ML18151A238
| ML18151A238 | |
| Person / Time | |
|---|---|
| Site: | Surry  |
| Issue date: | 12/30/1992 |
| From: | Marshall B VIRGINIA POWER (VIRGINIA ELECTRIC & POWER CO.) |
| To: | Wagner T VIRGINIA, COMMONWEALTH OF |
| References | |
| NUDOCS 9301050239 | |
| Download: ML18151A238 (130) | |
Text
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5000 Dominion Bouler:ard Glen Allen. Virginia .13060
.... ' ~ "'
December 30, 1992
- VIRGINIA POWER Mr. Terry D. Wagner Environmental Program Manager Virginia Water Control Board Office of Spill Response and Remediation P. o. Box 11143 Richmond, VA 23230 RE: PRELIMINARY GROUNDWATER WITHDRAWAL APPLICATION - SURRY POWER STATION
Dear Mr. Wagner:
In accordance with the Groundwater Management Act of 1992 we hereby submit the attached application to withdraw groundwater at Surry Power station. We have attached the requested information that we have available.
As noted on the completed application form, we plan to apply for groundwater withdrawal rights based on savings from conservation.
we, also plan to apply for withdrawal rights in excess of those established by historical use and savings achieved through water conservation. The basis for the excess amount will be the unique requirements of Surry as a nuclear power generating facility, which will be delineated in the final application following issue of the final regulations.
We recently requested modification of the present groundwater withdrawal permit to include language which will specifically allow monthly flow meter readings to be used in calculation of daily water use in lieu of daily meter readings. In accordance with a longstanding agreement between Virginia Power and the Board's staff, since 1984 the method used to determine daily groundwater use has been calculation from monthly meter readings of the wells' flow meters. However, the present permit did not reflect this practice. It is requested that any new permit issued indicates that this is still the appropriate method.*
To date, we have been unable to locate Water Well Completion Report (GW-2) forms for wells "G" and "H". Copies of those forms will be forwarded to you as soon as possible.
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Mr. Terry D. Wagner December 30, 1992 Page 2 We appreciate your consideration of our application. If you need further information please contact Wes Sprouse at 273-3552 or Daniel James at 273-2996.
cc: u.s. Nuclear Regulatory Commission Region II 101 Marietta Street, NW Suite 2900 Atlanta, GA 30323 Re: Surry Units 1 & 2 Docket Nos. 50-280/50-281 License Nos. DPR-32/DPR-37 U.S. Nuclear Regulatory Commission Document Control Desk Washington, DC 20555 Re: Surry Units 1 & 2 Docket Nos. 50-280/50-281 License Nos. DPR-32/DPR-37 Mr. M. W. Branch NRC Senior Resident Inspector Surry Power station
. THDRAW GROUNDWATER APPLICATION TO WI
~ SURRY Paiilll STATION .
REC ID W/LTR IJID_ 12/30/92 .... 9301050239
-NOTICE-THE AITACHED FILES ARE OFFICIAL RE-CORDS OF THE RECORDS & REPORTS MANAGEMENT BRANCH. THEY HAVE BEEN CHARGED TO YOU FOR A LIMITED TIME
. PERI.OD AND, MUST BE 'RETURNED TO THE RECORDS & ARCHIVES SERVICES SECTION P1-122 WHITE FLINT. PLEASE DO NOT SEND DOCUMENTS CHARGED OUT THROUGH THE MAIL. REMOVAL OF ANY PAGE(S) FROM DOCUMENT FOR REPRO-DUCTION MUST BE REFERRED TO FILE PERSONNEL.
-NOTICE-.
STATE WATER CONTROL BOARD PRELIMINARY GROUND WATER WITHDRAWAL APPLICATION TO CONVERT AN EXISTING CERTIFICATE OF GROUND WATER RIGHT OR PERMIT TO WITHDRAW GROUND WATER TO A GROUND WATER WI~RAWAL PERMIT PURSUANT TO THE GROUND WATER MANAGEMENT ACT OF 1992
- Section 62.1-260 *.A and Section 62. 1*265 of the Groc.nd \later Management Act of 1992 r~ires that ill penons holding certificates of grOU"d watfl" right or.penaits to withdrati1 grfJ'rd water issued prior to July 1, 1991 wio were withdrawing grou-d water prior to July 1, 1992 or who were providing s~lemental water cia'fog drought conditions to aR)lY for a grou-d waur withdrawal penait by December 31, 1992. Section 62.1-260.A r~ires the State Water Control Board to issue groc.rid water withdrawal permits for the total alllO'.Jit of groc.nd water withdrawn in a/ffY consec1Jtive twelve month period between July 1, 1987 !Ind Ju,e 30, 1992, together with such savfrl;s as can be demol'lstrated to have been achieved through water conser'Vlltion. Section 62.1-265 requires th* State lilatar Control lolrcl to issue a gr~
water withdrawal pen1it for the lff1Ulll !IIID.rlt necess.ary to suppor"t huaan c ~ t i v e use. Pn,cedures for demonstration of water consorvaticn savings !Ind lll!'nJal need for hUllln consUlll'tive l.!Se will be daYeloped as part of grouid .... ,er withdrawal regulations that are in de"ielopnent. A ~rate 9'lPlfcation aat bl filed for each existing certificate of gl"OCIICI water right and penDit to withdr1111 grouid .,..,er. Ccq,leted applicationa a&St be received at the State Water Control Soard, Office of Spill Response end llemecHation, P. o. Sox 11143, lidard, Va. 23230 by Oeceaar 31, 1992.
Ai:,plicant "5. /J.. fo1. 01. r<;. L // ?. IE.* - .J111Ho ~ r, /Ja. 'fer--
Address :X-11.,,s brook. Tee ,,..,'ca. I Cf!*,,,.'f-oer-, Sooo b';; .. .'.1','o .. "B4u le,111,...J
~ le" AJ/e,, 1 Y.,, 2. lo, o Phone {(o&f) 2. '71*J9f o Contact Perscn W, A. S procriL, :J,., {:z.., ~- 1 s-r2-)
Location of Withdrawal Facility: (County/Cfty) __~__u__rt__l'L_,'/,-...-4-o-*--------
- 1. Existing Certificate or Per11it: No. Sc-J/,e-,,,
ma per , , mane (cir1:le one>
- 3. List all Pe,..itted or C.rdfic:ated Wells an reverse side and actadl wacer Well ~l~ian 111..,a"s or other well c:cnstMJCtion doct.aw'ltat:ion for eadl c:artificated or permitted well lilittl well lccacian and rumer on USGS 7 1/2 minute topagrap1ic ,.._.
t.. Total Amou'lt of GrOU'id water Withdrawn During Any Consacuciw Twelve IIICnttl Period hCWNn July 1, 1987 and Ji.,e 30, 1992 CS.Ction 62. 1-260 *.A.)
Consecutive Twelve lb'lths begiN ;7uly J, I Cr'I/ and erm 'J,;111-e Jc,, /f'f .L Per;od Ill.lat begin an the ffrst day of ttle begiming aandl and and on ttle last day of the anding manth.
Total GrOU"d W.t:er Wittldrawn during ttlis period
- I~::,..~ 1dd (Ji) i..llons D~tation of clai* - t be provided. TIie praferr.d doc"..ntacian of vidldraal ai:u,ts a.-. CirOU'ld waur Punpage and UN llep,rts required by aist:fnv certificat:e or penait =nditian1 or water vithdr-l rep,"s required by ,,,., ... Wittldr-l Reporting * ...,Latiana (VI 615'>-15*01).
- 5. W.tar use cuetary: If 11111:er UH catlll'W'f is puDlfc ~ly sumit a ~ of die Virtinia Oeparu.nt of Health w.un,oru Opencian ,.,..,. (sectian 62.1-264) c > Industrial Cinc:ludfw; fuad practiliifit)
C > CC1111ercial c > Public 51Wly (fncludfng iNticutional)
- 6. ooes the ~ l icant intend ta ~Ly for ! i i ~ water 11ithdr.,.l rights baed on savings adli...,_ through ,..,er c:anservaticn? (Section 62.1-260 *.A. > ~ T * -"°
- 7. Doa the ~licant intend ta a!R'lY far gro&rd waur withdnwel rights in ucau of ttlCIM *tablisn~'historic:al use and savinp achieved throuah 1111ter c:onarvetian witft this ac:iplicacian1' (Sec:ticn 62.1*Z60.G.) _ T
- _110
- 5. Does the ~ l icant intand ta ~ly for grOU'ld _)llltlf" rights conditions? (Sec:ticn 62. 1-265) _Tes L"O
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Address P.O. Box 31S , ~ IU ton SenN r,11bllc * - -.....Nu.ulA.:t..__ _ _ _ _ _ __
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SWCI llo. - - - - - - Owner lo. - - - - - - - SKI llo. °"1'.er llo. - - - - - - -
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Addrtn P,O. Box 315 ,op1.11uton Served r,wblfc' ___Nu<<.,/AD.. .________
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5~1 llo. Owner llo. - - - - - - - SWCI lo. Owner llo, - - - - - - -
SWCI llo. Owntr l o . - - - - - - - SVCI llo, - - - - - - O,,ner IIO. - - - - - - -
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1f aieuureinents lrt for I st1191c-aeter f1tld rudt119. 11st we11s Included t* f11141 SWCI llo. Oiimtr llo, - - - - - - - SWCI llo, - - - - - - ~ r llo, - - - - - - -
S~I llo. 0-ner llo, - - - - - - - S.,CI lo, O,,n,er llo. - - - - - - -
SWCI lo, O,,ner llo, - - - - - - - Ml llo, O,,ntr IO,-------
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1f aeasurements art for 1 5fnt1t..-et1r fft1d re1dfft9. 11st wells fnc111ded 1a fft1*
SWCI llo. Oiitner llo. - - - - - - SWCI No. - - - - - - Owner llo. - - - - - - -
SWCI llo. - - - - - - O.ntr lo. - - - - - - - SWCI llo. ~ r llo. - - - - - - -
$WCI lo. Ol,tntr llo. - - - - - - S'IICI llo. - - - - - - U-ntr ISO.-------
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.. ftD,111 71 3o<::>
Ttu I C. IIOAS D,,,1., Oi1r&er 7 / 50 c:>
- , , ..... ' " ' H '"' ., ... Y,*pwllfl"I " " " TtCA 1 0pe,u,..
" c,p.,,u .. -. 3o
.... ., U\tA ta w *11 1*
- f111f 0 1ttelf1 tlfllcll 11111 - - - - 11111 U1 I I lloft UI 3o 0.11 ~** 0v,,,1r 1 an *,,heulr e, ~,wn,-ow*
wtU. llttlUI Dl,ert1111u.,..,,.ft1.
fl,611c nt.r '"" ' " ~ 11111 I lHt'llf ,,.n, a,,, ...
- Z 37 7 "237, Dvrl
"' "°"lll D..rl"I Ovit\-'
1 7'l'Z-GROUNO WATER PUMP.AGE A.NO USE REPORT lb\UI AP1'i! IL S111t Dtpar11nc11l e( Hullh and Sute Wucr Contrvi loar41 ~ar\.lr I (i) J
- __X..__ "- II (I I ,.11tc. Sf!lf ce,1 tf 'lf'O'I lt "1lt11, I Sue., v,c.,, C.*l"II to. ... Offtc, l!!I (Cfrc:lt 0.-.)
le9to,,,I Sut.1 Neall.A Oc~rtw,,1 Offlct ~11t7/Cft1 l"'llv11r11I. S~ cot, ef rtPOrt lt 1,,t1,.,.1 Sl4lt .. c.,, Co,,,trel kt*f Offtu . Surry
- - ~ \trltot(II c.,.,,..,
0~111,. S*,,. coo,,,"" lt 1t11o"'I Sue., 11,c.,, lot" Offtct
- - - ¥tll(IJ ,,.. Wl"th)
- 11t of wu,r.o,** - !luw or Ooerttor ~l/A Va .. Electric ,_ Pc,...,er Co. - Surry PosftfOI\/Tlt11 -~N,.,/A~------------
ewVt~- -Va. Electric a.rd Pc,.,Je.r Co. SfQnUwrt N/A o.i. _N_J_'A_ _ _ __
Addr-us P.O. Sox 315 ,op1111Uon Sentd fPvblfc'---H~/A...._ _ _ _ _ _ _ __
_ _.Sur~a...::ry~,_V__a=*~*--=-2=38:a..::8=3'--- Phoiw (804) 357-3184 No. of CoMtctton, fP11b11cl _ __.N..,./....A....__ _ _ _ _ __
"Ptrlt10ft ,,,..1t 1'.C,er (Pllb11c) ~N"'LuA,...________
Ty" of u,,: Puti11ct_ lnd11Hrf1L._x._ Other ( , p e < 1 f 1 - - - - - - - - - - - - - - - - - - - - - -
lf aeu11re111ents ire fOf' 1 s1ng1e-Mttr ffe1d rud1nt, 11st wells fncludfd 11 fh14 S\ICI llo. Owner llo. - - - - - - - SWCI lo. - - - - - - Owner llo. - - - - - - -
SMCI lo. Owner lo.------- ~I lo. Oimer l o . - - - - - -
swca llo. Owner l o . - - - - - - - SVCI llo, - - - - - - O,,ntr IO,-------
~ter rudfngs ,,. 11 --~ga;ji!a,ll.,.l~ons2.lllil______________ (9111ons, 1000*, of 9111ons. cubic fHt, ttc.)
lot.I: If IJlla fl vl'llltUrM, HllMtt ~91 S~I lloJ5Z - /fj't:> -7 I P °'"11tr IO. G 11 ~lft 11 1o,,er rlthl*t.l"' Conllf'o E).ta P',tttr Rudtng* ~11ons V*ltr Ltv11utt O.ta Ktltr Rudt 119* C.11ons v,ttr Level""
"""ft " Sutic" r~, .....
Ust<t Used r"' *'
t.,n lb\t.A 1
31 I.Z.o '7'0.0 If" ,,,, 16 17 2 **. 18 l 19 4 20 5 21 22 1 23 I 24 '
9 25 10 26 11 27 12 28 13 29 14 30 F353 ,/300 2.. z/3 fed lS 31 Total c.n.. ,,u1 C.tto,11 {o o
- . . . NW I ... lf.. NCI f,J (l"lflf't'1J ~ tf flJJ Hlf Ul. . , tfff It 1n, ef IIOll*~l"I ,CtlNI lh,r fnt lblll z 'Z.13 cfoo 0..rl .. ~UIM z. 2.,. / 3
..... , u,,. 11 1111 wll I* .,,,,-~1111
- , .. , ... rttf It '"' ., ,.,,o,
- ff1t,, ,,.cu, .-itcli wll - - - - o.,, 1111 I llonU.
t,ut 11pe,n111
.3 c:;,
rout Operatliit 0.11 1111, Ovtrler
-. 3o 1 Ill ,,1utal1 w !PIA11M11r-o,,"" i,\Altc " ' " '"" IJ'l. . DIii I lwl"lfl A ilJ l,1r1t1 wflA Keel UI Dt~rtllllc1~rwtt1.
Dwrl flt lloAUI 73 7ao O.,t1"9 Ov*rtlf 7378"0
e I I * ...., 1111"
'"' t-j'"f 2--
Jarttr I r J
- _ .....x_wll(IJ ,.allc. s<<flf co, ef rt90rl ll ..,,t,11,11 St.,t, Wei.Ir Ct*tf'tl loe-. OUiu ~ (Cfrt1t h )
lttl-1 SU\I Nul\11 Dl~r~& Office Covftl7/(ft7
~-- ~, ..1,, l"'lllvHrlll, ,,.... UfJ 1f rtPOrl It ..,,,11.11 !UU lltl.l* C611V.i lot** Off1u . Surry o,....,. s, .... cot,., " " ' ' l.e 1t1to11.1I SUt, ...... c... ,.... loirf Ofttu
- - - lltllhl *"' S,.l"f(I)
- etVa.of Electric Water.or*,
' Po,..,er CO. - Surry lluw of Ooerttor ~l/A Poslt1on/Tlt1t - ~ N i 7 / A . - - - - - - - - - - - - -
Ow1'r Va. Electric a.rd Po,,.le.r Co. SfQn,turt N/A O.tt _N_J_'A_ _ _ __
Ad4rtu P,O. Box 315 ,QPYhlfon Sened 1,ubl1c' NIA Surry, Va. , 23883 PhoM {804) 357-3184 No. of Co,wctton, lPub11cl'.'""---.,4.N..._/,...A~-------
VPtnt1011 Pc~ft !uar ('ublfc) 4N:.c.l/.:..,A,...__ _ _ _ _ __
Ty~ of u,1: Publtc~ Jndustrtal--X_ Olhtr (s~tt, ______________________
If aieu11rements art for I stng1,:-wter f1e1d rudf"9. 1ht wells 11\Cluded t* ftt1*
SWCI llo. ~ r llo, SWCI lo. - - - - - - Olffler llo, - - - - - - -
SWCI llo. Owner llo. SWCI lo, Oitner llo. - - - - - - -
SWCI lo, Owner llo, SVCI llo. - - - - - - Owner N, - - - - - - -
llltttr rudf 1191 1 re f * --~ga~l1..1l~ons!.llil-------------- (g, 110fts.
