting to the Virginia State Water Control 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 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 or 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 fcr public supply wells. 10.DRILLERS LOG (use additional Sheets if necessary) 11, • 12 DIAGRAM OF WELL CONSTRUCTION (with dimensions) - DEPTH(feet) TYPE OF ROCK OR SOIL . REMARKS Drilling �',IG,Q/) -J—LIS From To - (color;material,fossils,hardness. (water,caving,cavities, Time 'etc.) broken,core,shot,(etc.) — (Min.) l • 0 56 mud, granite - • 56 225 granite • • • D n—J l3s 13. Well lot dedicated? ;Size ft. X ft.;Well house? -- Distance to nearest pollutant source ft.,Type Distance to nearest property line ft.,Building ft. 14. WATER SERVICE PIPE: Checked under p.s.i. for State Water Control Board Regional Offices minutes. Pipe Si:e incnes, Molerral_ Valley Reg.Off. Piedmont Reg. Off. Installer 116 North Main Street 4010 West Broad Street P.O.Box 268 P.O. Box 6616 Dote Bridgewater,Va.22812 Richmond,Va. 23230 703-828-2595 804-257-1006 Southwest Reg.Off. Tidewater Reg.Off. 15, I certify that the information contained herein is true and correct and that this well 408 East Main Street 287 Pembroke Office Park and/or system has been installed and constructed in accordance with the requirements P.O.Box 476 .Suite 310 Pembroke No.2 for well construction as specified in compliance with appropriate county or independent ' Abingdon,Va.24210 Va.Beach,Va. 23462 city ordinances and the laws and rules of the Commonwealth of Virginia. 703-628-5183 804.499-8742 West Central Reg.Off. Northern Virginia Reg.Off. Si natured U (Seal). Date a —/ Executive Park 5515 Cherokee Avenue I driller or authorized person) 3312 Peters Creek Road Suite 404 'cense No. Roanoke, Va.24019 Alexandria,Va.22312 -- ---. 703-982-7432 703-750-9111 • R Biological, Chemical, and Physical Analysis of Water, Air, and Solids Biological and Chemical Treatability Studies; Flow Measurements L. Ec D R CD IR I .B , 11,E .. : P.D Box 4006 : Charlottesville, Va. 22903-0841 Phone i8041295-1716 A. H. I. P. 02/09/S' ATTN: MR. STEVE SHIFFLET 409 C EAST HIGH STREET CHARLOTTESVILLE, VA. 2290 BACTERIOLOGICAL ANALYSIS REPORT TOTAL COLIFORM IN DRINKING WATER JOB NUMBER: N2812 SAMPLE NUMBER: N28125 DATE RECEIVED: 02/0 f/ SS • DATE REPORTED: 02/0 i'S'3 IDENTIFICATION: BLAIR/WHITE WELL WATER, 250 WEST, YANCY MILL;:;, '/ /S'3 3: 30PM SAMPLE MEETS STATE STANDARD FOR COLIFORM BACTERIA IN DRINKING WATER. PUN BY THE. MEMBRANE FILTER PROCEDURE. 1 COL IFCRM BACTERIAL ERIAL COLONIES PER 100 ML. DF WATER. -C MEE: -:HE STATE STANDARD FOR COL ;>ORyy DRINKING RiIlINu WATER SAMPLES RLN B7 - E Ir� MEMBRANE _ .. ...,.,,.E MOST HAVE NO MORE ONE COLIFDRM ACT RIUM PER ,JTii,iL .. ,iS '1'.::.iJlai THANii::�, .i ::i, PER 100 ML., AND NO MORE THAN :CO BACTERIAL COLONIES ON THE MEMBRANE FILTER. THE SYMBOL '>' SHOULD BE READ 'HEATER THAN' THE SYMBOL ';' EHDJL BE READ 'LESS THAN' ACUA—AIR LABORA ; ES,�� REPORTED BY Commonwealth of Virginia Uniform Water Well Completion Report OwneTP,CS-y,_- a - j i ' u Cj - Tax Map ID < - I -(0c,�Address C-io I'�N i P VDH Permit C `I Oct C. 1; (_/)i `h1,ctbti