She et No....:../ PROP: MONTPE LIER MRS. dupont SCOTT COMP: C. A. PALMORE COUNTY: OItANGE VDMll WZLL NO. 02.Z0 FR.OM: TO: VDMR WELL NO. O:;}:2 0 Sa mple Inte r val Is;'-:J.ss- j T otal Depth ;2SS...-" Oil Ga s Wa t e re x pl ora tory Cutti n g s V C o r e Othe r F r om -To J - F r om -To ) Jjt/-S- - ss: 6 /j----- f5" 16-10.5"- /IS' /)5" /3j /15 15 /6)- /7S- /! F.>- (95'- JO.s ;2/ ;2;;;.5".3.5 dtf ass: F 'r orn e T' o From-To F r om -To
.-. 0,..,;; r'l j Q... County Map I'ro pcrt j- of Y I-D n..-t.s-c -, -ld:,,-- W ell No. 1-.:.... (a) City or Town l1. o n ye l l er Location (b) Count y Or"'1J" ( direction) of FORM GW 2 Commonwealth of Virginia Department of Conservation and Development VIRGINIA GEOLOGICAL SURVEY Box 1428, University Station, Charlottesville, Y». WATER WELL COMPLETION REPORT (This report must be submitted within 30 days after completion of well.). of and Address App roxi mately 1, miles WELL NO. 02'20 W ell No. @ '. Office No. Map No. ( G ive direction and distance in or tent hs of a mile from two ( 2 ) location reference points or map coordinates shown on quadrangle topographic map or, where such map is not available, give direction and distance from two (2) known reference points on County Highway map.) Dr iller C. A. P oj.., Q c't.. Address D rilling commenced E levation ( ground surface). Total depth : a s S Bedr ock (hard rock) al-- 1 S; Casing : Yield : (a ) flow W ater at (a) ( b) pump. (b) (c) P umping test :. i n c h to inch inch inch s: to to to GP M GPM L to to to,,;,-\ I S" - -- --- - -- Drilling comp let ed Diameter --illch, surface to' inch, inch, -,inch, Screen (Strainer or P erforated Diam. Mesh Size Main supply developed at to to fcct. to Casing) to to to to Determined :(a) Pump test. at ",....--- (b) Bailer L. --' (e) Estimated ( hrs.); F inal yield GPM U se of water (a) P ublic supply ( <1) (check) ( b) Municipal (e) (e) Commercial (f ) Temperature of water (if determined) Governmental Jns titntional "E. hi's. pu mping a j GP 1 Appearan ce of wat er I ndu stri al Clear Cloudy Taste Odor P ump {installed ) Ty pe. Capacity Set at-- Remarks GPM We ll shot at : ( I) ; (2) ; ( 3). Charge used : ( I) lbs, ; (2 ) Ibs. ; (3) lbs. P acker at Salt wat er at. Shoe at Brackish water at, Wood plug at-- Fresh water at Log of well, given on reverse (over ) Rema rk s This form. No mailed ta'- - - - - - ""';:c,.,-- - - - - - - - - - -- ---- Name on =,---- Received by on ----- Na me Completed and mailed by on -=------- :Name Received in offices of Virginia Geological Survey on "" over Address
Report 1'10., Wen No. LOG Furnished by Date Compiled hy Date Sample No. Formation Color Hard or Top Bottom Thickness Soft ( Feet ) ( Feet) ( Feet ) I Remarks Water, fi s h j ng shut down, screen, caving, shot -, -..,,.,
DEPARTME NT DIVISION COMMONWEALTH OF CONSER VAT ION OF OF MINERA L VIRGIN IA AND ECO NOMIC DEVELOPMENT RESOURCES Bo, 3 667, Uniyersity Slo tlon, Charlottesvill e I Virgini a WAT ER WELL COMPLETION REPORT OWN ER:...J!.ln...J2lI.,P!:Ln.t'---. i.c.clt..t..n::jl TENANT: ---=------,---::::--:,,---- DRILLER: C. A. a l ore WEL L L OCATION: Counly--'OoLr""-"l 8...D.yg:;,.e""- east ( ire c t ion) of?-'.on t pe J 1 e r 15 220 Moiling Address: Moiling Addre ss: Mailing Address: ----,-.,...,..,,- ] It ond miles 01 IWA"'ro:R UI'IUI DEPTH STATIC WATER LEVEL 15 WATER ZONES (f issures or formations supplying water) (from) (to) (from) (to) ft.. ft 85 f.. fl. QUAN T ITY OF WATER WELL PUMPED (or boil ed) at 5 Gal. per Min. with PRAWPOWN af te r HOURS PUM PING. FLOW (naturei) G.P.M. HEADft. (above ground) W REMARKS:.I N UI'I::>I E COLOR "IDOR QUALITY OF TA STE OTHER WATE R ANALYSIS: AVAILABLE- Y.. 0 No 0: ATTACHED YII C No O TEMPERATURE (from) (1 0) WATER ft. ft. (sal1. brackish, iron, Sulfur, acid. oth er) USE OF WATER: Domlille 0 Town C Indul l ry 0 Farm 0 PublicO S i ICONST R UCTION' HOLE SIZ E CASING SIZE RIG TY PE (or met hod) (rotory, ca ble, bore d, driven, er e.. ) in tt 6 DATE: Started I Completed TOTAL DEPTH 255 ft. SCRE EN (or perf or ation s) BEDROCK at 15 f t. METHOD GROUTING USED GROUTING INFORMAT ION MATERIAL TYPE (diam) (froml (tal (diom) (fr om) (t o) in ft ft. (diam) (from) Uo) (open ing sile) In ft. 11 IPUMP (Inl lalled ll. Cop. (gpm) DEPTH OF GROUTING H.P.. Depth of intake ft. REMARKS: Log 01 well (oyer)
LOG FURNISHED BY DATE : DEPTH ( ) T YPE OF SOIL OR ROCK PE NETRATED RE MARKS FROM TO (grovel. clay. etc., hardness, color, etc) (water, coving J shot, sc reen. sample, etc.) - (Use additional sheets if necessary)