Iott:
1000' s of 9111 If 111ta h ~l'lllllttl'1f, t1t1Ntt ~ I t
°"'. cub tc f Ht, ttc. )
SWCI Ro. Owntr llo. F=- fa '°'" fa IMt rf9llt* .. ~ COMllf'.
~u Kettr Rtldfng* ~110/II v,ur Level .. " Dnt Ket.tr Rud1r"9* &. 11ons Vdtr Leveltt"
.,._,l'IQ***
St1t1," ,IIIC)f~ " Used St.A ti,"
tlld .,
16 LHt lb!UI 37 ro Io i 1 17 2 .. 18
- 4 5
l 19 20 21 22 1 23 8 24 9 ~5 10 26 11 27 12 28 13 29 14 30 3744'30 3..f "2..-G) lS 31
~,,
Toti I
. c,n.., Teul C.IIOM
~ta 34-z-e;, Durl8t O,ut.er 34zo
,,u1 ep.,,u,.. -.
o.,, ..II lb!UI '5o Teul Clperat111t Dt11 VIII Ol,arltr 3o Da111 lwer111 .Ail1 ***, .
Durt .., flofttll II 4- °"""' Ovuttl' II 4
......., ..... "-' . . ' .. '"~ **
THr / t'fZ-
__x_ "'11(11 ,.allc.
GAOUNO WATER PUMPAGE A.NO USE REPORT S111t Ofpu1rn,111 e( Huhh an4 Sult W11,r Co".. loar, S.111 COi af rt90rl ** lft!...., I St.u, Vet.er C..11lrtl 1o,,... Offlu l!!f 1\,ftt)
~tr\fr AJ>~ /L I (f) J *
(Clrc1t Ont)
=
--- s.,,,..,., ** ,, °"41 I SU\I Nu I CA l)tp,rta,,,11 Offlct
- ,..,.,u,ul. 1~ co,,,, rti,,o,1 tt "'110 ... 1 SUit llfl.lr ~!NI to.** lff1c, O~iw,. St"' cot, at reporl '- lttltftlf SUll ¥tllr Colllrtl eo. ....
~nty/Clt1
. Surry Offlc,
- - - "'""' .... ~l"thl
- 11t of vu,rwo,t, ll&lllf of Oo1ruo, -.H:;-'-/,.A.-------------
Va. Electric ' Pa,..,er Co. - Surry ro,1tto11/IHl*--~N~/A.------~-------
Owl4r Va. Electric ard Pc,,,Je.r Co. s 1qn,t 11 rt _ _ _ _N.;;../A ____ OU.t _N_J_'1'_ _ _ __
l.dd,..u P.O. Box 315 ,09\lhtfon S1rvtd rrvbHc'---Hu.utA12..._ _ _ _ _ _ __
_ ..........,,Sur=~ry~,.....,Vc:a""-'-' <-=-2~38:.!8:.:3'-- Phont {804) 357-3184 No. of CoMfctfon., trvblfcl _ __..N..._/..,A..___ _ _ _ _ __
Ty" of U<t: rublfc~ JlldwHrl1I--L Ot.ller (s~1f1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Uptn t Ion ,. "It ll.c>tr ,,lib 11 c) .a.;N..,/.,.,A,__ _ _ _ _ __
If eeu11reieents 1rt for I sfftgle-Nttr flt14 rud111f, lht 1re1h lnc111ded tn SWCI llo. Owner llo. - - - - - - SWCI llo, - - - - - - Owner llo, - - - - - - -
SIICI lo. l),,ner lo,------- SWCI lo, l),,ne, lo. - - - - - - -
swca 11o. l),,ner lo,------- Ml lo. Uitner IO. _ _ _ _ _ __
Mtttr rudfngs 1rt 11 --~gawl...i.l~oOllS.--------------C~11ons, 1000'1 of 911tons, c11btc fHt, ttc.)
loll: If 111t.a Is w1111eUrtf, nttull ~91 s~, 110. °"'1lt,. lo. G. f* ~an 11 1o,,e, rfthl* .. "' <OMlef',
l),i. Meter Rudfng* ~ 110ftl V1t,r LtvcluH Oltf Met.tr Rudfr,g* &. 11ons Vattr Level""
I '~,'1 Used Sult, .. Used suu, ..
tflld ., 't/ll/1//)
- LHI fb\UI io ooo 'f////lH///1,. 16 1 17
- 2. 18 3 19 4 20 5 21 22 1 23 I 24 9 lS 10 26 11 27 12 28 13 29 14 30 ~I loo I lo c0 15 31
~,, fn1 I C.110ftt
- IUf .. W .... tlat HCI C.r (1"tfff'1*1r tfll *f f11J Toti I C.11..,
,. bl.II //t!:>O ~ ... ~.,&er / / c::> 0
- If UlHI, rfff ti ..... tf ICll*"""ffll ,.,1e,
..... , ..... , .., ** '"' ., lltl*J*Pll'l!Pfllt " ' ' "
o.,,
1tt, I Optra\f .. feul Clperat1"1 -.
"-If UltA II ""wll la I fl11f, IPf(lfJ ..Mell 11111 - - - - Ulh ~~ 3o DIii IAII Ol,trltr 3c:s:>
t All Jrht\alJ W M1 . .11J*Or~ fl61IC w11tr ll!H1J IJ1U.
w1 U. Nell UI Dt~rt.ica~,.111. DIii , ......,. ..3 7
.,..11, ***,...
'37 Durt "t i.o,.111 °"""t Ov*rltt
...... 'lt"'WI . . . . , , ..... ,
... ** *'-'****~ '"' t "f 92-GAOUNOWATER PUMPAGE ANO USE REPORT lblUi Afll: /~
"' ,, , '°""'.: S111e £kp1r1mc111 et Huhh 1114 Stace W11tr C.01111.a loar4 Qua,~, I([) J *
(Cfrt11 One)
~, ... ,,,
_....,.l(......._ "'
--~ ***'°""'co,'""90°
P.111c. kllf tf 1"4vll'111, h4'f CotJ tf LI~'""' Slate w,i., C.*lrtl to.rt Offlct IIUIUI 0.p,r~, Office tt lf.tlol'lt I U.1tt vu,, CoA&nl to.,1 Office
~
Cov11t7/C u,
. Surry 0~111,. Se ... coo, 1f rtPOrt LI ltt11iwl 11.11.f 11,t,r (e,1trtl lotrt Offtu
- - - Vtll(IJ *"" Wl"'tll)
~ ... of V1ten,,ork1 lr*Df or Ooer* tor --.:MiJ/-.A_ _ _ _ _ _ _ _ _ _ _ __
-Va. Electric , Pl:wer Co. - Surry Pos It toft/1 It 1, _ _"iiN7/ A . - - - - - - - . . - - - - - -
~14,. Va. Electric ard Pc,..ie.r Co. S1Qn1t11rt N/A o.i. __N_/7'.______
Addrtn P.O. Box 315 Poe,uhtfon Served (P11bltc'---Huu/A....__ _ _ _ _ _ __
sun:y, va. , 23883 Pt1oiw (804) 357-3184 No. of CoMfct1on, f P11bl tel _ _....,N.._./A..,.___ _ _ _ _ _ __
Uper1 tfon Pe ~u N,..,)~A!...-_ _ _ _ _ __
11..c,t r (Pllb 11 c) ...
Ty,,. of U<e: Puhttc~ lnd 11 st.r1a1--X- Ot.Nr (s~ify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If me1surenents art for I sfnglt-tWttr ff11d re1df"9, 11st *e11s fnc111ded 1* 1111, SIICI llo. ().mer llo, - - - - - - - SWCI No. - - - - - - o.,n,, llo. - - - - - - -
SWCI *o. 0-ntr *o. - - - - - - - $WCI lo. ().mer llo. - - - - - - -
SWCI lo. Oi,ntr llo. - - - - - - Ml lo.------ ~ntr IIO. - - - - - - -
Meter rudin9s 1r1 11 ---!:ga~l~l!,,!onsl.Jil.--------------C~11ons, 1000's of g*11ons. cvbfc fHt, etc.:
If 111la h WNIIIUrM, t1t1Nt.t ~ I I SWl:I 110. C).fler IO, 1-1 Iott:
11 '°an 11 loo,tt rftht*'611d COMlff',
O.ta Meter Rt1dl119* ~11ons 11,t.,r ltve 1utt O.ta Mtt.er Rud1119* &. 110tlS Vet.er ltvtl**tt Used St..tt,",, Py11pf"' " Used u.. t1," 1,-IM***
[l'ld .,
z773oo- 16 LUI~"'
- 1 1 17 2- 18
- 3 4
s 19 20 21 6 22 7 23 I 24 9 ~5 10 26 11 27 12 28 13 29 14 30 Z7'f 3oo :z c::, C> ~
15 31 Tott 1 c.11- Tile I C.110ftl
- . . . NW I ... tlN HCI ,., ll'tflf'l~IJ tftl tf f*JI Z.eoe. Dwrl91 Ovarlef' -:z_ C:, 0 CD C..,rl . . . . Ill
.. ., tilttl, ' " ' It '"' ., IIOll*fljllflflt ,.,,. .
- If t1ltt1 0 ralf II ,,_. tf .,,,,.i,wae1111 ,er, ..
t 1
- 1f UltA la 1111 11111 la I llt1f, ltt<lfJ -" 11111 - - - -
an"'" w Mtwn,-o,,.. '1,611c .,,,., ,.,,,,, '"ie.
o.,, .,. . .
Teu I Opernl1t Dtll J lrttltl
~ ,3a.
Ttt.11 Clpcret1111 D111 11111 Ov1rter
.3c:,
w1UI Ditti Ill Dt,ert..u.,.,.111, Dwrl
"""°"'p b7 °"".., °"" \tf
~7
-*-* ,,,, .... ,,-~. GAOUNO WATER PUMPAGE A.NO USE REPORT lb\UI A/~ ~~ 9 /z__
L v,,,, '°"": $1111 O<pir1mol e( Huhh u4 St.ca W11cr<:G111roa lou4 ~art.tr I (jJ J
- __x_'"""' , ** lie. Sf"" c.,, ,, rtfOrl le t.tt~I St,t, Vtt,r C.*l-.1 k,tr;i Offlu l!!f
- '°h'II
""' '"'" 11ol1A Dt~r~t Ofttce ~11t7/Clt1 (Clrtlt Cne)
- - - ""'"11(11 ,...,vllrt1I, co,, tf r1p0,t ti ~10--.1 ,u,, .. t,, CoAl.rtl to.** Off1u . SUrry 0~111,. St,.. cot,,, report l.e 1,,10,wl h.11.t -...,, CtAtrtl lot,.. o,r, 0
--- '"""' .... s.,,,..,,,
- 11t of wuerwor* 1 If*~ of Ooera tor - . H r : / i i A , - - - - - - - - - - - - -
Ya. Electric'~ Co. - Surry Po11t1on/THl1 _ __,~N7i/A~------------
Ow1'r Va. Electric and Co. SfQnHvrt N/A O.t.t N/1(
Add rt U P.O. Box 315 Surry, Va. , 23883 Po,,.ie.r Phoiw (804)357-3184
,opv1.i1on Ser,t4 r,vbllc' _ __.Nu.fuA~--------
No. of COMfCt10M r,vb11d _ __..NJl.,S./...taA..__ _ _ _ _ __
t Up tn t Ion ,,,..ft ILc>I r ('vb I 1c) ,a;.N...../...,A.____ _ _ _ _ __
Type of u.. ,: Puta11c _ _ Jftd 11 strfl L.J- Ot.htr hPK 1f1 - - - - - - - - - - - - - - - - - - - - - - -
1f ae1swrenents lrt for I s1ng1e...,t1r f1eld read1nt, 11st wells Included 11 ,1,1, SWCI llo. Owner llo, - - - - - - - SWCI llo, - - - - - - Olffltr llo. - - - - - - -
S\ICI lo. Owntr No. - - - - - - - $WCI llo. Owner No. - - - - - - -
SWCI lo. Owner N o . - - - - - - - SWCI l o . - - - - - - ~ner I O , - - - - - - -
Meter rUdin9S lrt 11 _ _4ga~l..}~Ol)Sl.llil.--------------(fll10t!I, 1000'1 Of 91l1on1 1 CubfC fHt, ttc.)
Iott: If IJlt,a fs w,-,,i!At"M, t1tlMll ~91 s~, 110. Owntr No.
.c:::o.Js..,-~if'-r10N SI-,- fa !loan la lo,,et ,1,~t-~~ COC"Mf',
°"~
l'otttr Rud1nt* &, 11ons V*Ur lev11°- O.t.t !Cf Ur lud11"9* C.llOftl V*t.tr leveltt"
, 111C> I fte" Used St.Ufc" "-111,Q***
[Ill.,
Lul lb\UI Z-Cfof74oo 16 1 17 2 18
- l 4
5 19 20 21 22 1 23 9
24
- s 10 26 11 27 12 28 13 29 14 30 zc:r;-07.,{-oo ~ o c,c:.o 15 31 Tei. 1 c.11..,
./~t>OC> let.al C.110ftt
- ltlf - ~ I ... tfllf HCl ,., (ytfff'l.1J W ef flJI c..,1111 lbllli ..,,, .. ~ar&er _.f6oo~
- If , ...... ru, u ,n, ,, titn,-~,,.
Hlf Ul.. , rNf II en, ef IIOll*""°'f"t ,Ct1t,
,cr1t, 1,u1 Clper1U .. ,,u1 Clpf,au .. -.
.... If U\ftl ta lftl 11111 fat rtetf, 1,<<tfJ llfllcli 11111 - - - - ..3o Jo f 111 ~htUlf If' Ml~IIJ*OrllH Jl,611c **\Ir sw,,IJ IJ1l*
lf1Ul llft1 UI Dltert11ut,t1Wfll,
°
DIii
"' " "911111 I lrt'l'lft D111 llill Ovarltr
.,.n, a.,,.,.
Owrf .., "°"~ IS-3~3 °"""' o.,.,,~ /S. .333
~_.lC...__lftll(al
~---- s.,, .. ,,,
GROUNDWATER PUMPAGE ANO USE REPORT
$1111 ~p1rtmCfll *' Huhh ln4
, ** lie. ""' "" ., '"'° ,* ..,,.... ,
1t910,,.,I Stitt Null.A Ot~r\Nolt Off1ct
.. ........... ~
Sue. Water CofttrGI lou4 sue. 111\tr C.Alrtl lotrf Offlc, ~
llldw1lr111. Sf'II C0'1J tf rtPOrl II ~10,,. I 1lltl lltt,r Co,,tnl lot*t Of flu
~::.,
~11t7/Clt1
~.
lf'f--z-(C rcle Or.I)
. Surry 0~11e,. St .. c~, tf report ._ 1tt1o,,.( Sutt lltt,r C111trtl lotrf Offtct
- - - lftlllll *~ Wl"thl
- ~ of v1 ttn,ork1 kui~ of Ooernor ~I/A Va. Electric , Power Co. - Surry Posttton/Tltl* -"uN"/A.-------------
C),,\ir- -V;:-Electric and Pc,..le.r Co. S1qn1t 11 rt N/A OIU _N_J_'1'_ _ _ __
Addrtu P.O. Box 31S Poe>u1Hlon Strvtd IP11bltc' _ __,NLU.,j/AIJL-.________
_ ___.Sur~-=-ryJ-A-1 _V'-=a~._.._,-'2:c..;:3'"""8-=-8~3- Phone (804) 357-3184 No. of ConMctto"' IP111>ltcl _ __,N~{.....A,.___ _ _ _ _ __
Uptn t 1on Ptr11f t !Lc,cr (P~tf c) ... .N..,/~A..________
Ty" of u,,: Puh11c!_ lnd11strf11_.X._ OtNr (spec1f1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If ~1111renents 1,- for 1 11119le-wttr field rudtnt. 1ht 11elh fncludN 111 SWCI IIO.
SWCI llo.
Owner IIO, - - - - - - -
().oner l o . - - - - - - - $WCI llo.
SWCI llo. - - - - - - Oa-Nr llo. - - - - - - -
Owner llo. - - - - - -
SWCI lo. 1).-n,r lo. - - - - - - Ml llo. - - - - - - O,,ntr IO.-------
Mtur rudfogs 1r1 11 _ _4ga,1Sl..1]...1.!.lon.,l.llit_ _ _ _ _ _ _ _ _ _ _ _ _ _ (91l1ons, 1000'1 of g11l0111, cubfc fNt, etc.)
lot.I: Jr IJllall 11 11.-t.ertf, Hltalt.1 ~91 S'-'=1 llo. :Z.9-/90 - 5"o C.. Owntr lo, A 11 lo.an fa 1oioer rlthl*lll"' <onwt".
O,t, Mettr Rud1119* ~llons 11,ur ltv11 .. " DAU Ket.fr ltud1t19* "llons v,ur Leval .. "
su,,, ..
P'\lllll?IA41" Used Hut,'" '"-l11a***
,,.,. ., fl 'IJIIIJ 16 t.111 "°""' /Cjz.PDZoo 1 17 2 18
- 3 4
5 19 20 21 6 22 7 23 9
24 25 10 26 11 27 12 28 13 29 14 30 15 31 /oz.S-ozoo ~o=o Tell , ean.., Ttul Cal10A1
- . _ , attar *
- Uat Helli .., (,..1ftf'1~1J
.. ,, ...... , .. , U ,,., ., IIOll*Nlflftl ,.,1 ..
lftf tf IIJJ ~rt Ill IIIIAUI ~OoC ~,1., ~er~ I/'? J"oc
- , u, ... rttf u '"' ., ltlYJ*Nlfllll ,.,, .. I llpcraU1t -.