tot-� � �� Phone 3 ` r�o — I LsL. VWCB Permit VWCB ID Location 1.),)Dr L,`r-x-r'), .Jr,yam. County l=+I htr,--)a)I.L. • Well Data • General Information Drilling Method 1Zr.r Date Completed Ci-S-ql I Total Depth of Well a(- J Depth to Bedrock --t q Yield �S-- (GPM) Length of Test Static Water Level Stabilized Water Level Natural Flow (Rate) Well Disinfected (Y or N) ^j Disinfectant Used Amount,Used Casing From L to -1 C" From to From to Size(c,'14" Material }7VC,, Size Material Size Material Weight/ edui ./0 Weight/Schedule. Weight/Schedule Gravel Pack From to From to From to Grout From CD to o?C From to From to Bore Hole Size i p Bore Hole Size Bore Hole Size Type e_-Q-r-r -''`} Type Type Method - ,,- Method Method Water Zones or Screened Intervals From to From to From to Mesh Size Diam. Mesh Size [Nam. Mesh Size Dlam. From to ' From to From to Mesh Size Diem. Mesh Size Diam. Mesh Size Diam. j • Use Data Private Well: Domestic k.Ic.Y Agricultural Industrial Monitoring Public Well: Community Non Community 1 6-\0am urluers Log • (Use additional sheets if necessary) Depth Description of Formation or Sediment Remarks nCt ►2OCk 'lc►-_Lc G U • • I certify that the information contained here is true and that this well was installed and constructed in accordance with the permit and further that the well complies with all applicable state and local regulations, ordinances and laws. Drilling Contractor FOSTER WELL & PUMP COMPANY, INC. Address 3V05 DobleAnn Drive _Marl ottesville,. VA 2290.1 Phone (804) 973-9079 • Drillers Signature` 9s-14Q,),---__.-r<59-Representing FOSTER WE�� PUMP CO ,, 1 Date Virginia Contractors License Number 2705001061 2 e y � C iJ e--A I F' o Biological, Chemical, and Physical Analysis of Water, Air, and Solids; Biological and Chemical Treatahility Studies: Flow Measurements E__Pi J3 D F: T D? I E ,. I C: _ o P.O Box.400S : Charlottesville, Va. 22903-0841 Phone (304)295-1716 A. H. I . ATTN: MR. STEVE SH I F FLETT 409 C EAST HIGHSTREET CHAR) OTTESV I LLE, VA. 22901 BACTERIOLOGICAL ANALYSIS REPORT TOTAL COLIFORM IN DRINKING WATER JOB NUMB R. :7-4c,1 1 • SAMPL NUMBER: ROSE11 DATE RECEIVED: 06. 92 — :'•ATE REPORTED: _ j 06 92 IDENTIFICATION: M. -REENE WELLL _0 _1 / i _.f 0 PM SAMPLE MEETS STATE STANDARD FOR COLIFORM BACTERIA IN DRINKING WATER. RUN BY T hE MEMBRANE I L T ER PROCEDURE. I COLIFORM BACTERIALOnL_;N;I ES P€=r' 100, M1 OF ! i''TP7 R. TO MEET THE STATE STANOARD FOR iCOLIFORM, DRINKING WATER SAMPLES RUN BY THE MFMBRA}E FILTER PROCEDURE MUST HAVE LESS THAN ONE COLIFORM BACTERIUM PER, .00 ML., AND NO MORE THAN 200 BACTERIAL COLONIES ON THE MEMBRANE FILTER. ...- SYMBOL '' SHOULD BE READ 'GREATER THAN' THE SYMBOL ' .F SHOULD LE READ 'LESS THAN' AQUA—AIR LABOR'ATOR T ES,, a /J REPORTED BY 0-68 rzfi 7cgcf f toy APg/A ��t# Fo;,r, ow.: COMMONWEALTH OF VIRGINIA - 1 9 78.10,000 WATER WELL COMPLETION REPORT •BWCM No. SS-7 State Water Control Board (Certification of Completion/County Permit) P. O. Box 11143 2111 North Hamilton St. SWCB Permit - Richmond,Va. 23230 County Permit A-G/Yj/y /e U Certification of inspecting official: County/City` This well does does not Court /City Sump meet code/low requirements. • S. •Virginia Plane Coordinates Date N •Owner G�/g PS O,�'ti`$ - E •Well Designation or Number (� For Office Use Latitude& Longitude Address �aze� LYO— . N Tax Map I.D. No. w Phone 4 79-3 4 Subdivision -- •Topo. Map No. (` I' '_ / /I Section_ •Elevation ft. •Drilling Contractor �04a�d [/��/ ,!'I N C Block 'Formation Address /1 e- O/ .64)( API -A `� Lot_ _.