INTERVAL SHEET

t o 3 (lO

VDMR WELL N O . : WELL NO.

T ota l Depth _

Oil__Gas,_ _ Wate r (....;- Expl ora tory _

S a m p l e Interval: from 0

C u t ting s ~ C or e Othe r- - - ----

IP a g e_ -,-_ _

)( M VJ 1 ~ tJ rr,\~_ I.-J< S

PROP ;l?ROP: WEST LElGH SUBDIVISION(W. L . CLOVER" E . G. SPIES)

COMP COMP: T. O. PERKINSCOUNTY: ALBEMARLE

C OU N 'l'.fDMR. WELL NO. 365FROM: TO:.. :.

F ::-om-To F r om - T o F r om-T o F rom - T o F r om -To

0 ­2- 11 ­:3 () .~o ­60 -81) ­'76 -

/tJ~ ./(J ­~ -

3 () ­.ao- ?~; - .60 '7ft) - Zt'

9(/ ..J."9-

/0 ­/<r~(;)

~" -.Jd

3d -'r- O9(J - S-"0',, - cPo0tJ - 7 070 - ~ 0

Za. 't~

'1~ - J,.!b ­) -

- Cutti ngs

Fr om-To

- - Core

From-To

I nterval Sheet

From-To

--- Water Well

Fr om-To

Sheet No.

--- Gas We ll

From-To

Tot al Depth _

DI VISION OF MIN ERA L

D EPAR TM EN T

COMMONWEALTH OF

OF CONS ERVA TION

VIRGINIA

AND ECONOMIC DEV ELOP MENT

RESOURCESI'/VICR 472VD1.'R 365

eo _ 3667, Universi ty Station . Charlott esv ille . Virginia

WA T ER WELL COMP LETION REPORT

Appro • •

Moil inq Address: _

Moilin g Addre ss: _

MoilinliJ Addre ss : ----: _

OWNER : West Lei gh Sub. Div.TENAN T : _

DRIL L ER: T 0 Pe;-ki ASII.

WEL L LOCATION: COUlll r_AaJ,.] boee"''''aa~r'"'l .ee___________ _--<2~:l~--------)('li 'n

\I'J ' di rec ti on) 01 _EU;arrlllm.i uPyg"'t..,O"'p'-- - - - - - - - " , ::. i l lS -------Of _

IWATER CONDIN

DEPTH

STAT IC WAT E R L EV EL

WAT ER ZONES (f i ssures or formations supplying wate r)

(f rom) (to) (from) (to)It. , Itft , It.

QUANT ITY OF WA T ER

WEL L PU MPED (o r ba iled) af Ga l. per Min . wilh

f eet PRAWP OWN afte r HOURS PUMPING.

FLOW (nal uro ll HEA D_ _ ft . (abave ground) WE

G.P.M.

REMARK S:

QUALITY OF WATE R

COLOR TAS TE

" DOR OTH ERI

-INALYSIS: AYAILA8 LE- VII C NoC: ATTACHED v" C NoC

T EMPERAT URE(f ro m) (tol

WATER fl . ft.(sort, brackish, iro n, sulf ur, ocid , olhe r)

USE OF WA T E R: Domu tlc 0 Tow n C Ind ul t r y 0 Form C Public O S

!CO NST R U CT ION I HOLE SIZE j CASING SIZE

RIG T YPE (o r method ) (diom) (fr om) (1o) (diom ) ( fr om) (1o)

(rolo ry . co bl e , bo red , d riven , et c .. ) ln It ln " ft.

DAT E: Sta rt ed ; Complele d

TOTAL DEPTH 300 ft. SCREE N (ar per foro l ions )

BEDROCK al ft .(diom) (from) '0) (o pe ninQ sin)

;, II "GROUTING INFORM ATI ON IPUMP linitollldli

METHOD USEDTYPE . Cop . (gpm)

GROUTING MAT ER IAL

DEPTH OF GROUTING H.P. . Depth af i ntake ft .

REMA R K S: _

LOQ 01 ...e ll (ove r)

LOG

FURNISHED BY OATE : _

DEP THTYPE OF SOIL OR ROCK PE NE TRATED REMARKS(f eet)

FROM TO (grovel , cloy, etc., hardness , colo r. etc) (water, covinOJ shot , scree n, sampl e, ete,J

,-

(U se additiona l sheets jf necessor)')