.... ., ut11 ta w .. 11 1* , rt,1,, 1,-c1f1 "" 11111 - - - - o.,, UI 11 "9ftUI ~/
Tn11 Optret1111 D,71 tall O.,arter G-/
1 All Jrhnalr ., M1t;.,11,..,llt4 Mlle .. 11, '"" 17'\tla wUA IIU1UI Dlptrt111of"'k,-111. Dlt1, l,tf'lfl AilJ l*1r11t1 Dl,rl
"' "°"u, /~/~ Dvt1"9 Ov,rt1r 1?6~
GROUND WATER PUMPAGE ANO USE REPORT
- e * ** l'-'1111"'
~ tJi
/f/7/z--
('1A:o/
S111t Dtp,anmcl\C ef Huhh *"' Sue. Wutr Co111rol loar4111 l).i1rte, ,cv,
- _ _.J-. lit 11 (I J ,.111c. Soll co, 1f '"'° II t.,1 ..... 1 S~t, Wtt,r c,,.,,,, to. ... Offlu ~
(Circle Orie)
--~ s.,,,.,.,,, lttlOflf I Slit, llft 11.A Difp,rta,,111 ~flu l"4<o1tr1al. St"4 <ot7 tf rtPOrl ll ~lo~I Hate .. t,, t4,.v-.1 lo&** Off1u 0~111,. St.., c~, 1f report to **t'*"'I Slit, 111\.lr COlltrol to.,.. Off1u
~11t7/Clt1
. Surry
- - - lftll(IJ .~ S,,1"9(1)
- ~ of W1te~r*s KaDf of Ooerator t-l/A Va. Electric , Po,,.,er Co. - Surry ,o,ltlol\/11t1t -,N.i'/'riA~------~-----
().rl.r Va. Electric a.rd Po,,.ler Co. SlqnH11rt N/A OU.t NIA Add,..u P.O. Box 315 ,091,1 ht Ion Ser-.td ("'b 11 c' --~H~tA1i-________ --------
Surry, Va. , 23883 . Phoiw (804) 357-3184 llo. of CoMtctlon, fP11b11d _ _,..N.,..1Aa...._ _ _ _ _ _ __
Uptra t 1on Penal t 11.ic,e r ('llt> 1t c) .&::.N~IJA2-.._ _ _ _ _ __
T1Pt of u~,: Pub1 tc ~ lndwstrlal _x_ Ot.htr (sp.cffy - - - - - - - - - - - - - - - - - - - - - -
If 11e1s11re,ients 1.-. for I s11'g1e--,ter field re1dl"9, 11st *ells fnc1udfd 111 fft14111 SWCI llo. Owner llo. - - - - - - SWCI lo. - - - - - - Oltner llo. - - - - - - -
SWCI lo. Oimtr lo. - - - - - - $WCI lo. Owner llo. - - - - - -
SWCI llo. O,,ntr l o . - - - - - - SVCI lo.------ 0-ntr IIO. - - - - - - -
~ttr rudings lrt 11 --~ga~lull!.C!)S!.ii-------------- (g111ons. 1000'1 of gallons. c11bfc fttt, ttc.)
- 11'--
s~, 110 * ..3" - 19o - ,;;;1 c Owner "°* :5 Iott: If la 11,-ctt,_, nttaete ~91 h boan ta 1o,,,er rl1ht* ... .., <OMll'I'.
Ktter Roding* v, Ur ltvel .... s.. non, Dau &, 11o.is Oilt Mtltr ltud1r,g* V1t.tr level .. "
Used Sutt,** Used Sta ti,"
["'
un 11ot1ui .3 3 'l~</-5o- ~
JI UJ 16 1 17 2* 18 3 19 4 20 5 21 22 7 23
- 24
- s 10' 26 11 27 12 28 13 29 14 30 15 31 ~t47Z~o 75'.-/-Te>o 0 1,u I C.llllf foul C.111111
- lclf IICW laa,e lfat HCI ,., (y1flf'tt.1J tftl tf ftJI L\i,1,. lblUI 7>"-li'DOO 111,,1 .. ~trW IS-/ot loo
.... tllftl, ' " ' It '"' ., 11(111*""""' ,.,1.i
- If tel,., tHC It ctnC tf lt1YJ*""'1111 ,trlof t,u I Opt,uc .. r,u, Opt,,u .. -.
...... u, .. ,. 1111t .... ,. I 11,11, 1,<<lfJ ..... , ...... - - - - o.,, Ulla li!DnUI ...3/ u,, °"" kl
- AU frhl\111 tr ~1'1,IIJ*O,IIH J\,tlCc ~,er 1""11 ll't. .
wiUI 111t1IU1 Dlt4rt1*,o~,.c11. D,C1 , ........ 'iz,~,;'8"~
Dur! 111 lloftUI Dt11 A IIJ l,trf11 0..rt"t Ov1rttt ZS'"Z "/71
- *. I I I I V I I ' 11'11 GROUND WATER PUMPAG£ ANO USE REPORT S11tt ~putmc111 *' Hultll 1n4 Su&c Water Co111r~ loar4
___x__ "'11(1, ,.111c. s,,.. "" tf rt90rl lt ..,..,....,, SI.II.I Vet,, c. .. ,,.., lolrf Olflu t!!f
~-~ ~ ..... ,,, lt9fo,,.,I SUI.I Nu1~ O.~rtN,,t Office llldwHrt1I. 1t<lf <OfJ tf report ,, ktto,...1 11.111 11,t,r Co,,tN1 s,,., to.** Offlu 0~11e,. coe, ef roort lt lt91o"fl SI.It, 11,1.1, COflt,..1 lo&rf Off*ct
- - - Wtllltl 1"'1 S,.l"fh)
- ..., of w,urwo,*1 11, ... of Ooer1tor -,1':;-l/r.A.-------------
Va. Electric , Po,.,er Co. - Sw-ty Posltfon/Tlt1*--~N.'1/,.A_ _ _ _ _ _~ - - - - - -
-- - -~ Co N/A Nt'1<
0w14, Va. Electric arrl Po,.,e.r
- sI Qn* turt - - - - - - - - - o. t.t - - - - - - - -
Addr1 u P.O. Bo>< )15 ,opuhtfon Servtd r,11b1fc' _ __.N~L...AUL-_ _ _ _ _ _ __
_ __,Socur=-=ry~,_v..:...a=.;.::..._..al..-:,2.,,_38;:;..c8::c.,3:._ Phont {804 )35 7- 3181 No. of COMfC t f on, f Pub lfc) --M~[..... A..__ _ _ _ _ __
~tn t 1011 Pc "ft ll.ilC)c r ( Pub 11 c) ~N""/LIA,___ _ _ _ _ __
T7Pt of u~,: Pull>fc!__ Jnd11Urf11__.X_ 01.Nr (s~ffy _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 11e1s11rem,rnts art for I s1nglc...,.ter fftld re1dl119, 11st wells included 111 f1t141 SWCI llo. ~ r llo. - - - - - - - SWCI No. - - - - - - Ollner lo.-------
SWCI lo. O.ner llo. - - - - - - SWCI lo. t\.ner llo. - - - - - - -
SWCI lo. 0.Mr llo. - - - - - - S'IICI llo. t)fntr IO. - - - - - - -
Meter rudings 1r1 f* --~ga~l.J.l~oOS1.lil--------------C~11ons, lOOO's of 9111ons, cubfc feet, tt.c.)
lot.I: If 111t* h wl'llll!ttl"M, 11tia.t.1 ~ "
SWCI rto * .3/- !"lo -S-2--c.. Owtltr No, ~ 11 bun ta 1o,,er r 1thl *\I "' cDnllf',
D.tt.t ""tcr Rud1119* V1~r ltv1luH Oltt ICet.tr Retd1 ng*
~\10i\S C.11ons Vet.tr level""
su,,, .. ,~111o"'
lktd SIAtt,"
[!Id.,
.,,,,,u,
~ ,,,,
Lut 1',or.lJI x-bu.,4c, 16 1 17 2 18 3 19 4 20 5 21 6 22 1 23 I 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 3~?/C,/oo 113?70<=>
Tota I C.11*
- lftf NW I ... It.. NCI"' (l"tftf'I.IJ ~ tf flJI ~,,w
'" C.111111 IS~~s-c:>-
.. ., tel111. , ... It '"' ., loCll-...-.1111 ,c,10,
- If 1111", .rtlf It 1111 tf .. ,.,,.,..,..1119 ,cr10, 111,rt o.,,
"°""
,,u IllI Opernt ..
//817°-<=> 111,,1.,
Ttta1 OpfrUllf -
.. **If U\tA la ..... *II 11 I flt1f, 1,e<lfJ l!fllcli llf11 - - - -
1 All *frtuu1, w f,A11~117-o,llt4 fl,tllc nur 1wppl7 ' " '
- Ill ta "°""' .3 I 0.,s VIII Ov1rttr l,1,111 6/
Dt11 , lttf'lfl tr1UI IIU1UI Dt~r~u~,.ttl.
Dwrl "' ...,..,. o ~ 3 77
... i ,,
°"".., °"" \ff ZS- ..336
., .... I,,.... .... ,,.aw,
- o I I 11oia11 I I I I,...
GROUND WATER PUMPAG£ ANO USE REPORT
$1111 Do(p1r1mtnl er Huhh an, Sula Wutr Con1rul loar4
__X.__. w 11 h I , .. 11,. ""' <1'1 tf rt90r\ \e "1*~1 St.,t, Ve\er c.-,,.., lo.rf Olflu l!!f
--~ ....,., ~
It I I Ot1t I SI.HI IIU I I.A 0t Pt r tafol I Off 1ct
'""'""* S~ cot, tf rtPOr\ \1 ~*o~I lu\e vu,r C...trtl 1o.,, ou,c, o~l,fr, s, ... coo,., roort te **1*0"'1 h,t,1 11,t,, (o,,tr91 to.rf O,flu
--- '"""' .... w,,..,,,
- 11t of Wlttl"wOr,s lluw of Ooer1tor ~I/A
,o, It fofl/ TIt 11 ---;;:N;-:/;-;;A:--------------
- Va. Electric , Pc,...,er C.O, - Surry o.,14 r Va
- Electric ard Pc,.,.ie.r Co* Sf o~ twrt N/A O.tt _N_J_'A______
A.dd~u Surry, P.O. Box 31S Va. , 23883 Phont (804) 357-3184
'°""' 1 No.
It f 011 Served ("1b 11 c' --~HuulA<i...________
of CoMtc l f OM ffwb 11cl _ _N....._.{A.,.__ _ _ _ _ _ __
Uptu t 1011 ,el"llt 11..C>c r ( 11 c) ... ,lib JJ'""L~A.._ _______
Ty~ of Uc.e: , ... , H e ~ Jrd strfi1__.X._ Olhtr (sp.cff1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
11 If eeuwrenents art for I sfngle-wttr f1t1d rudfng, 11st welts 1r.c1udfd hi SWCI IO. ~r IO.------- SWCI lo. - - - - - - ~ r lo, - - - - - - -
SWCI llo. t\fner lo.------- SWCI lo, O,,ner llo. - - - - - - -
SWCI llo, t\,ner lo.------- SVCI lo.------ ~ntr IIO, - - - - - - -
~Ur rudfngs lrt 11 _ _4ga,s;1.1,I..lons!>4.tir-------------- (gallons, 1000'1 of 91110fts, cwbfc fNt, ttc.)
Iota: If''- ta Wl'IICtfrH, ttllNtt pui,Q,191 S~I No. Oltner llo, I ) 11 flo&H ta '°" rt9lll-~,.. Conllf',
D.Ai.. P'ie ttr Rudt119* ~11ons v,ur Ltvel .... 0.tt Mtttr ludtng* 1., llon1 V1ttr level .. " ;
Usfd Sutt,**
"~'""
rm .,,
Used Sutt," "'-IM* ..
~n ~"' -z4r.,,.-z.1 o o ~~ I tlld .,
16 1 17 2- 18 3 19 4 20 5 21 22 7 23 a 24 9 25 10 26 11 27 12 28 13 29 14 30 lS 31 -Z. S~o7 c::>o -1 ?= e, 0 Tee, 1 c.11 ... Tiu I C. lllftl
- lo4 acw ,.., tlac ..,, ,., (,,-1ftf'e,11 .,.. ,, **11
- If Ulttlo rttf II 1111 If IIOll*"""111f ,crlO, lll,rl1111 lb!UI l_,->8000 111,rl"I 0,,1,w /~ 7'..30~
- If ,,u1 Opt,u, .. -.
t,l ... ruf II tllf tf llc117*"""'t111 pcr10,
.... If U\" 11 lftC *11 11 1 1111' 0 att<lfJ llfltc* wll - - - - o.,, I"'" ~~
1tl4 tlper1tt ..
.31 De11 ~** Qvarltr ~/
1 All frhn.11, er Mlwn,.o,,IIH ,i.t11c w1 ~ 11t11 UI Dt~ri.iu~nilll,
.,11, '"" ,,,ua o.n , ltlf'III .,ejfJ l,1r1tt 0.,,1 .... "°"lll 31~/ °"'""' 0.,1,t ..
z_77S:-
., ... '.,, .... ,, ..._, OROUNO WATER PUMPAG£ ANO USE REPORT
~I) 1 ;lfZ-
~
IIHtt \owl'\t: S111t Dtp,r1mct1I er Hcahh u4 Sue., Water Cot11r9' loar4 t-1,1.er I /1l J4
__X..__ lit II (I J Pwtllc. Scllf co1 tf tt90tt t* '-""' Slit, Vet.tr C."t"'I to.!"f Offlc, ~
(Ctrtit Or.)
- t*-1 II.Ill MultA Dtp,r~I Offlct Covtlt7/C tt1
- - ~ s.,,, .. ,,, Jlldwttrlll. ltftl COfJ tf rei,ort le ~to11o1I \lilt v.1.1, Co"trtl to.** Ofhc, . Surry Otiw,. s,,.. coo,,, report c. 1t1**l'lfi h.1t.t v.u, Co,1t,...1 to.rf Offtu
- - - lltllhl .... s.,1,..11)
- 111 of 1oun,o,*1 N*~ of Oocrator -.~:.-1/11A , - - - - - - - - - - - - -
Va. Electric , Po,..,er Co. - Surry Posftfon/THl*--~Ni"J/A.-------------
0,,1', Va. Electric ard Pc,,,.le.r Co
- Sfqn,t11rt-----"---- NI* ou, - Nt'Jl Addr-tss P.O. Box 315 P~htfon Sentd (Pvblfc'---'H"/s.Aa.__ _ _ _ _ __
_ --JSur=-=-ryJ.-'L._V:...:::a::...:::.__._,-'2::..a3""'8a...:::8=3- Phone (804) 357-3184 No. of Conllfctfon, fP11b11d _ __.N.1.J/:.JCAL-_ _ _ _ _ __
Uptu t fon Pe rwf t ll.c>t r (Pl.It> 11 c) .._N'L/...,A'--------
T1" of u~,: '"""' ~ lnd11s trfl 1 __x_ Othtr ( s~1f1 - - - - - - - - - - - - - - - - - - - - - - - -
1f -.eu11reeents lrt for I sfnglc-Nttr ffetd rudfnt, 11st weth lr.cllldtd 111 flt14 SIICI llo. 6,,ntr llo. - - - - - - - SWCI No. - - - - - - Oltner llo. - - - - - - -
SlaCI llo. Owner llo. - - - - - - - SWCI llo. Owner llo. - - - - - - -
SWCI lo. Owner llo. - - - - - - - Ml llo. ~ritr ao. - - - - - - -
l'tter rodfngs lrt 11 --~ga~lul~QOS!Uiill:-.-------------(9111onS, 1000'1 of 9111ont. C11bfc fNt, etc.;
..;- Iott: If ,,,tta h 11,.t.trN, ntwtt ~91 S~I 110. / ~z -/-!o -7/pOttntr llo. 11 t,ou, fa To,,er rlt~t-llllld COl"fttf'.
~lt Mtltr ltudlnt* ~11ons V1ltr ltvel .. " Dile Ket.tr Rudfn9* c. non, V1ttr level .. "
[~
un 1
"°"'"' 3 .!> 3 3 ..;300 Usf'd mi 16 17 Used IIAtl," ....-h,ca ...
2 18
- 4 s
3 19 20 21 22 1 23 I 24 25 10
' 26 11 27 12 28 13 29 14 30 15 31 ~SS--z f7.e:oo 2. lf'o /o6
- * ., .. w 11111e u .. Hca ,., ,,,.,,,.., .., tftl *'
.. ,, u,111, '"' n 1111 ,, __ ,_,..,,. ,.,,.,
- ,I .,,,
Ttta I C.11*
'II ftof!UI 'Z- /9o r'-=
Toul C.IIOAI
°""' ~3J'>'oc,
- If Ullfl, rtlf It I~ If flell'J*puatflll fJIOO, ,,u I ~,nt1t
~.,tel' r,u, Optrat1111 -.