__ •Lithology Ens/71v,'ll•e ) Lick • a.,-).9.3e, Class Well 1 ___ , IIA . •River Basin Phone 11B , 111A , IIIB __ •Province IIIC IIID IIIE •Type Logs WELL.LOCATION: Cis (feet/miles <5'40 direction) of 11.40uL.- __ -_ •Cuttings and feet/miles (direction) of ______ __ •Water Analysis (If possible please include map showing location markedl •Aquifer Test 3 ? < Date started 5 - 93 •'D a t e completed —.93 Type rig fa - Q f/)--. I.WELL.DATA: New Reworked Deepened 2.WATER DATA •Water temperature___ __ _ of •Total depth /G-Q ft. •Static water level (unpumped level-measured) ____ ft. •Depth to bedrock tilir *IS— ft. •Stabilized measured pumping water level tt. •Hole size(Also include reamed zones) •Stabilized yield gpm after __hours • /o inches from d ft. - to Natural Flow: Yes � No , flow rate. (eC� -� gpm • Ce_inches from 4. to 0 / Ci It. Comment on quality__ _ • inches from to ft. 3.WATER ZONES: From To T ' ' •Casing size(I.D.) and material 4/65 From_ To From To •_ (9# inches from 6to !Vd`.ili+h'� ft. From To . From To Material— p, IJ r C 4. USE DATA: / Wt.per foot or wall thickness in. Type of use: Drinking ` Livestock Watering • inches from _to ft. Irrigation Food processing__ _ _ , Household �r Material Manufacturing , Fire safety . Cleaning— Wt.per toot or wan thickness in. Recreation , Aesthetic . Cooling or heating _ • inches from to ft. Infection ,Other Material •Type of facility Domestic_Public water supply Wt. per foot or wall thickness in. Public institution Farm____ , Industry _ 'Screen size and mesh for each zone (where applicable) Commercial , Other • inches from_ to ft. c --"'—5.PUMP DATA: Type 5 .1 1 Rated H.P. �"' •Mesh size Type .a_— __ �- . •Intake depth '5' Capacity__ at head • inches from ____to ft. 6.WELLHEAD: T YPc well seal lliQ -ITS(I/t •Mesh size Type Pressure tank 3a gal , Loc. f� _� • inches from to ft. Sample tap , Measurement port •Mesh size Type — Well vent ,Pressure reli:f valve • inches from to ft. Gate valve . Check valve(when required) •Mesh size Type Electrical disconnect switch on power supply •Gravel pack 7. DISINFECTION: Well disinfected._ _ _ yes_ no •From to ft. Date _, Disinfectant used •From _— to ft Amount Hours used •Grout 8.ABANDONMENT(where applicable) •yes no •From 6 to 0,1-40 ft., Type flis A✓ j CernC Casing pulled yes__ no _ __ not applicable •From to tt , Type Plugging grout From to material - Owner BWCM No. __.__--I_ 9 State law requires submitting to the Virginia State Water Control Board ireformation 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 water well completion report, lull 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 or 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. 