INTERV AL SHEET

VDMR WELL NO. :---'------JP a g e_ _ -,-_ _

03 0Sample Interval : f r om to _

PRO P : A J. T o N T ot a l Depth _

(,J t.t: E' COI.L./ER.,C OM P : J , Oil:...-_ _ Ga s W a t e r_ -,-X:...-Explorat o ry _

C OU N T Y : IlJ.BE'MIl~J.E Cuttings X C or e Other--- ----

F !"om - To F r o m - T o F rom-To From -T o From -To

;Jo 3 S..3S _ "10"/0 _ "'oS'~S _ .5'0So oS'S

- Cut t ings

From-To

- - Core

From-To

In t erval Shee t

From-To

- - - Wa t er Well

From-To

Sheet No.

-- - Gas Well

Fr om-To

Total Depth _

DIV ISION OF MINERA L

DEPARTM ENT

COMMONWEALTH

OF CONSERVA T ION

OF VIRGINIA

A ND ECONOMIC DEVELO PMENT

RE SOURCES\,/WGR 194VDl.1R 369

Bol 3 6 67, Univl!fsily Station , Chorl o t1esyil1e. Vi r ~in i a

WAT ER WEL L COMPLE TION REPORT

7

Mai1inlil Addru s: _

Moil in';l Address: _

Mailin';! Addrus: ---, _

~fihe~ar] ear1 0ttesvi lle

~'.o ore

Hall

G. R.

Qort h

OWNER:__-'-'!>U.-'-- _

TE NANT :_ -,;--=:--.,.,.- _DRILLER _

WEL L L OCAT ION:

TODO.: h i l IREMARKS: _ _ ~=~__'_'_'~ _

IWAT"~ ~nl 1111<::1 N

DEPTH

S TAT IC WA TE R LE VEL 24

WAT ER ZONES (f i ssures or fo rmations supplying water)

(tro rn) (to) (frcm) (ta)It. , ftIt , fI

QUANTITY OF WATER

WEL L Ilttl MWKFI (or ba ile d) at 2 Gal. per Min. wil h

feel DRAW DOWN af ter HOURS PUMPING.

FLOW(nat uro l) HEAD__ft. (abave ground) W EG.P.M.

REMARKS:

QUALITY OF WATE R ,

COLOR TASTE

~DOR OT HE RI

""NALYSIS: AVAILA8 LE- Yu C No O : AT TACHED Y.. 0 NcO

T EMPE RATURE(from) ( t o)

WAT ER fl . ft .(solt, brack ish , i r o n , sulfur ,acid , oth er)

USE OF WATER: Domu tlc 0 Town C IndUlt r y [J For m 0 PublicO S

ICONST RUCTION I HOLE

'''~CASING SIZfen g t h

IRIG TY PE lor me t hod ) (diam) (froml (tol (diom) ( from) (10)12

(rolory , ce bte , bo re d , dr iven, etc .. ) i , " in " It.

DATE: Sl art ed ; Camplele d

TOTAL DEPTH 56 f I . SCREEN (o r perfaralians)

BEDROCK al ft.(diom) (f rom) 60) (opt rlln ll size )

tn II. ff

GROUTING INFORMATION IPUMP llnltoll tdJI

METHOD USEDTYPE . Cap . (gpm)

GROUTING MATERIAL

DEPTH OF GROUTING H.P. . Depl h af in l ake f l ..

Sour ce of inf ormat ion - Gi r . 2 (Cr oss II )

L09 of w,1l (ov.r )

LOG

FURNI SHED BY DATE: _

DEPTHTYPE OF SOIL OR ROCK PENETRATED REMA RKS(feet)

FROM TO (gravel, clay. etc., hardness, color, etc) (wate r, covin9J shot, sc ree n, sa mple, etcJ

(Us e additional sheets if necessary)