.. "If Ultfl ti W wll 11 I ftt1f, tftctfJ llflldl wll - - - - Ill I f !loft UI J/ 11111 UIII Ovartlt' b/
f Al.I trh1tel1 w M11Ji1117-o,1114 ~ltc n\lr 1ve,l7 IJ'Ula w1Ul IIU1UI tlltptrt.ur,eiwfll. Dlt1 1 ll'trllf 7o~~r .,.n, t,1,1tt Dvrt
... "°""' °"" "1 0..* tltf 7:z.193
.., ...... ,,.. .... ,, ..._, GROUNO WATER PUMPAGE ANO USE REPORT S1111 Dt~r1mc111 e( Hcahh *"' Su .. Wutr Co111rol lou4
,.,11c. Sfftf Cl'1 1f rt90r\ ti ~lt<1,I Sut.t Vtt.tr C..*t,..1 to....i Offlct l!!f
-~x-. "'""' 1t11~1 Sut.t Null.A Dilp,,r~t Office llldvttr11I. ,..., cot, ef "'° "1**,,.
tt I Sutt 11tt.t, COlltnl to.** Office
- - - \tt'IAt(II o~iw,. ,, .... CNJ . , report ti ***'*" Slit., 11,14, (o,11 ... 1 to.l'f Office
- - - 11tllhl *"' Wl"11*1
- 11111 of waur-,,orls -.~ of OoerHor ~1/A Va. Electric , Pc,.,.ier Co. - Surry Po,ltlon/Tltlt -,N:;-:/11A.----~---------
(),,Vt r Va
- Electric ard Po,,.1e.r Co* N/A OU.t Nii\
ldd.-.u P.O. Box 31 S Sfqn1t11rt
'°""'ht Ion Sent<! t,11b1f c' ---.l:IN:.1..IA~--------
Surry, Va. , 23883 Phone (804) 357-3184 llo. of Connfc t 1OM ,,.,.11, l _ _AJNu..f.cA...__ _ _ _ _ __
Uptf'lt Ion Pt 1'1 t N,..,/~A._________
'l.c,e r (Pllb 11 c) ...
,,~ of u~,: Puti11c !.__ ll'd11S v11 I __x_ Other ( spec1f1 - - - - - - - - - - - - - - - - - - - - - -
1f 11,tls11reinents lrt for* stngle...,ttr fft1d re,d1nt, 11st wells Included 11 fh14 SIICI llo. ~ r llo. - - - - - - - SWCI lo. - - - - - - Owner llo. - - - - - - -
SIICI lo. 0-ner lo.------- SWCI lo. Oitner llo. - - - - - -
SWCI lo. Oi,ner lo. - - - - - - - Ml llo, - - - - - - u,,ner IIO, - - - - - - -
Keter rodings 1rt 11 --~ga~l~l!lo!onslliiL--------------<9f11ons, 1000'1 of 9111ons, cubic fttt, ttc.)
1ou: If ,,st.a ts 11,..u~. ntlMU ~91 S"'I 110. ()l.ner No. J:: 11 kan 11 1c,,.er ,1,11t ... 114 c~.
o.u w,ur levtl .. H Meter ludtng* ~ 110ftS
'~" "'
Olte Meter ludtn9* &.11on1 Veter Leval**"
- USN Sutt,** Used nut,"
I.In l'o/lUI 37'f+3o
~ 16 1 17 2 18 l 19 4 20 s 21 22 7 23 I 24
- s 10 ' 26 11 27 12 28 13 29 14 30 15 31 31 c.c./-, 0 z..o 3-o t,c, I C.IIOIII Ttu I C.111111
- lftf .. tar s... tfN HCI 111 (f"tflf't.11 tftf tf ltll
- If Ul. . , lttf It tftf tf IIClll*Pl,<IIIOlllf fttlef Dl,r I. . flg,i~ 2..c:, 3 e, Dvr*at ~,,w ~fls-o
- If Ult41, Itel It tftf tf lit1Yl*Pl,IIIP111f Pl"" I 0ptr1Uat r,u1 .
...... Ultll II tlle .. n I* * ,,,,,, ,,e,cu, .,._,,. wll - - - - D111 1111, ~"'
- an .,,1nu1, er fl,61~111-owftt4 111111, .,.1,1, '"" lfltlla
" 3/ 0p<<,11111t D111 "'" °"'"'
~/
w1 UI llu 1UI Dtpert111u~,wt11. o.n , a,er111 AilJ l,1, ...
Dl,c-1
... "°"'" &:,~
°"' " °"" *~ ?9 - -
... ***~****"'
'"' ~
~ ~4 1 ..... * ,,... -** ,., ......
GAOUNO WATER PUMPAGE ANO USE REPORT
-~X..__*lll*I S111t Dcp1r1rnc11l e(
, ** lie. Sc/If " " ,, 'tfO
Hulet. an4 Su!.e Waler Co111,., lou4 If If.ti~ I """ V1t,, c.~, ... , 1o. ... Ofllu ~
(Ctrc1t One)
=
lc9I0111I Sull Nul&A Otp,tr~& Offlct Covft tJ / Ctt1
- - ~ s,.,, .. ,,, 1"4v1tr1al. St.., <OfJ tf rcpo,c l l "1101\tl U.*tt .. u, ~~'"' lo.** Ofr1u . Surry O~iwr. s,,.. c~, 1f report t.t lt9to111i Sut.a "'"' Ccnlrel io.l"f o,11u
- - - lltllhl .... S,,1"911)
- ine of va ur-.o,*, Ila~ of Ooe ra tor _"Nii/'i:A_ _ _ _ _ _ _ _ _ _ _ __
Va. Electric ' Po,,.ler Co. - Surry ,o,1t1on/Ttc1t ___,N.r/'nAr--------,,s-f'-----
O.'lltr Va. Electric ard Po,,Je.r Co. sf QnH" _ _ _ _N_/A____ 0. t.t _N_l_'1'_ _ _ __
Addl"tn P,O. Box 315 ,opuht1on ServN (Pvbllc' _ ___.N.i.luACA.-________
_ ____,Sur"'-='-==ry~,_V~a=*~*-2=3e..:8;..;::8...:.3_ Phoiw ( 804} 3S 7-3184 No. of CoMtc t 1on, 1,11b ltd _-J.N...l..,A....__ _ _ _ _ __
Uptr at ton ,e r11f t 11.c,t r (,llb 11 c) ,&;N.._/...,A'---------
T1~ of u~,: P11h1tc*_ _ Jnd111tr111_x_ Other c,~1f, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 11us11renents art for 1 111191e...,.t1r fftld rudfnt, 11st wells fnc111dfd 111 SWCI llo. C>wntr llo. - - - - - - - SWCI llo. - - - - - - Olffler lo.-------
Sl,,(I llo. O,,n,tr IO. - - - - - - - $WCI lo. Owner llo, - - - - - - -
SWCI lo, O,,ntr l o , - - - - - - - S\ICI llo. O.Cner IO. - - - - - - -
Meter rudfn9s 1r1 11 _ _...:,ga~l~l~onsu,,i:.______________ (911lo,1s. 1000'1 of 9111ons, c11bfc fttt, etc.
Iott: If 111t. h uNl!fttrtf, t1\la,tf ~ I I SVCS 110. Owntr llo. 6 1a klan ta to,,,er r1tM*'6~ <Of'111f',
Datt Ket tr Rud1119* 6.l 110"S v,ur ltve1°" O..tt Met.tr Rudf r,g* C.11ons V1ttr level .. "
Usfd Sutt, .. rll'IPIR " lked Stut," ,,,_-IM ..
.,, ~
[,wf .,
LI n l'<ollUI S' I loo ,, 16 1 17 2 18
- l 4
s 19 20 21 6 22 7 23 8 24 9 :s 10 26 11 27 12 28 13 29 14 30 15 31 ?/7'oc, ?<:>0 Total c.n. T1ul C.IIOAI
- lc14 NW , ... lfllf HCII CIJ (lrtftf'1*t1 tM tf flJI 2o~ /7'&l Hlf Ulftlo rttf II ..... tf IIOll- ..... lfll ,erte,
- If u, ... , .., n .,., et "****"""' ,."., ,,u, 0.,,1,. lblll o.,, Opt,au ..
~, .. ~art.tr 1,u1 Opt,au .. -.
0
...,, ...,... 6/
- .. If Ull1' 1a tftl .. 11 ta I fltlf, lpt<lfJ llfltc, w11 - - - - Ill I I !bl IA ...3 / Da71 UIII Qv1rler 1 All frh1ttl1 tr M11Ji1ll1-o,ne4 J\A)Uc u\lr tvP911 IJ1\lla w1 U. IIU 1UI Dtptrt~iur,.,-111. o.n I a,tf'III Owrt "' lbtlll z~ °"""' o.,.,t.. 3/
...... ,,,... .... lJ*lwl
............... ,"' ,,., L:z'?' z__ -
GROUND WATER PUMPAGE ANO USE REPORT v,1e, Sov*u:
___x__
$111, 0cP'r1fflCIII ., Holch ln4 Sue. W1ltf Conlr9' lornlll ~~, (Clrt1t '~ -
11e 11 h I P.tllc. so, u,, ef 'tfO tt a.,,....,, Suu v,u, c,,.,,.., ao. ... omu ~ One) lt9to,,.,I suu llctllA O.~rtwolt Offtce Cou11t7/Ctt1
- ~ - \,,ta,(*> llldvttrttl, 1tflf ,.,, tf ' ' " ' ' Ct ~10,.,.1 Sutt 11,u, C..11v.1 lo.I** Otr1c, . Surry 0~11e,. Stlloll cot,,, report ti 1,,,,,.,.1 St,tf lltUr (Olltl'tl 161,.. Offlct
- - - lltll(IJ ,,,. Wl"tll)
- 111 of W1ter-.o,,, N1N of Ooerltor ~I/A Va. Electric
- Pcwer Co. - Surry Poslt1on/TIC1t -"iiN7/ A . - - - - - - - - - - - - -
o-,..v;-r- -Va. Electric a.rd Po,.1er Co. S1qn,t 11 rt N/A o.i. _N_,_*~-----
Add~u P.O. Box 315 Popuhtton Ser...td ('1ib11c' _ _-AN.,../~4',._________
_ __.Sur=..,,.ry~,_V:.. =a::.. c.___,_,2=-=3c..;::8c.;:;8..:.3_ Phoiw (804) 357-3184 No. of CoMfct1on~ (P11b11cl _ ___.N~/.....A....________
Uptn t 1011 Per111 t 11.c,c r (Pub 11 c) .. N...L.::.:A,...__ _ _ _ _ __
Type of Uc.e: Puh11c !.__ Jnd11S tr1a 1 __.X_ Other (s~ 1fy - - - - - - - - - - - - - - - - - - - - - -
If 11eu11reratnU art for 1 111191c-Nter field rud1ng, 11st we1h 11'1C111ded 111 SWCI ~. Owner No.------ SWCI lo.------ Olffier llo. - - - - - - -
SWC8 No. 0-ntr *o. - - - - - - - SWCI lo. - - - - - - Owroer llo. - - - - - - -
swca lo. Owner 110. - - - - - - Ml lo.------ 0-ntr IO.-------
Meter rudings ire 11 --~ga~lul~ons!l.liil--------------C9'11ons, 1000's of gallons. cubfc fttt, 1tc.)
lot.: If 111'- fl 11.-Urtf, nt!Mt. ~91 s~, No. Owntr lo. fl 11 kian 11 '°" rltht*hi"' COMllf'.
O.tt "'eter Rud1119* ~1 lons v,ur Lev1l 11 " o.i. ICeur Rud1ng* g,, 11 OC'II V1ur ltvel**w l'~IM"' Used SU ti," l'\acl 11111* **
[M ef 16 t.ut "'°""' 279300 1 17 2 18
- J 4
s 19 20 21 6 22 1 23 a 24 9 :s 10 26 11 27 12 28 13 29 14 30 15 31 2..-tJo~e>O //c,c:,
a,ew Tot.I I C.11* ,,u1 C.110ftl
""' "°"~
- ltt4 I.., lfllf Hc:I .., (lr1ftr1,IJ ~ tf flJI / / e:,.e, 11,,, .. ~.,-- 3 / c::,c:::,
Hlf Ulttl, rttf It I"' et IOll*...-.1"1 ,crte, .
.... ., u, ... '"'
11 It lllf .,
tilt"'" t1 ... ..,.~, ... " "..
t,u I Opcratl .. r,u, c,p.,u,,.. -
Ult11 I flt1f 0 IPf(lfJ 111\tc* 11111 - - - - Da11 tltl I floft UII .3/ ..,. " o,.,,,,., ~/
f All ,,tuttlr er Ml1.s.e111-0rlll4 ,..,., wt\lr '"" 1,u...
st~ 111t1I UI lllttrt~uP'kiwtll. O,tl .1111, l,,, ...
Owrt llt "°" \II J~ Dli""t Ov*rt1r S-/
., *.*. ,,.. .... ,,.a;,, . . ' .. '"-' ****" '"' /j'f'.Z-GAOUNO WATER PUMPAGE AAO USE REPORT ~t) /J,,ft!(--
1A'J
- Srut ~p,ar1mc"I ef Holch 1n4 Sue., Wuu Co"~ loar4 ~., \f,
__X.__ "-III I J ,,eltc. k,,. Ct'1 *' 90 lt ~lt11,I 1t.,t, Wei.fr c,,.,,,, lot..i Offlu l!!f (Ct;:r, t °'"4 )
--- s.,,,,..,,, o~rw,. s....
1t91°""'1 Hu, Nul\A Ditp,er~t Offtu lodvn,111. ,,...., cot, ,r " ll lf.t!t,...I 1u,, w.i.,, CoAtrwl Sot** Ofhu coo,.,"" C. ** ,,oiwl 1t.,t, W.t,r (Ofllrtl ao.rf Offlu
~11t7/Clt1
. Surry
- - - 11tll(1I ,,,,, s,,1"1!1)
"*lllf of WHt~r*s II ui, of Ootrltor M/'A N/A Va. Electric ' Po,..ier C-Q. - Surry , OS ft toll/T It lt o-..1'r Va. Electric arrl Power Co. sf Qnl t11rt N7A O.te Nfll Addrtn P.O. Box 315 , QP\llllfOII Served c,11blfc' NI.A Surry, Va. , 23883 Phoiw (804) 357-3184 No , of Conntctfon, t,11bltc) NIA t ~ trltfon Per111t 11..abtr (Pllbllc) lJ/'A T1" of u~e: Pullltc _ Jrdustrt1I __x_ Other (s~tfy _
If ~,sure11tnts are for* 1fngle--,ttr fftld rtadtn,, list -*1 h f IIC 1llded hi flel*
SWCI llo. Owner llo. - - - - - - - SWCI llo. ~ r llo.
SWCI llo. O.ntr llo. - - - - - - - SWCI llo. Owner llo.
SWCI llo. l),ner llo. - - - - - - - Mt llo, Oorntr NO.
Mtttr rudf n9S art f I --..!;ga~}...1,l~QOSl.lit.--------- (gallons, 1000°1 of ga 11ons. cub1c fHt, etc.)
l>,,1)t r
lfo ..::::. e> N S TJ<:.CJ C.I f O
- 5 I -r<iS""
...._ Iott: If,,, .. ts Mr,actfrM, HllMtl ~91 fa kllft fl ICMr rftht-~,_. CDnltr.
S~I 110.
o.iu Mtttr Rud1ng* 6411ons w,ur ltvt1 11 " o.u Ket,r h1dfng* &.11ons Vat,r lev,1 11 - . I Us~ Hall, .. l'lllc;)lft" Used
,,, ,,, Slatt,"
Zf~7foo ~
'l/1/J
[ltd .,
~n PlolltJI u,IN/1, " ' f/1, 'H4o 16 1 17 2 18
- 3 4
s 19 20 21 22
'1 23 a 24 9 ~5 !
10 26' 11 27 12 28 13 29 14 30 15 31 ~~(,.~S-r:>c. /S-? /oc,
- lct4 - ~ *
- 11* ttcl ,., (l'tflf'tllJ lftfl er ,,,1 Tttl I c,11..,
IS-7' /oc:;,
Ttul C.11CNII D1,,, .. ~.,~ ~/j? /o=
- If tlltt1. ' " ' n ,,., ,, aoa-,u.pt,. ,.,,.,
- If 111141. rttC It tftf If .. IYJ*p.iaipfftl lfrlof
- .. ,, ut111 ** 111t .. n ,. * "* 1JtCtf1 -*c* wll - - - -
"" .. !bill TtU I Oper,tf ..
o.,, -3/ " Ulfl Dl11 Opt,u1111 Ouarltr
~/
"'" lb,~
- AU frhu.,, er ,wlt.s.,117-0,,1114 fl,t11C -,1,1r '"" IJ'lfl9 w1 U.* llet 1 UI Dtt4 r11auf">t t9f II. Dlt1 I Arlf'lfl AilJ l,1r1te S-/ 3 /o/4~
Dl,rf flt "°"'" 2-a.- O.,r,"t 0..1rt~
.............. ,,.a,;., -. . ' ....... ****" '"' /f'7'Z-
~ t) :::re,I/Vc=
CROUNO WA. TEA PUMPAG£ ANO USE REPORT
__x.__ 1H II (I J S111t Dfp&r1fflCIII .r Huhh '"' Sutt Waler C.0111,vt
,,,lie. S...i co,*' 10 tea.ti....,, St,t, Vet,, ~"lrtl to.~ Offlu t!f 1,,,-1 Sut, Nul&A DfP'rtNo\1 Offtce loar4
,c~.