10.DRILLERS LOG lure additional Sheets if necessary)- 11' 12.DIAGRAM OF WELL CONSTRUCTION (with dimensions) ' DEPTH(feet) , TYPE OF ROCK OR SOIL REMARKS Drilling From To (color,material,fossils,hardness, treater,caving,cavities, Time etc.) broken,core,shot,(etc.) (Min.) G 7 R.e J ° I 0 t - w 3 � 6i�� "i57c6fft . r e. 3 Ij I/(e 690k 1%) Lf /Iuric- - / V p if& /dv A-cl deo°. 13. Well lot dedicated? ;Size ft. X ft..Well house? __ Distance to nearest pollutant source ft.,Type Distance to nearest property line _ ft..Building ft. 14. WATER SERVICE PIPE: Checked under p•e.i. for State Water Control Board Regional Offices minutes. pipe s;ze inches, Material — Valley Reg.Off. Piedmont Reg.Off. Installer - ------ 116 North Main Street 4010 west Broad Street P.O.Box 268 P.O. Box 6616 Dote Bridgewater.Va.22812 Richmond.Va.23230 703-828-2595 804-257.1006 Southwest Req. Off. Tidewater Reg. Off. 15. I certify that the information contained herein is true and correct and that this well 408 East Main Street 287 Pembroke Office Park and/or system has been installed and constructed in accordance with the requirements P.O.Box 476 Suite 310 Pembroke No. 2 for well construction as specified in compliance with appropriate county or independent Abingdon,Va.24210 Va. Beach, Va. 23462 city ordinances and the laws and rules of the Co nwealth of Virginia. 703.628.5183 804.499-8742 West Central Req.Off. Northern Virginia Req.Off. Signature /Jeri (Seal), Date s q/,�3 Executive Park 5515 Cherokee Avenue (Well drill or authorized person)5312 Peters Creek Road Suite 404 License No. 765' O jdc 3 Roanoke, Va.24019 Alexandria,Va.22312 701-982-7432 703-750-9111 3, • . • . o - . • A— I IF: : Biological, Chemical, ,and Physical Analysis of Water, Air, and Solids; Biological and Chemical Treatability Studies; Flow Measurements L Pk]3€J!='A T iD F' I la SS , I NJ C _ : P.0 Box 4006 Charlottesville, Va. 22903-0841 Phone B-041295-1716 CHARLES ROGERS, BUILDER 06/25/93 . 3 _ BOX 180A CHARLOTTESVILLE, VA. - - 22903 • BACTERIOLOGICAL ANALYSIS REPORT TOTAL COLIFORM IN DRINKING WATER JOB NUMBER: UOSE04 SAMPLE NUMBER: U05604 DATE RECEIVED: 06/24/93 DATE REPORTED: 06/25/93 IDENTIFICATION: B I SCARD I WELL 6-24-93 7: 15AM . SAMPLE MEETS STATE STANDARD FOR COLIFORM BACTERIA IN DRINKING WATER. RUN BY THE MEMBRANE FILTER PROCEDURE. <1 COLIFORM BACTERIAL COLONIES PER 100 ML. OF WATER. TO MEET THE STATE STANDARD FOR COLIFORM, DRINKING WATER SAMPLES RUN BY THE MEMBRANE FILTER PROCEDURE MUST HAVE LESS THAN ONE COLIFORM BACTERIUM PER 100 ML., AND NO MORE THAN 200 BACTERIAL COLONIES ON THE MEMBRANE FILTER. , THE SYMBOL 'i' SHOULD BE READ 'GREATER THAN' THE SYMBOL '<' SHOULD BE READ 'LESS THAN' AQUA-AIR LABORA O 'I REPORTED BY 2 • • • Commonwealth of Virginia Uniform Water Well Completion Report ottner • A , f� k Tax Map ID h� i-.►1a "`fir VOW Permit t 1-93-c)fao `l cj,3 A I Lt.,--1 �Yt t i.a, �.vt I Lc QQ-9 1 VWCB Permit ano"e • -xadon��1 k` 11u U C f, . County CST Z lUt C • \Weil Data• Genera:into /� / p �nling Mec- r Ota>, Date�oe:ad t 3- 3 Total✓eom m I3ecr }7' Yield '7 Length of T of Well o � Sax Watt rL evsi lam) Lettpttt of Test Stabifzsd Water Laval z Nan rel Flow(Raub) weir Diemfecrd(Y cr N) /Li DiiW!octant Used s ArrantUtied • • Casing • "o'Tt_� To f From To Sas lr,'/` Size WterW Size /"Material V From To �ial wagnv '--/0 Weight/Schedule - WeipJWSchedtr(e Grave:Pact :. *-TI To From To From To • • G rout orn L To `70 From To From To Sore Hole Sc s I vf�.,- Bore Hole Size • Bore Hole Size 'r Ps CQ.r s_c_r-i d - ,-w5 0 2 t Typo Type kAeclod.