~mte, 111) > 4 On.t)
--~ s.,,,,..,,, '""'"""*'* s.... cot, *' report tt if.tto.... 1 u.u, v.u, Co11trtl lot** Ofrtu O~r. Stllolll cotr tf report tt lt9lo"II St,t., V.t,r C~trel loal'f Offlc,
~nt7/Cft1
. Surry
- - - ¥tl1(11 .... S.,t"9(I)
- 1111 of lt1ttr.ar*1 ll1e, of Ootrtt.or ~l/A Va. Electric ' Pc,..,er Co, - Surry Posttton/Tlth -"iiNi7/A~------------
C),r\ltr Va. Electric ard Po,.ler Co. SIQnUurt N/A O.t.t _N_J_'A_ _ _ __
Ad<freu P.O. Box 315 Popuhtfon Sentd (l'vb1lc 1 _ __.N~/UIA..___ _ _ _ _ _ __
Surry, Va. , 23883 t
"'°"' (804) 357-3184 No. of Co,wctlon, fP11b1ld _ __...N.,../....,A_ _ _ _ _ _ __
Upen t ton Pe ~u 11..cle r (Pub 11 c) .. N...../._.A.___ _ _ _ _ __
Trpe of u,1: Pulltlc _ _ ll'ld11Hrl1l_x_ Olhtr h~lf1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If ~u11renents .,.. for* 1f11g1t-Mttr fftld rudlnt, 11st welh fnctu<fed fa ftt14 SWCI llo. ~ r llo, - - - - - - - SWCI lo, - - - - - - Owner llo. - - - - - - -
S.CI llo. O...ner lo, - - - - - - - SVCI llo. Owner llo. - - - - - - -
SWCI lo. O,,ntr lo.------- S'ilCI llo. Otntr ao. - - - - - - -
Meter rudings 1r1 11 --~ga~l...,l""ons...._______________ (9111ons, 1000'1 of geltons, c11bfc fHt, etc.)
Iota: If 111ta h Yl'IIIICUrM, t1'1MU ~91 S'-"=1 110. z '7-19'0 - 5"'"°6 C. Oltntr llo, ~ fa lioan la 1o,,er rt1H*~III <onwt',
D.tu "'ettr Rudi~* ~11ons v, ttr levt 1..... O.tt Meter Rudi 1'9* C.llons Vet.tr levcltt"
,,._,IIQ...
Sutt, .. 1'~1~"' Used su,t,"
,~
un lb\UI /OZ-'>t!!J -z_.oo
.,. 16 1 17
- 2. 18
- J 4
5 19 20 21 22
'7 23 I 24 25 10' 26 11 27 12 28 13 29 14 30 /07'3/s;,o 13/300 15 31 Toti I c.11.., Teul CIIIOAS
<<//-=-=
- lltt4 N\.er laat tf* HO ~I (l,'1flf'1,IJ 8i'4 If flJI
..., Ulee, rH* It ,,,. ,, -*Plllf'"I 111,111
~rt .. fblla /8' r/.300 ~I .. ~art.er l;'o
- If u,,., rue 11 tnf ,, 11c1,,-pwap1111 ,-,,.. 1 Opt,au .. -
M**lf UltA 11 i11t 11111 11 I f1t1f, IPf(ffJ llfltc* 11111 - - - -
1 All .1rhn11, .,. MlfJ.1111-ow* ~He.,,., '"" ,,,i.
o.,, Ulla !loft~ .3 is, ftt.11 Operltlllf DIii Ullt Ov1rllf' ~/
w1 ~ ICI t 1 UI OtP4 r i.iu f">t,.111, 111111 ........ .,. n, a,1,.,e Dwr1 &. /,:/'3 Dl,,i "1 0,.,r ,~ 33 ~ "l----
"' "°""' - .
- *
- I I I ..... I I ' I , . . .
, ...... ,,.,. .... ,,.e.;.1 GAOUNO WA TEA PUMP.AGE A.NO USE REPORT S111t ~par1incn1 e( Hulcll 1n4 Sc..ee W,cu Co"crvl lou4
_..,.x_ lie" h, ,.111,. s.1111 U'1 *'
- ,,OIi, '"° lt lfttt11,I Suu vn,, c,,.,,..1 to.rt Otttc, l!!f
--- ~,..,,,, Ovwr. s,,..
I SU\I Nu 11.A DIM rtNo,C Offlct
,..,.,11,111. S"" COfJ tf r1,or1 lt a...1, ... 1 Sc.,11 .. c.,, C...1.rtl So.** Office coo, ef " " ' ' c. 1t111... I Sutt .,c.,, (o,11,..1 to.art Oft1u
- - - 11tllhl 11111 Wl"tlll
- 1111 of WUtr"'WOr*1 N*~ of Oocr.tor ~l/A va. Electric , ~ Co. - Surry ro,ttton/Tttlt --.N"/r.A:---------------
~lir Va. Electric a.rd Po,,.ier Co. 5f qnHwrt N/A 0. t.t _N_7_'1'______
~d~n P.O. Box 31S ,~1uto11 Senl'd (Pwbllc'--~H ....LuAL.A..-._ _ _ _ _ _ __
Surry, Va. , 23883 , Pho11t (804) 357-3184 No. of CoMfcl1on, fPwblfc) _ _Nu.,. ,/A<.L. ._ _ _ _ _ _ __
,,~ of u,,: '"""' ~
I.IP tr It ton Pe rwtt lutit r ( 1t c) -li-L...
llld11strt1I ___x_ Ot.Nr (s~tfy _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
'lib A'----------
If 11eu11renenu are for 1 1t~h-wt1r fft1d rud1nt, 11st we11s 1r.c111dtd 111 SKI llo. Owner llo, - - - - - - SWCI l o . - - - - - - Oilner llo. - - - - - - -
S\ICI llo. Owner lo. - - - - - - SWCI lo. ~ r llo. - - - - - -
SWCI llo. Owner llo. - - - - - - 5\ICI l o , - - - - - - ~l'llr IIO, - - - - - - -
Attar rud1ngs.are 11 _ _..:;ga~l~l.!io!onsl.lil.______________ (~11ons, 1000'1 of 91l1on1. cwb1c fHt, ttc.}
lot.a: If 111t,a h 11N11eU,..., HllMU ~91 SWCI llo.3o -190 - S-/ G o.-ntr IIO. 3 fa 1c ... ta 10,.,.r rt1~t*M"' <Ol"ftlf'.
O.t.t Ktttr Rudi~* ~ \ 1ons w,ur Level .. " O.tt letter lud1ng* &.11ons V1ur Levcl 11 "
suet, .. l'~f11e"' Used Sutt," ,.,.; ! /WI I ...
["4 .,
~n 1
"°""' r1..J7 2-soo I 16 17 2 18 J 19 4 20 s 21 22 7 23 a 24 9 :s 10 26 11 27 12 28 13 29 14 30 '-l'1,Y1z. 8'oCJ 8'~.yo3ao IS 31 T,ta 1 c.11 ... T1ul C.111111
- letl .. w I - 11* HCI ,., l,rtfere,tr lftl tf IIJI Owrf .. IIQoill , -J/ 3 IOT ~ O~ Dwrl9t 0,ar~ z. 3 (le/I ,jo o Hlf UI . . , tttl It IN If IIOll*,.,..1 .. ,.,te,
- If Ulftl, rtll II Inf tf ICIWJ*,.,..1 .. ,cr1e, ,,u I VIOper1U
.,.,. .. r,u1 0Nr1t1 .. ..
...... UllA ta Ille *II I* I fltlf, lpt,elfJ illlcl1 11111 - - - -
t All frhu.e1, w M11.ii111r-o.* '1,611c .. 11, '"" 11'\lla II lloll UI J= 0.71 Uifs Ov.,te, '//
wt~ IIH1UI Dl~r~ar,t,.111. 0.111 **.,. ... ..,.11, ,*.,...
Dwr1 flt "°""' z3/34'-3 °"""' 0..1,t" zt, I 'I'? 3
...... ,,.. .... ,, ..._. .. .... ,., .... ~
'"' /~z_
GAOUNO WATER PUMPAGE A.NO USE REPORT lbldl 'J~ -
S**** O(p1r1111e111 e( Huhh 1114 Sutc W11~, Co111rol lou4 ~*rte, 1 <1)J 4
, .... ,. Sfftf ,.,, *' 'tf'O It -.,,~ I St4t, Vet,, C.*Vtl lotrf Otrlu t!!!I (Cfrc1e Ont)
_ ....lC...... ""
s.,,,..,,, ltfl011tl Sutt NullA 0.Ptr~, Office 1"4v1lrul. '"" u,, tf rt,Orl It ~lo"tl 11411 V.t,r Co111nl lot** Offret 0,111,. Stf'IIII coo, tf re,0,1 c. 1t110...,f Sc,t, i,,c,, Cliltrtl So.rf Offtce
~11t7/Clt1
. Surry s,,,.,,.,
- - - - - VtllhJ ....
- 11t of Wlltl"'WO'" Nuit of Ooerttor t,J/A Va. Electric
- Pa,..ter Co. - Surry Posftfon/Tlth - ~ N " / A . - - - - - - - - - - - - -
~1'r Va. Electric ard Pcwe.r Co. Sfqn,tiirt N/A o.i. _N_J_'A_ _ _ __
Address P.O. Box 315 P09Ylttfo11 Strvtd CP11bllc 1 _ _ _Nu..<.,IAa._________
_ __.,Sur=..::..ry~,. . .,V:..:::a:.. :.*-L..*...:2:.::3c::.8~83:...- Phoiw (804) 3S7-3184 No. of Cowctton, fP11bltd _ ___.N....,/c..cA..___ _ _ _ _ __
"Ptn t 1011 Ptr91t 11..c)c r (Pllb 11 c) 4N.._J...,A,...__-'--------
Ty" of "'e: Putilfc ~ Jnd11Str1e1 __x_ OtNr (specUJ - - - - - - - - - - - - - - - - - - - - - -
If 1DtlS11rements ll"t for 1 111191e ..... ter f1eld re1dfng, 11st wells Included la ffel*
SWCI llo. ~, No,------- SWCI llo, - - - - - - Oainer llo. - - - - - - -
SKI llo. - - - - - - O.ntr lo, - - - - - - - $WCI lo. ~ , llo. - - - - - -
SWCI lo. Owner lo.------ S'IICI llo, - - - - - - O,,ntr I O , - - - - - - -
fitter rudtngs art 11 --~ga~l~l~ons!.Jlii.--------------Cf'llons, 1000'1 of g111o,is, c11bfc fHt, etc.)
S'-'=1 Ro,.3/ - 1'70 - ~z.. c. °"11er lo. C. fa llolft II '°""
1ou: It 11 1t11 ts ~-u"", t1twu ~91 rl9llt,~III Conwf',
["'
un O.tt Keter llud1119*
1
"°""' 3t,,'8'/t;. /oo ,,'H/H, "11ons Used
'1//////////////J, v,t,r level ....
su,1," ,~111411"'
Dltt 16 17 Met.tr lud1 ng* &. 11on1 Used V1ttr level .. "
St.ut," l"-IM***
2 18
- 3 4
5 19 20 21 22 7 23
- t 24 25 10 26 11 27 12 28 13 29 14 30 13 7 , z. 7 ..J.od 6?1/..3c:>a 15 31
,... , .... , 1.1110M
.. ., u,... ,... It,,., ., IIOlll*,._.1,. ,., ...
- ltaf Nier * - lf* ttCI ~f l,rtflf't'1J tfll ef flf)
,.~1,. ,.,.,.. " ,,.
,,ua I C.11*
!bill '?// 3oe "1,1., 0-trW ;!.
t/~b.?oo
..... , ..... ' " ' It ,,., ., ....
.... ,, u,.. 11 .,.. wll ** 1 11,1t, ,,.cu, 11111(111 wn ____
f an frhu,1, 11 Ml . .11,-o,1114 "'611c w11o1r lwH1_J *f1'-
o.,, Ulh°"""lion~.. ...3o ret.11 0pt,1t111t D111 "'" Ov1tttf' ~/
w1 IA 11t11 UI DtPfrtll,u~,-fll. 0.11, Aun11 AilJ l,trttf
°" "I ~UI 30377 °"""I Ov*rtlf 2.~ '1'? 8'
., ..... ,,.. .... ,,-~, CiAOUNO WATER PUMPAGE ANO USE REPORT
.... .., ****" ,.Hr
~~
/z..zz-
-..,JPN?'
S111t ~par1mc11t el Hcahh an4 Sc..i. Wuu Co11u9' loer~ ~., ... , 1 ' J *
(Circle ~)
__x...._ - ""' , .. 11c. Stn, C1'1 ,r rt90rl &e t.t*~ I Sut, v.i., C..Al"II lo.'1 Offtu l!!f 1t1t0i'III Sute NulU °'"'~' 01rtce ~t1/Clt1
~-~\f,'1..,1,1 lodwllrttl. St<lil CotJ er r1,o,1 II ~IO"tl 11.,tt .. u, C411trtl lo.** Ofhct . Surry 0,w,. S.111 coo, tf ""'° &e **1*1"'1 Su~ vu,, <ont"II 1o.tr1 Offtct
- - - - "'""' '"' s,,, ... 11,
- -.eVa.of Electric
().rlir Addl"<<u vuerwo,*,
, Pc,..ier Va. Electric a.rd Power Co.
P.O. Box 315 Surry, Va. , 23883 Co. - Surry
"'°"' (804) 357-3184 II*~ of Ootr1 tor S!QnHurt
~I/A Pos1t1on/Tft1t -"i<N"/A.--------""-,-'11<------
N/A O. t.t __
Popu ht Ion Servtd CP1111 ll c' ___NUL.;IAo..__ _ _ _ _ _ __
No. of Co/l/lfct1on1 fP11b11d --.uH1.L/.cA..._________
.,_n_____
Uptrat Ion ,11111t ltA>tr (Pw lie) ,A;.N""'/.1.JA!...-_ _ _ _ _ __
Tr~ of u,,: Pufl1tc~ JricMtr1al_J_ OUltr (1~1f1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If aieu11remients ,,.. for 1 11ng11-e,t1r fftld rudl"f, 11st wells IAC1uded 111 flt14 SWCI IO. ~r IO,------- SWCI llo. - - - - - - Olmer llo. - - - - - - -
SWCI llo. Owner lo.------- SWCI lo. Oimer llo. - - - - - -
SWCI lo. Owner lo. - - - - - - SVCI llo. - - - - - - o,,ner IIO. - - - - - - -
fitter rt1din9s 1r1 f* --~ga~l.1oo.,141iL--------------C~11ons, 1000's of g1ll0ft1, cubfc fttt, ttc.)
loi.: If 11,ta II w,_Ur-M, t1l1Mtt ~91 SWCI "o. ~ , IIO. 'j::;, la ~an ta 1o,,tt ,1,~t*lll!lf <OMlff'.
r,,~ Kettr Rudtng* ~ 11DI\I V*ur ltvtlte" O.tt ICtltr Ae,d1 ng* g, 11on1 V1ter Leval .. "
,~lfte" Used Sult," l"->11111 ...
r,.. ,, ,u,.
LH t l'\:M\ UI 2S'"foo7oo 16 1 17
- 2. 18 3 19 4 20 5 21 22 1 23 a 24 9 ~5 10 26 11 27 12 28 13 29 14 30 2t:. '- 3 ~ e.o /..:=. 3 /.:;,c, 15 31
- . . . - Uf' , ... U* HCI ,a, (f'lftrl'1J tflf If IIJI .,,, 1 c,11..,
Teti
/03 /oc:,
f1ul C.IIOftl
.,,,.., ~.,w 2. 7 2..4-eoc:,
- If
-**If tllttlo FNf U tftf If IIOR* ..... lllf Jilrllf
- , .. , ... ,.., u .,., ., lel'IJ*l'\llfl .. " ' ' "
Ul .. 11 lftt *II tat f1t1', lff(lfJ lllfltc* wll - - - -
,.~' c,p.,.u..
"' lloflll D171 Ull1 ll&>ftUI 30 f1t1I Optrut., -.
9r t an ,,1uu,, 11 M1t:.Ur-orllt4 "'611c .. 1.1, ,.,,,,_ '".._
wt~- -.,1 UI llllput1111u~1,.111. DIii , hlf'ltf D111 ' " '
AilJ l,1r1tt
°""'"'
Dwr1 .., ....-ui .3c.,l,3 7.
°"""' o,.,.,,~ ;z...'7 t' ,3
.,. .... ,,,.,. -** ,,.a.;,1 GAOUNO WATER PUMPAG£ ANO USE REPORT S111t Dtp1r1mc11c e( Huhli 1114 Suec Wuu Co,urvl 10114
-~X- lit II (I I , ** lie. S.'lf U'1 tf rt90r\ ~ a.tlt11,I St,t, vu.a, C.11t,...1 lollt11 Olflc, ~
lt9lo;,,,I St,l.t Nul!A Dep,ertNftt Office
- - ~ St<'lllt(II ,..,.,"'"'* 1f'lf cot,,, PO Cc ~1,-..1 Suu "'"' Co,,trtl loll** Off1u 0~11t,. St"" coo, tf report ~ lttlt11o1 I Su 1,1 l&eCcr C111t,,1 to.rf Offtct
- - - Wtllhl *"4 w*11tl1I
- 11t of VUtrworU 111~ of Ootrl tor 't-l/A Va. Electric ' Po,.ter Co. - Surry Po,Ctto111t1t1* -"iiNi7/A*-----------
OwVtr Va. Electric a.rd Po,,.ie.r Co. SfQn1t11rt N/A O.t.t Ni1' Addrus P.O. Box 315 Popv1Uf0ff SenH (Pwbltc' _ __.N.ul~A._________ --------
_ __.Sur=~fYJ.-L.*_V:...:a=-=*~*-'2::..:3=8c.:8:.,:.3_ hone {804) 35 7- 3181 No. of ~ c t f OM CP11b ltd ---.....Hu..f...A_ _ _ _ _ _ __
"'Ptrlt 1011 Pe r111t II.cit r ( Pllb 11 c) ,N.._/.:.zA'--------
T1pe of u,,: P11t11lc~ 1nc,11 strt11_L Other (spe<tf1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
4 If me1s11rements art for 1 1tngle~t1r f1tld rt1dtng, 11st wells 11\C 1llded '" flt 141 SWCI llo. Olmtr llo. - - - - - - swca lo. - - - - - - Ollner lo.-------
SliCI No. - - - - - - - Oi,ner No. - - - - - - - $WCI lo. 0,.,-.er llo. - - - - - -
SWCI lo, Owner N o . - - - - - - SWCI llo. - - - - - - Owntr NO.-------
Mtttr rudfngs art t1 --~ga~l...2~0Cflu,r.______________ (91l1on1, lOOO's of g11lon1, c11btc fNt, ttc.)
SWCI 110. /~2 -/9o - 7tro.Mr IIO. -
c::.
lote: If l7St.a h t1NICU1'1'1, t1tWtl ~91 11 '°an ta 1oiotr rlt~l-~,-, COMltf',
O.t.t f'.ettr Roding* 6'11ons v,ur ltvt1 11 " Oltt Meter ltud1n9* 6.1 llo,11 VU.tr lev11*u*
Used HHt,** P1111Pf~a" Used Hui, ..
r"' *'l'ollUI ,~~z./700 ~ , , , , , , . 16 un " ~
1 17 2 18 l 19 4 20 5 21 22 7 23 I 24 25 10 ' 26 11 27 12 28 13 29 14 30 kf~KZ3~o /Z..?,?8/eo lS :n
~.,~
"Tr<?c,c> ...,,, * ..,,...C.111111
- . . . Ntar .... If* Hell ,., (ytftrl'1J tfl4 tf 1111 Ttt.a 1 c.11 ...
Hlf tlltl, fffl It fr,f tf IIOll*"""lftl ,.,,..
1111,, .. lloolUII /2- S-70 2..6oe>
- If ti\ .. , rte, It lftl tf lclYI*"""'"' ftrl ..
"**If tlltA II 1111 .. 11 1,1 I flt1f 0 lf,KlfJ lllll(ll 11111 - - - - DIJI UI II Ron UI TtUI Oper1U ..
.3'c:, o.,,
,,u, Opt,1t1111 tall Q111,1er
~/
f 111 ,,1,n,11 ., M1 . .111*0r~ M11c ""' 111H1J 171t*
wtUI Ntt1UI Ol1Mrt1*urkralt1. DIii J lwtrlft Ai1J l,1r'1f Durl 7"3Z7"3 o-,,..., Ow*rttr ¢,Z~~
"' "°""' --
,*--* ',,, .... ,, .._,, . . ... '""' '"'~~/~r~f'~z.::::___
GROUNO WATER PUMPAOE ANO USE REPORT lbft~ _.:rz.;;;,..~~/\1...:;~;;,_--
$111, ~p,r1mc111 e( Hullh 1n4 Su&c Wtru CG""°' loar4 ~*-' 1cI> J *
~~lC'...__ 11tll(1J ,.111c. S.111 ce,1 ,, rt90rt le 1.tt1.,..1 Sutr V1t.,r C.At"tl So.'11 Otflct l!f (Cfrc:1t ~)
~-- s.,,.,.,., .,,,~, St.ttr 1101111 °'~'~' Office l"'4vUrttl. SW co,1 tf ttPOrl ti 1.tt10,..1 Sutt .. tr, CoAtrtl lotrf Off1c, '°""t1/Clt1 Ot11tr. St,.. coe, tf rtPOrt lt lt910,..f St.tt., v.c.,, Co,1t,..1 to.l"f ou,u
. SUrry
_ _ _ "'""' ,,.,, s,,,,..111 11,11e of Vtttr.o**1 ll'*me of Ootrltor ~I/A Va. Electric, ~ Co. - Surry ,osltfon/TIC1* - " i N i 7 / A * - - - - - - - - - - -
(),,1'r -Va. Electric and Po,,.ler Co. Sfqn,t11r, _ _ _ _ N_/A____ o.c.. __ N_/7'-
Address P,O. Box 315 ,09Uhtfon Strvtd (Pl!blfc 1 _ __.N .......
{A.....________
......,~23~8~8'"-'3_ PhoM (804) 357-3184
_ __.Sur==-ry..__.,"--"V,-=a___ No. of Conntctfo"' r,11b1fcl _ __.N...,/""'AL-_ _ _ _ _ __
Uptratfon Ptrw1t JLc,cr ('vb lie) ...~...L~A...__ _ _ _ _ __
T1pe of u~,: , ..1111c ~ Jnd 11 s trta 1-.__x_ OV..r ( Spe< t f1 - - - - - - - - - - - - - - - - - - - - - -
1f ~1s11reinents art for 1 1111911-etltr ffe1d rt1df119, 11st wt11s fr.eluded 11, fft1' SWCI llo. o.-ntr llo. - - - - - - SWCI llo. - - - - - - o-mer lo.------
SWCI lo. o.-ntr lo.------ SWCI llo. C>.tner llo. - - - - - -
SWCI lo. Owner lo.------ SVCI llo. ~ner IO.-------
--~ga~lul~OOS!Uiil:...--------------C~llons, 1000*1 Meter rodfngs lrt f1 of 9111ont. c11bfc fett, etc.) ,
Iott: If 111ta fl w,-et.tf'ff. 11t1Nte ~91 SW\:I lo. ~ r llo. I- la ~.&ff fa lo,,er rf9M-~ .... CC>nllf',
l).IU Ktttr iltAdlng* &.110IIS V1tfr ltv11 .... 0.C.. Miler llud1t19* g,, Ilona V1Ur levt1ttH r,_ .,
St.ul,"
'"""'Iii" Used Stulc" ,,.._,, 11Q***
lut "°""' 311:>c../-foo ,,
~ 16 1 17
- 2. 18
- 3 4
5 19 20 21 22 1 23 I 24 t :s 10 26 11 27 12 28 13 29 14 30 37 7'T90 /~30 15 31
... c.n..,
,~,,,.I foul C.UOAS Dw,,.,
- lul *w , ... ti* HCI l,J (1"1ftr1'1J tfll ef ftJJ /'S"" ..3o 1),1,1.er &.??o Hlf Ul... rttf ti 11'1111 tf IIOII*""""'"' ,.,,..
- ., ...... ,,., tt lflf ., ,.. ** ,.pw,ap1111 w, ..
..... , Ultt1 ta 1111 11111 I* 1 fltlf. 1~lf1 _..,,, wll - - - - o.,,
"°""
ftU I Oper1U111 Ill t I lb;\ VI ,3c:::,
rot.al 0pe,,u.,
Dt11 \Alt 0w,,, ...
9/
t 111 frhU.tlf II Ml~11J*<<-rllM Pl,611c .. ,., lvP,IJ I J ' i .
wt"' IIUIUI DtJtrt.ou~l'Wltll, DI.rt ... ...,,.,.
0.11 , htrlll
~, .1111, , ** , ...
Dwrt"t Ov*rt~ 77 ..
GROUND WATER PUMPAGE ANO USE REPORT
- * * *II.._. 11, I,....
b~
/ 'i' f
~-vc 2-i S111t Dt~rtmcnt *f Huhh 1n4 Sue. Wuc, Co111rol loar4 ~*rte, I Cf) J *
-~X.,.__ "- II hJ P.tllc. Sf"',.,,*'
''°"' 'tfO ll ~ ' " " ' Sue, vu.er c..~t,,1 to.~ OHlu l!!f I St.HI Nu' UI Do.. rt.fol, Office (Cfrc1t h )
Cov11t7/Clt1
- - - Stt'lllf(II 1...s.. ur11I. St<lf tofJ ., " " ' ' ll ~""' Stitt ... c,, eo~1.r1, to.,, Ofhc, . Surry Ot,w,. S."4 coo,,, report t.1 ltt""' Sutt"'"' Co,1trel to.,. Off*c,
- - - 11111(1) IIICI S,,l"'t(IJ
- 111t of 1t1ttn,o**1 11* ., of Ooeru.or ~I/A Ya. Electric , Po,.ie.r Co. - Surry Po,ttton/Ttcl, -"iiNi7/A.------~~------
Ow1' r Va
- Electric arrl Po,.1e.r Co, S1qnu11rt N/A Ott.t NIA Address P.O. Box 31 S PopJ ht f on Servtd (Pwb11c' ~-....1ff.i.luA~--------
Surry, Va. , 23883 Phone (804) 357-3184 llo. of CoMfctfonc lP11b1td _ __,H......,/A.....__ _ _ _ _ _ __
Up trat 1011 Perwf l ILc>t r (Pub 11 c) .._N,..,l.:..:A1..-_ _ _ _ _ __
Type of u~,: Publtc ~ lnduUrtaL....X- OU\tr ( s p e c i f y - - - - - - - - - - - - - - - - - - - - - -
11 NU11renents art for a 11nglc-Nttr fft1d rudlftt, 11st welh Included Ill SIICI lo. ()tner llo, - - - - - - SWCI llo, - - - - - - o-,ner lo. _ _ _ _ _ __
SWCI llo. - - - - - - - Oimtr llo. - - - - - - - SWCI llo. Owner llo. - - - - - - -
SWCI llo. Owr,tr llo. - - - - - - SVCI llo. - - - - - - O,,ner N. - - - - - - -
Mtttr rudings art 11 --~ga~l...alJ.COSUi1.--------------<11al1ons. lOOO's of gallons, cubic fHt, etc.)
lot.I: If 11sta fl w~tArN, nlta.Lt- ~ I I SWl:S 110. Owntr llo. 6:, fa ~&al fl lo,,,er rl9~l*lw~ COMllf',
Dau VHtr level ..... O.tt Meter Rod1119* ~llons U s - t t , * * ,\111111)1~ "'
ICtltr ludf r,g* C.1ton1 Used Vittr level .. "
suu,.. ,-, .....
tlld .,
Lut l'MUI ~I 'Joe:, ¥Hf/I, **
- 16 1 17 2 18
- 3 4
5 19 20 21 22 7 23 a 24 9 25 10 26 11 27 12 28 13 29 14 30 'if .z. / C>-=- zc::)~
15 31 .
Tota C.11111 I '" ~,,...
- ltt4 NW , ... ti* HCI l&J (,,.lftf'l~IJ ~ If flJI Z-=o .,, ... ~trc.r 2. / c:, c:,
.. lloolta
..., u,... '"' ,, '"' ., IIOll*N"IP*.. ,.,,..
- If 1,1,., rtlC It 1111 er .,,..,.p,.,aiplfll ,en..
i,.,,
Ttll I Clpernt .. fetal Opfratt .. -.
.... . , Ultfl 11 1111 11111 ta I flt1f, 1PKlf1 !lfllcll 11111 - - - - &lll !loll~ 3~ C,.,r1 11111 0111rllf' ~/
1 All ,,1uu1, w MIIJ!lllr-o,"'4 fl,611c .. 11, ,.,.,, IJ'lal9 wt u. !Itel"' Dt.. , *
- r,,,.111. DillI A,tl"llf .,.n, 1,,,.,.
Dwrl
.. "°""' 7* Dwru't Ov*rl_. z.3
---1
-*~* .,,.. .... ,, ._..
GROUND WATER PUMPAQE ANO USE REPORT
- I *II,._ I 1 *I,...
lbl ~
/ff-z-
- Tu ,N'C -
_1 v.i,, '°""': S111t Dtp,r1"'c111 *I Huhh 1114 ~cc Waler Co111,8' lou4 ~., ... , l 2:i) J
- _ _x.__wllhJ P.11tc. s. ... ce,, *' ,t90,, le ifi 1...., 1 St.u, v11.e, C.11tr1I 1o,,.. ou,u ~ (Circle Orlt)
~ - - \tt'lllf(II 1"4vHritl.
"°""' St.It.I Nul&A Ot~r~, Offtce
'"" rot, 1f r1p0,1 ll "1111111 SIAlt lltt,r C...trtl ~** Off1u
~t7/CU1
. Surry O~iw,. St"' coo, 1f ,epo,t te lt9t1"'i St.,&, 11.t&tr COlltrtl ktr1 Oft1u
- - - lltllhl .... ~, ... ,,,
- of W*ttr-.oru Kara, or OoerHor 't-1/'A Va. Electric ' Pc,,,ier Co. - Surry Po,lttoft/Tlt1t -~Ni1/..:'A-------------
~1'r Va. Electric a.rd Pc,.,Je..r Co. SfonHvrt N/A O.t.t _N_1_'1'_ _ _ __
Addrus P.O. Box 315 Pop1.1lttlo11 Servtd CP11bHc' _ __.N.uL~AIL-_______
Surry, Va. , 23883 Phone (804) 357-3184 No. or CoMfctton, (P11b11cl _ ___..N:u:I..... A...__ _ _ _ _ __
t* IJP<<f'lt Ion Peral t lbC)e r (PIii> 11 c) "".N"'"/...,A,__ _ _ _ _ __
T1pt or u~e: Puhltc _ Jl'lduHrt1I_.X_ Other (spectf1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If ~1s11re,nents lrt for 1 11ng1,....,.t1r ffe1d re1d1119. 11st wells lrw:1uded 11'1 fl11' SWCI llo. O,,ner llo. - - - - - - swca lo. Owner llo. - - - - - -
Sll(I lo. O.ner l o . - - - - - - swca 11o. ~ , 11o. - - - - - -
SWCI llo. O.ner l o , - - - - - - Sliea 1o. - - - - - - Oifner IIO. - - - - - - - -
~ur rudin9s lrt 11 gallons (p1tons. 1000*, of 9111on1. cubfc fttt. ttc. l s~, No. Oltner No. rl Iota:
I* loan fa '°""'
If IJSlla fl 11i.UrM, 11ttau, ~ ..
rl9ht-~lllf c~.
v,t.tr 1:, '""""'"I
().a~ Meter Roding* ~ l1011S ltv11 ..... Dita Ket.tr au<11 r,g* C.. 11ons VI tar Leve 1u" Used S\.ltl," '-'"'ll"""
r"' ., 16 Lut ,O,,Ui .2?07'0D I 17
- 2. 18 3 19 4 20 5 21 22 7 23
- 24
- s 10 26 11 27 12 28 13 29 14 30 Z8Z4'=c, z..~oc=:,
15 31 1etl I C.11* o.,,,.,
T1ul C.IIIM r .s-c::,, -c:,,
- ltlf at\at .... If* HCI l,J (1'lftr1*l1 tftl ti flJI 0.,,1 119 lbl&a Z-~OIO O.uw
.. ,, u,... '"' ll .,,, ., --""""' ,., ...
... ., u, ... ,, .... '"' ., ,... ,,.f'YIIPtlll "".. Teu I ilperl\1 .. r,u, Ope,1t1111 -.
.... ,, u,,. 11 ll'C wll I* 1 ftt1f, 1ft(lfJ llfllcll wll - - - - 11111 illc!"Ul '30 '?/
t 111 Jrh11.11, er ,...11J,tl11-0r"'4 M1tc .,,., lvPtll II'.,_ "
Dell
..,, "'" 0v,,,...
.,.n, ***'ttt "1~ Nul Ua lltr,ar~*t,t19fll. I A,trlfl
°""' "°"'" .?c::> °"".., o.,., ,~ 4=,C>
GAOUNO WATER PUMPAGE ANO USE REPORT t I I I""" I"
~~
/ ~,
q'9 z_' ~
.::T"() d v,,., \ow*u: S111t Ofpar1mc11c el Hult II an4 ~I.I Waltr Co111rol lou4 l).i1rt.tr 1 (l) J 4
__x_ "'11 h, Pwallc. S.111 u,1 tf rt90r\ lt t.t1....,1 St,1.t lf1\4r C.11tr*I to,,.. Ofrlct t!!f (Clrth One) lt9IOO'lfl St,tl Null.' 0tPtrtNOII Offlct
--~ s.r, .. 1,1 llldv1lrt1I. h"' <Ofl tf re,or\ lt 1tt1,,..1 St,te .,t,, to"'"' to.** Offlct ~11t7/C1t7
. Sur!)'