(-A,-y-_p Method Lietthod water Zones or Screamed Intervals "om To meAA n Size _ p;� From To From To nes To From Slze Diem • Watt Size Diam can Siz• To From To Dlam ktesh Size Dian Wah Size Dam .Use Data' a rive to W.a Domestic k X X pyej C IndusCtal a u ty a C Wens AAortittxirtg Community �Community�~ •Abaridcrmant Iniotmatioel• .- . a .d o.0�5 w.u, « Casing rp Re c+e4,Y orN? Casing rtumoYod.Y of W? Wells other than Bored Wells Y. pogo, = **tictt casiryO vaa removed: ItY. �aovt Ord '7•,•d Fill 'Dapthtztitilot cuing Wasremoy/d:_ IISourca of= ' eppide,c� dsp h(a).and type'of pre aVeard fir: Source of gravel or sand; 3 entoniu -._;s:From to From to Camenc From tp From to ed of:-•-nanenty marking Iocalkn: - �_ Noio .-- • 39 ..„. ' - / : • ••.,:".••. •,•.".!..' - • •.....,.. • ..-.. . . •. • . . • a;1•!!'s 11! '.•.' .•''.es.t't.:",. . f t_il--'CI 3 -- 0/C;-2 0 DK Descripeort of Random cs,Sediment . Remark: , ' • . , .t._. — '5---3--. - - -: sc.. .....- .. _ . ....3 . . . - • •.: - • '.'.. • ......• . . .... •.., . •-I ..„ •t..., 5-0.- ' •..*.••••:•..;%••.•;••.'. •:. • -V- • •• • . . . . . .. . . , . .. ... ..-' . . - . . • c _ .. . . • . • • ‘°Ike . •f../e . . . . a • erte;t, ..'J. -470 .15, • • ... - •... - ' . •(User edcitkrtalS444)1.r4rtmaary)"•• ' • . • 1 cant tt he trazernatcn contained here is true and that this well wailnitai?il pt!cicretopi0 in accorciehie Ibith the pa:mit and tUrther that.the Well CCGOI""th" tUa and Iccag rpuladcnj.or:Enemas and laws. riarna _ -WELL & PUMP COMPANY INC Addis, ... .... ,„„ . Dr - - • -filiada & . ' gr/r1) Data-TItt4S Fircroiantrg Wriailly - -- 0 virgui, ntracora Licansa Numba. 2705 015945A 40 • : Biological, Chemical, and Physical Analysis of Water, Air, and Solids; : Biological and Chemical Treatability Studies; Flow Measurements L_ €cC3F:.1-T-C3F: I EE , I C: — P.0 Box 4006 -Charlottesville, Va. 22903-0841 : Phone (B04)235-1716'1 Virginia Laboratory ID 1 00015 C-.ARL M RANKL I N p, SON -: -=- c)7/21(9 *'"' 403 ALLEN DRIVE r! CHARLOTTESVILLE, VA. 2290, ,;,, k� ;;.. • BACTERIOLOGICAL ANALYSIS REPORT TOTAL COLIFORM IN DR I NK I Nl3 WATER JOB NUMBER: U0711'' SAMPLE NUMBER: U07112 DATE RECEIVED: 07/20/93 DATE REPORTED: 07/ 1/93 IDENTIFICATION: KIRTLEY WELL 7-20-93 0-93 10: :30AM SAMPLE MEETS STATE STANDARD FOR COLIFORM BACTERIA IN DRINKING WATER. RUN BY THE MEMBRANE FILTER PROCEDURE. < 1 COLIFORM BACTERIAL COLONIES PER 100 ML. OF WATER. • TO MEET THE STATE STANDARD FOR COLIFORM, DRINKING WATER SAMPLES RUN BY THE MEMBRANE FILTER PROCEDURE MUST HAVE LESS THAN ONE COLIFORM BACTERIUM PER 100 ML., AND NO MORE THAN 200 BACTERIAL COLONIES ON THE MEMBRANE FILTER. • • r THE SYMBOL '>' SHOULD BE READ 'GREATER THAN' THE SYMBOL 'C' SHOULD BE READ 'LESS THAN' AQUA—AIR LABL ATO,:IE. REPORTED BY07— V , 1, la 1 _ l'j 11 110. ! 0 1 v!p "1-4: • CU b IA I-1 3 �Pc —Is '-ZI I { —• - 1 1 -L. .L.... *-/- � • i U PA wh