.,t,, c.,.,,..., ao. .... Off tu Ot11tr. Stlll coo, et rtPOrt t. 1t11,,.. J Sut,
- - - Wtllhl .... ~, ... ,,,
- of vu,r-..o,*1 11,111 of Ooera tor ~I/A Va. Electric ' Pc,...,er Co. - Sw-ry Posftton/TIC1t -.:Ni"i/;.A-------------
0..,Vtr Va. Electric arrl Po,,.le.r Co. Slq~turt N/A O.tl _N_J_'1'_ _ _ __
Addrtu P.O. Box 31S Popvlatton Stntd (PubHc'--~HLU..IIAi::a...__ _ _ _ _ _ __
Surry, Va. , 23883 PhoM (804) 3S7-3184 llo. of CoNlfctloM fPvfl11cl _ _,.....N.J.J/'"""A..__ _ _ _ _ __
Uperatlon Ptrwlt ~ r (P~11c) .a;N:..c.1....,A.__ _ _ _ _ __
TyPf of u~,: P11111tc!_ JnduUrt11__.x._ Ot.Nr (s~tt, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 11us11rements art for* stnglt-Mttr fftld rudtng. 11st wt11s 1nc1udM 111 flt1' SWCI lo. OwNr No, SWCI lo. ().,ner llo. - - - - - - -
SWCI lo. Owner llo. SWCI lo. Owner llo, - - - - - -
SWCI lo. Owner lo. Ml lo. l)tner IIO, - - - - - - -
Meter rudi119s ar, 11 gallons (9111ons. 1000'1 of 91l10ft1. c11blc fHt, etc.)
Iott: U s,si. h 11,-urM. nUut, ~91 SWCI llo.
~ r IO c.o~s.-.R-t.)c:...,rooJ
- 51~ 11 '°'" ** lo,,et ,1,11t ... "' (Ot'1\lf',
~~ Hettr Rud1ng 0 ~110111 11,~r Ltve1°tt ~ti Met.tr lludfnv* c.nons v,ur Lo11eew
,,_,/IQ...
Used Sut1,**
'"""'11411" Used SU\1c"
[1114 .,
z,~~t.soo~ 16 t..11 1\)11 UI
~
1 17 2*- 18
- 3 4
s 19 20 21 H
7 23 I 24 9 :s 10 26 11 27 12 28 13 29 14 30 'rz..'i'f'3 ~70.:::. 3~2--Zec>
15 31
. I c,n..,
Ttul C.llllftl
- * . , NW I - lfar HCI Iii (Jf'lf~1*l1 tftl ef 1111 I.rt *'-Iii 3~:z.. z_oco ev,1., C),1rt.tr 9.//sot:!:>
- ., .. , ... ' " ' It *"' ,, aoll*fw'lf' .. ,.,,..
- If Ultt1. r1t1 U tGI tf lfl*J*~1"1 ,c,,..
.... ., Ultfl 11 I'll 11111 11 a fltlf. 1ttelf1 i,111,11 11111 - - - - -
,o.,,., I °"'ttt11 ,3o Teul Optr1t1119 -.
Ill I I llol\Ui *11 IAh Ouarter ~/
t All -frhtttlr tt ~IWll,-o,1'114 tl,61tc "1111 "ulUI DIP1riiaur)t,wt11.
N\lt SVPf11 11'\cla DIii , l,tt'III .,.11, ,**,...
Dvrl ... !bit!* /07~ "'",., °"" \If
/ o 3<-1-~
-. ~HUUND WATER PUMPAGE~AND ~*th 14>ttr Sovr,:-2: Si.ate ~partmfflt of Health and State Water Concrul Board . Quuter ~ 2 ;7 =
-~:X:.__Well(s) Public. ~lid copy of ~r-t to Rag10NI Sutt Weter Cofttrol Soard Office llld frcle One) llt9fDn1I Sutt HHIUI Dep,rtaent Office - County/Cfty
- - - - Sprt119(SJ lr>d11strt1l. Send copy of rtPQrt to Reg10111l Sutt W.ttr Cofttrol loird Offtc,
- Surry Other, Stnd co01 of report to Rt9fo111l Sutt W.ttr Control Soard Off1ct ---....:.------
_ _ _ Wtll(s) *lld Sprtftg(s)
!fame of Waterworks Name of Ooerator --;?-;-;'l/,.,A;.--------------
ric & Pc:,..ler Co. - Surry Posftfon/Title __~N.:,/r;A_ _ _ _ _ _ _ _ _ _ _ _ __
Va. Electric and Pc:Mer Co. Sfqnature _ _ _ _N/A _ _ _ _ _ Date - - Nt'A Address P O. Box 315 Population Served (Publfc' _ ___...N...1.a..A_ _ _ _ _ _ _ __
---'S=ur=rv::..,....o,~V.=a.....__._,.....2~3'--8__8'"""3_ Phone ( 804) 35 7-3184 No. of Connection" (Pub 1tcl _ _,. .N..IA.._________
Uperatfon Per111t Nuar (Public) .a.N::.1.l.:..:A,___ _ _ _ _ _ __
Type of U<:e: Public+_ _ lndustrfal--X._ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measurements are for a single-meter field reading, 11st wells included tn field SWCB No. Owner No. SWCB N o . - - - - - - Owner llo. - - - - - - -
SWCB No. Owner No. SWCB No. Owner No. - - - - - - -
swce N o . - - - - - - - Owner No. - - - - - - - SWCB No.------- U..ner N O . - - - - - - - -
Meter readings are fn _ _...:g~a5c.1.l.:lo~ns!.!:2.-------------- (gallons, lOOO's of gallons. cubic feet, etc.)
Nott: If systea ts umietered, tstflllte pu111p191 fn boqs fn lowr rt1111t-lllnd conlef',
Date Heter Reading* Gallons Date Meter Reading* 6111ons Ill ter Leve 1**-
Used Used Stlttc- l"-fna*-
End of I List llontll 7g, 7,([)c,0 16 1 17 2 18 3 19
\~t ~l~J\~l\ iqqd") -
I -
4 20 i I
I 5 21 i :..
6 22 II 7 23 ! -
~
8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 ~ ?1t./1,cX) /8'7 /oo Tota 1 Gallonr Tout GlllORS
- leed aeter Slllt t1ae Hell d1y (prtftr1bly tnd of day) t1ko, rttd it end of IIOll-poac,1ng period Dur f"!I llonUI /87
. I
/0> Dur1119 Quarter /J7//oo f taken, rtad 1t tnd of llt1wy-~1ng period Toti I Oper1t1119 roul Oper1tt119 f Uktn tn one 11ell 1n I field, SPte1fy wti1clt veil - - - - Days UI 1s llon t11 - 3/ DI.rs tllf s Quarter 3/
11 prh1tely or publfctlly-owned publtc water su1>9ly systeal 1111 UI Htl 1 UI Depari.ent perwf ts. Oat 1y Aw1r1119 . ..,. i I J A~tra9e
- Our 1119 llontll 6,03S-O.,r i 119 Qua rttr d,/03*~
\ J. '
GROUND WATER PUMPAGE AND USE REPORT S1ace ~panment or Hcallh and St.ate Wacer Concrol loar<<I
_ __...:X:.__ Well(s) Public. ~nd cop7 of rtPOr1 to lt9fONI Sutt llattr Co11trol loa,.. Offfct alld R19f0111l Sut.t llfflUI o.p.r\Mllt Off!ct -
- - - Spr1119(1) llldustr11I. Send coc,y of rtport to lt9fonal St.Ht llitlr Control loa,,_. Offlct Other. Stnd coo, of rtPOrt to b91oNI Stitt llittr Control loaN Offlct
_ _ _ ~ll(s) 1nd Spr1119(s) lfuie of Waterworks Halle of Ooerator N/A Va. Electric & Pc:Mer Co. - Surry Position/Title _ _.:N.:/TiA~-------------
0-°W!r Va. Electric aro Pc,,.;er Co. Siqnature N/A Date _N_/A ______
Address P O. Box 315 Population Served (Publfc'---4lNLL/s.::.AL---------
Surry, Va. , 23883 Phone (804) 357-3184 No. of Connection!. {Public) _ _NUL,1/AICL-_ _ _ _ _ _ __
+ Uper1t1on Pera1t Mualber (Public) .. .N..,.1/-=-A..___ _ _ _ _ _ __
Type of U'-e: Puhlfc _ _ lndustr111_x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measurements are for I s1ngle-11eter field reading, 11st wells included fn ffeld SWC8 No. Owner No. SWCB N o . - - - - - - Owner llo. - - - - - - -
S~B No. Oimer No. SWCB llo. ().mer No. - - - - - - -
SWCB N o . - - - - - - - O.ner No. - - - - - - - SWCB llo. - - - - - - ~ner NO.-------
Meter re1dings are 1n _ _...;g;;;,:a..._l..,_l..:O.cM~-------------- (gallons, lOOO's of gallons. cubfc feet, etc.)
Not.I: If systa ts unaiettrtd, tst1Ntt puap&91 SWCB No.:3o- / o- S" I G Owner No. fn boan 111 1oi.er rf911t-llalld corner.
Date Meter Reading* Dlte Meter Reading* Gillons Va ttr Leve 1**tt Used Static- 1,-111a***
Clld of Lu t ttan tJI 2Zl71c.o 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 ( JO 15 31 !'1.S-~ J' Joo 73S'o~oo Tota 1 Ci llClftf Toul CitllOIII
- lead *. ter ,.,. tlae tacll day (prtftr*bl1 tncl of d11) f tit."* rNd 1l tnd of non-~1"9 period Dur
'"' llotltll 73S"o?oc. Dur1119 ~arttr 73S-o Yoo f Ul111, rtld It end of llt1v7-puapf"9 per1od Tou I C)peralfnt rot.al C)perltfllf
- If .tllt11 tn one -ell fn
- flt1f. specff7 wflfcll wll - - - - o.,s Ulfs NcntJI 3/ 0.71 tllft Qu1rter 3/
- All prf,1t111 or Pl,tl11cal11-owned public water suppl1 s1sltlli w1 tJI Ku ltll Depari.en l perwt ts. O.t 1y Awtra91 A ilJ Awtra91 Our 1119 Mofttll 237/23, Our i "9 Quart tr 237 123
I~ - I GROUND WATER PUMPA GE AND use REPORT bdl VA-It/d ~
S1alt lxpanmtnl of Hul1h 1nd Su&e Wa1tr Control Boartl Quarter~ Z l4 frcle One)
_.....,..:x.__ !!ell(1) Public. Stncr copy of rfPC)rt to b9lon,I SUta ll1tar Contl"Ol loa1'11 Offlct 1~
Rt9lon,I SUta Kt1IU1 ~rtMfl t Off1ct - County/Cf ty
- - - Spr1119(1J lndustr11l. S~ copy of rtPOrt to Re9I0111 1 SUlt llltar Control IOl1'4 Office . Surry Othtr. Stnd co01 of l'fj)Ort to Rt91orw1 SUlt lllltr Contl"Ol loa1'11 Offtct
_ _ _ lltll(sl ind S0rt119(1J
- me of Waterworks of OoerHor N/A Va. Electric & Pc:Mer Co. - Surry Po sf tfon/Tit 1e N/A
- o.,'14r Va. Electric arrl Po.,.,er Co. N7A N1~
sf qn*turt O.te Address P O. Box 315 Popu latfon Served (Publfc' NlA
_ ___,,Sllr===c..:ry:.J.-L,~V.-=-a~._.,'-----'2~3~8~83'---_ Phone (804)357-3184 No
- of Connection~ (Publfc) NlA Uperatfon Peraft Nuiit,er (Publfc) NLA Type of u~e: Puhl fc +_ _ ln<Sustrfll-.X_ Other (specify_
Jf measurements are for* s1ngle-11eter ffeld re1dtng, 11st well s fncluded fn ffeld S"'8 No. Olimer No. - - - - - - - SWCB No. Owner llo.
SRCB No. Olimer No. - - - - - - - SWCB No. ~ r llo.
SWCB No. _ _ _ _ _ __ Owner N o . - - - - - - - SWCB No. U-ner "°*
Heter readings ire fn ___ g~a-1.lo~os~---------- (gallons, lOOO's of gallons. cubfc feet, etc.)
Nott: If system ts uiaeltrtd, est1Nlt ~ge swca No. a"i- t o- SZ C Owner No. 1n bozes 111 lowr r1911t-llaftd COMllt'.
Date Heter Reading* Date Meter Readfng* &lllons II.I ter Leve 1**..
Used St1t1c" ,._,;1-***
Clld of Lut lbltll 3-i.. b IO foo 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 32. ,z, toe= //~ 4oe:,
Toul C..IIOAI Tou 1 Gi 110ftf
- ~*d aeter l&at t1ae HCII d17 (prtftr*bly tncl of d*Jl Ultfl, rNd 1t tnd of IIOll-~1119 period Durt 119 llontll //~ .Jje10 Dur1119 Qu1rter //t,,. ~ a ,e;:,
f Ul111. re,d It end of 11t1v7-pvaip1119 period Tot, I Operut119 roul Oper1t1111
- If t,l111 111 one 11111 tn I field, 1pectf7 9'11cll wll - - - - Dlys tllt 1 11on tll - .3/ Dl,s tJlfs Ou1rttr 3/
f All pr1ntaly .or publtc.117-owntd public wuar supply s,sce-il 0,1 17 Avtr191 w1UI llteltll Oep1ri.ent pel'lliU.
Our 1119 Monti! 37.rr .11il7 AYtr19t Ovr i "9 Ou1rttr ..3 7S-~
GROUND WATER PUMPAGE AND USE REPORT 'bldl ..:;TMLl+te.~
S11ce IHpartmt*,11 or Hulch and Suw Wacer Concrol loar4 . Quuterq 2 l 4
-~:X:.__ ~ll(s) P11bltc. ~lid copy of ~ r t to leglOMI Sutt Water Cont1'111 ao.r11 Office aM fn:le Ont)
Re9I0111I Sutt HttltJI ~rtNftt Offfc1 - County/Cfty Surry
- - - Spr1"9(S)
- - - Wtll(s) ind Sprl"9(S) llld11str1al. Send cor,7 of rtPOrt to legfOIIII Sult W.ttr Control lotnl Office Other. Send coo, of rt$)0rt to 1,910,wl Sult W.ttr CCflt1'111 ao.ni Off1ct ----=-------
- me of Waterworks Name of Ooer.tor N/A Va. Electric & Pa,,/er Co. - Surry Position/Title _ _-.:Ni'./r,;A.-_ _ _ _ _ _N""'t'"".A..------
- Owlir Va. Electric arrl PCMer Co. Sfqn.ture N/A O.te - - - - - - - -
'-ddress P O. Box 315 Population Served (Public:' _ ___,,,,N....la.JA..__ _ _ _ _ _ __
Surry, Va. , 23883 Phone (804) 357-3184 No. of ConnectfoM CPubl fc) _ __.N.....l""'A.__ _ _ _ _ __
Uperatfon Peraft Hunlber (Public) N/A Type of Uo:e: Puhlfc + __ lndustr111__x_ Other (specify ~~---------
If aeasurenents are for I sfngle-lW!ter field re*dfng, list wells included fn field SWCB No. Olmer No. SWCB N o . - - - - - - C>,,ner llo. - - - - - - -
SWCB No. Olmer No. SWCB No. Oi,,ner No.-------
SWCB No. Owner No. SWCB llo. Uitner IIO. - - - - - - - -
Meter readings are fn _ __;g~a1a...._ll.:o~ns!,.!2._ _ _ _ _ _ _ _ _ _ _ _ _ _ (g11lons, lOOO's of gallons, cubfc feet, etc.)
Nolt: If systea h 11naetered, 11t1Nt.t pu11P19I SWCB No. Owner No. 1:::> 1n bons 111 l~r r1911t-llllld conwr.
Date Heter Reading* Date Meter Reading* Gillons VI ttr Leve 1**-
Used Static- " * *
- Cnd of LI st lton t11 Z Io£/ /.t::> 'D 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 Z Ff8' S-ac 9¢ "7"'oo Toul GIIIOIIS
- Read aetar SUit t1ae tacri day (pr1ftr,l>l7 ttid of da7)
Uken, rHd ,t tnd of IIOll*p,,II0111CJ per10d Tota I &.11onr Dllr 1119 llontll r~*¥o~ Dllr1119 ~,rtar 7'-/. L/oo f t1k1t1, read u end of lleaw7-pu111p1119 per10d Tou 1 Operat1119 roul Operat1111 If Uk111 1n_one w,11 111 a field, specify wfllcll wll - - - - D,y I tll 1s llon tll - 3/ D, 71 UI I I Ou, r ttr 3/
t A11 ,rh*tely or pvl)lfc,117-owntd public **ltr suppl7 s,su.
wi UI Hee I tll Departlllent perw1 U. 0.1 17 Awtra91 * .11117 A,tr191 Dur 1119 llontll ,3o',f~ O..r i 119 0,,1rt1r ..30¥,*~
uHUUNlTWA I ER PUMPAGE AND USE REPORT Mon th Scace !Hpartmfflt or Hulch ind State W11er Con1rol loarllll . Qvuur 1 2 l 4 (Cfrcle One)
---"'X:...._ w<<ll(s) Pwbllc. SetW copy of rt901"t to bgton.1 Sutt Veter Co11trol loird Offlct 1 -,
Rtglo,yl Sutt Nt1IUI Otptrt;afflt Offtc1 - County/Cf ty
- - - Sprt119(1) ln<11,1str111. Sefld c097 of rtpc,rt to le,g1onel Sutt W.ter Co11trol lot,.. Off1ct . Surry Other. Stfld co01 of rtPOrt to *,9101W1I Sutt V.ttr COAtrol So.rel Ofttc,
- - - Vtll(I) illd SprtiwJ(I)
Na.ie of Ooerltor -,1'.;-J/ 7 A~-------------
ric & Pc1,,ler Co. - Surry Pos ft ion/Tit 1e __---;;N:,-/r,Ar------~...+1-----""-
Va. Electric cuu --~ P ~
- Sfqnature _ _ _ _ _N/A _ _ _ _ _ _ O.te - - Nt'A------
Address P 0. Box 315 Population Served (Public'---A.lHu.lc.AL--_ _ _ _ _ _ __
_ __,Sur=:.:::ry~,_V..=.ca:;c..."--- -=2=3-"-8=83~- Phone (804) 357-3184 No. of Connection?. (Publ fd _ _N......_./A.__ _ _ _ _ _ __
Uper1tfon Pe,..1t Nuaiber (Publfc) ...N...,/...,A,___ _ _ _ _ _ __
Type of U<.e: Puhlfc + __ lndustr111---X- Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 11easurements are for I single-titter ffeld reading, 11st wells included 1n field SWCB No. Owner No. _ _ _ _ _ __ SWCB No. - - - - - - - o-.ner lie.-------
SWCB No. Owner N o . - - - - - - - SWCB No. Owner llo. - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB No. Oifner No. - - - - - - - -
Meter readings ire 1n ___g~asa.&a.l...:lo~ns!5l.-------------- (gallons, lOOO's of gallons. cubic feet, etc.)
Note: If systea fs u..etered, estwtt pgiip19I tn bo11es 1n 1owr r1911t-l'lllld corlllf'.
Date Date Meter Reading* &anons WI t.r Leve 1**-
Used St1t1c- "-ihia***
Cftd of Lut flantJI 7:z.B#fao 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 ( 30 15 31 7.¥.ofz_. ooo s-7f?2.oo Toti 1 &ellont Toul Gel10As
- lead aeter s1111 tlae Hell d1y (pr1fer1bly tncl of day)
Ultt1. rHd ,t efld of fl0fl*INII01ng periOd Our1 119 !lofttJI '5"7/7 2£JC. Dur1ag ~erter :s-7¥7 *z.o 0 Ulen, rt1d 1t end of lle1v7-i,u-s,1119 periOd Tou I Opera t1 llf roul Operet1111 f u1te11 1n one -ell 111 1 field, specify wti1cll well - - - - O.ys Ul ts Noll tJI - ..51 0.ys Ulfs Quarter 3/
11 prt,1ta1y or pytilte111y-owned pub11c wetar supply sy,ie..
w1 tll Hte 1 tJI Depa rant pel"ll1 ts. 0.1 1y Average .Mi Ir Awtr191
- Dvr 1119 Noll tll l?S- .39~ O..,ri119 Querttr /8S- 37',Y
GROUND WATER PUMPAGE AND use REPORT Jt>n di -:::J?t<<tJ Ir,~/
S111~ ~putmml of H~allh and State Waler Concrol loa,4 Qu1rterl"1) 2 l 4 /
_....,.,J{.__Well(s) Pwblfc. ~no copy of "l)Ort to t.g10IWII St.Ile ll1t1r Control lotl"f Offtct alld
'"t(trcle One)
- ,9t01W1l Stitt llfflUI ~l'tNftt Off1ct - County/ C1ty
_ _ _ sp,-1119(sl llld11str111. S~ COl)J of rtPOrt to ~10ftll Stitt lllter Control lot,. Office Other, Stnd coo, of rtl)Ort to 11~101111 St.Ill llattr Control lotl"f Off1ct
- Surry
_ _ _ W.11(1) 111d Spr1119(s)
- me of Waterwo,.ks Nuie of Oi>erltor N/A Va, Electric & 'l?o,Jer Co. - Sun:y Posft1on/Title -.N:."/;;A.:--------------
- Owlir Va. Electric am Pa,..,er Co. Sfqn*ture N/A O.te __ N_/A______
Address P.O. Box 315 Popullt1on Served (Publ1c'----1.1NLL/A~---------
_ __.Sur==ry:..,....L,_V..:..a~._.,'---"'2-=3...c..8..:..83____ Phone (804) 357-3184 No. of Connection~ (Pub11c) _ __,Nu.ulA._________
Uper1 t ton Pel"ll1 t Nult>er (Pub 11 c) .a.N.,,,:/~A:..-._ _ _ _ _ _ __
Type of u~e: Puh11c *_ _ lndustr1*L-J'-_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf 111easurenents *re for I s1ngle-11eter ffeld re1d1ng, 11st wells included in field SWC8 No. Owner No.------- SWCB No. - - - - - - ~ r llo. - - - - - - -
SWCB No. Owner No.------- SWCB No. Owner No. - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB llo. - - - - - - O.ner NO.--------
Meter readings 1re fn _ __;g~aid.1""-1,..o"'ns~--------------C~llons. lOOO's of gallons, cubfc feet, etc.)
llote: If systea ts uraettrld, est1Ntt P1,11Q191 swca No. Owner No. i::' 1n boxes 111 lowr r19ht-l\llld corner.
Date Heter Reading* Water Level*"'* 0.te Meter Reading* Glllons ~ter Level**"
Used Sutic- '"-i111a***
Cnd of 16 LH t floft tll 3(, Ou;)
1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 370 18'?:? / I '7,o Tota 1 Q,11on, Tou I Ga IIOIIS
- ~IO aeter ,.., tfae Hell d*1 (pr1f1r1b1y Ind of d*1 l t1t<<11. rHd , t tnd of IIOll*Pl"IC'11MJ period Dur 1119 llotl t11 //~o Durt99 ~arter //~o t1l111. rHd *t tnd of lle1vy-puq,1119 pe,-1od Tou I Operul119 foul Operettnt f Ult11 tn 0111 i.,11 111 1 field, spectfy witcll w11 - - - - o.,s tll ts Non UI - ,3/ Days tllts Quarter 3/
11 pr1**talr or put,11cally-owntd public w*ttr supply sysltlll w1 tll Hu 1tJI Dep*rtllent perat U. 0.1 ly Avtr191 * .,. i I J ber191 Our 1119 Monti! 37 I Ouring 0..,1r"ttr 3J_
uROUNO WATER PUMPA GE ANO USE REPORT !\)(It)! _-"'tll[<L~&c/
Scace ~panment of Hulch and Stace Wa1er Con1ro, loartl 0u1rter d' 2 l A
_ __..X:.__ Well(s) P11bllc. StllCI copy of ~ r t to ~fOIIII Stitt Witt,. C411tr"11I loenll Offlct llld (Cfrcle One)
Rt9I0111l Stitt Httltll ~rtN!lt Off1c1 - CoYnty/Cfty
_ _ _ _ Sprf119(s) lftd11strl1I. Stftd copy of rtport to legfOIII I Stitt llltl,. C411t.r11l loi....i Off1c1 Other. Stnd caoy of rtPOrt to *,910~1 Stilt llltl,. Contr'111 loenll Offfct
- Surry
_ _ _ _ Wtll(i) 1nd Sprl119(s) lf1me of Wate~rks Name of Ooer* tor N/A Va. Electric & PcMer Co. - Surry Po sftfon/Title N/A Va. Electric arrl PCMer Co. Sf Qnitur* N7A Date N1~
Address P O. Box 315 Popu latfon Served (Publfc' H/A Surry, Va. , 23883 Phone (804}357-3184 No
- of Connection~ CPublfc) HlA
+ ~ er1tfon Penaft Nuaber (Public). N.LA Type of U<.e: Puhlfc _ _ lndustrf1L.....X- Other (specffy_
Jf 11e1surenents ire for I sfngle~ter ffeld reading, 11st well s included fn ffeld SWC8 No. Owner N o . - - - - - - - - - SWCB No. Owner llo, S'9CB No. Owner No. - - - - - - - - - - SWCB No. Oimer No.
SWCB No.---------- O,,ner No. - - - - - - - SWCB llo. U.ner IIIO.
Meter rHdings Ire fn _ _~gll<a...l..,.l~ons=!----------- (g1l1ons, lOOO's of 9111ons, cubfc feet, etc.)
Note: If systa fs unaettred, tst1111tt ~91 SWi:B No. Owner No. 1n bous 111 lowr r1911t-llllld coner.
O.te Heter Reading* Dlte Meter Reading* &lllons WI ter Leve 1**-
Used St1t1c- ',U.,1...,***
Cnd of 16 Ult l'onUI ?-u9b 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 :?5 10 26 11 27 12 28 13 29 14 r 30 15 31 7YS-oo 300
- lead attar u111 tlae HCII d11 (prtftrlbly tnd of 411)
Ultt1, retd at end of 11011*P1111C>f119 per10d Tot.a 1
Our1 119""ont llot! UI ,3e:,.o Tout C:.110fts Dur1ag Qu1rter Joo f Ult11, rod at tnd of l1uv1-P1111C>1111J periOd Tot, I Ope rt t1119 roul Oper1tt11t If Ultn In one -e11 111 1 fftld, specify wflicll wll - - - - - 11111 tll Is Non tll ..31 111,s Ulfs Qu1,.ter 3/
All *P,.h1tel1 or putilfcally-owned public w1ter suP9l7 systta wfUI Hultll Dep1rwe11t Ptl'IIIU. 0.1 ly Avenge .11IIJ Awtr1ge
- Our 1119 llontll /e;, O..ri"9 Ou1rt1r /0
ATER PUMPAGE AND lbldi ...::.:..~~~:::;l..-
S1a1e ~partmenl or Health and Stale Water Control Boar~ . Qu.art.r ~ Z l 4
_ __...X,__ Wt 11 (I) P11blfe. ~nd copy of "1'01"1 to ~fOIWII Sute llate,. Co11trol 10 .,,s Offtct ,,.. f~lt One)
Rt9IONI Sutt He1IU1 ~,.talftt Offfc1 - County/City lnd11str1a1. Stftd coc,y of rtPOrt to ~fOtMI Sult V.t.tr Co11tn1I ao.,.. Office SUrry
- - - Spr1119(1)
_ _ _ lltll(s) 111d Sprf119(s)
Other. Stnd co01 of rtpOrt to lttg1on,J State V.ter Control lol,.. Offfct ----=-------
111.ame of Waten,,od:s Name of Ooeritor -.f:.l/11A . - - - - - - - - - - - - - - -
Va, Electric & Po,,ler Co. - Surry Posftfon/Title _ _"i:Nn/r..A_______,__~-----
- 0-'W!r Va. Electric arrl Pa,.,,er Co. Sfqn.ature _ _ _ _N_'/_A_ _ _ _ O.te __ N_fA_ _ _ _ __
Address P O. Box 315 Popul.ation Served (Publfc' _ ___..N"'/.LA..__________
Surry, Va. , 23883 Phone (804) 357-3184 No. of Connections (Publ fcl _ _Nu.L,,1/Ai.L-________
t Uperation Penrit Mulit>er (Publtc) .a;N"'L~A.___ _ _ _ _ __
Type of U,;e: Puhl fc _ _ lndustrh L_.X_ Other ( s p e c i f y - - - - - - - - - - - - - - - - - - - - - - -
If measurements ire for I single-11eter ffeld re1dfng. list wells included fn field SWCB No. Owner No. _ _ _ _ _ __ SWCB No. - - - - - - Owner lo. - - - - - - -
S.CB No. Owner N o . - - - - - - - SWCB No. Owner llo. - - - - - - -
SWCB N o . - - - - - - - Owner N o . - - - - - - - SWCB llo. U-ner "°* --------
Meter re1dings ire fn _ _...:g::i:a!d."'-ll,..o~ns!,S._ _ _ _ _ _ _ _ _ _ _ _ _ _ (911lons, lOOO's of 91llons. cubfc feet, etc.)
Note: Jf systea ts urwtter'ld, est1Mtl ~91 SWCB No. Owner No. If tn bolfl h 1owr rtgllt*hllld cOl'lllf'.
Date Heter Reading* Gallons Dlte Meter Reading* &lllons II.I ter Leve 1**-
Used Used Sutic- ,,_,!IQ...
Cncl of Lut llonUI 273100 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 Z7c/z.oo //oo Toti 1 ;anon, Total c;.110AS
- Reid aeter s._ tfae Hell day (preferably tncl of day) //e,e;, DurlllCJ ~arter //oo Uktt1. rHd u tncl of 11()11-~IIICJ per-fod f t1l111, read at end of he1vy-puapf119 per1od °""' 119 llontll Tota I Oper-1tt119 rou1 Oper1tt"9 f Ulen 111 one 11111 1n I ff1ld, specify lllfltcll wll - - - - O.ys UI ts !Ion UI - ....3/ 0.ys UI Is QIN r tar ~=s/
1 prt,,te1y or pub11ctlly-owntcl public water supply systeal w1 UI Hu I UI Dtpart11e11t perwtts. Dlf 1y Aver191
- JI i 1J Awtr191
- Our- t 119 1'o11 t II ....3S- Ouri"9 Qv1rttr ss-
GROUND WATER PUMPAGE ANO USE REPORT lb!U- J;.,,-11/u,4,er S1ate ~partmenl of Health and Suu Water Control loartl Qu1rt.r 1 2 l 4
_-J.}{.__ ~ll(s) P11111tc. Stnd copy of "f'Or-t to ~fcuwl Stu, ll1tt,. Co11tr"OI lot1"11 Offfct allf (Cfrtle One)
Rt9f0111I Suu HtaltJI Oeputaeftt Offfc1 - County/Cfty
- - - Spr't119(s) llld11strt1I. Send copy of ,.,p0,.t to ~fcuwl Sutt lllltr Control lot1"11 Office . Surry Other. Stnd coc,y of rtC>Qrt to ltt91onal Sutt llltt,. COlltrol lol1"11 Offlct
_ _ _ lftll(s) 1nd Sprl119(s) 11,me of Water-.o,.ks . Name of Ooer,tor _ 1 f~1/7iA;;;--------------
Va. Electric & PcMer Co. - Sun:y Posftion/Title __--.:N.":/r..A_ _ _ _ _ _ _,..._ _ _ _ __
- --- - - - N/A Nt'11 o.,'W!r Va. Electric arrl Fewer Co. Sf qn* tur! _ _ _ __;.__ _ _ _ O.te - - - - - - - -
Address P O. Box 315
- Population Served (Pub1fc' _ __.Nuf.s:.A1._________
_ __.Sur=:..o:rv~,_V._,_a==-=--._,,'---"'2=3..:;.8=83~- Phone (804 )35 7-3184 No. of Connection" CPub1fc) --H~IAu,....________
t Uperltion Perai t Mullt>er (Publtc) NJA ,&_;,£,:,_ _ _ _ _ _ _ __
Type of U<!.e: Puhlic _ _ 1nc1ustri11__.x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measurements ire for* single-.eter field re1ding. 11st wells included tn field SWC8 No. Owner N o . - - - - - - - SWCB No. - - - - - - <Mner lo. - - - - - - -
SWCB No. Owner N o . - - - - - - - SWCB No. Owner No. - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB No. Oifner NO.----------
Meter re1dings 1re fn --~gasa.1.i.:lQ!ai!OS!.!ii!.-------------- (gallons. lOOO's of gallons, cubic feet, etc.)
n.. N ~otJ s*TRuc.-no~ !Iott: If systa fs ,uaettred, esttllltt pu11p191 SWCB No. uwner o. Sl"Tc tn boats 111 lowr rt1111t*llalld coner.
Date Heter Reading* Gallons Date Meter Reading* Gallons W. ur Leve 1** ...
Used Used suuc- "-it1111***
Cnd of 16 ult flantll 27 i"('f;; Z.c:;O 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 :?5 10 26 11 27 12 28 13 29 14 r 30 15 31 Z78b$qoc ,p70 ]oe>
Toti I C.llon, Toul GallOfts
- lead aeur saae tfae HCII day (preftrably 111d of day) 67e>
f tO.ffl, rHd .i tnd of IIOft*,...,1119 period Dur! 119 llolltll ~70 700 Dl,rf119 Quarter 700
.f Ula11, rHd It tnd of llt1wy-,...,1119 Pfr'iod Tou I ()per, t1119 roul Operattnt If Ula11 In one wll In I field, spec1f7 llflfclt i,ell. - - - - 0.ys tJI 1s llon tll - 3'/ O.,s tllf s Outrtar 31
" All prtwaitlJ or put,lle1lly-owned public w1ttr supply sys~
wt UI Hu I tll Oepar1Jlent perwt ts. 0.1 17 Awtrl91 . .11117 lwtrl91 Our 1119 llontll Z/~3r- During Ou*rttr 2/ ~ 3 S-
GROUND WATER PUMPAGE ANO use REPORT
.S1a1e [Hpanment or Health and Sutt W11er Control loar_.
-~X.,.__ Well(,) Public. ~lld copy of "11Qrt to leg10NI SUtt V1ttr Contr"Ol lou'f Offlct llld Rt910ftl1 SUt.t HHIUI 0.p,rtN!lt Offlct -
_ _ _ Spr1119(1J
- llldustr11I. Sefld copy of rtPOrt to le9lon.l Sutt Wlttr Control lolrd Off1ct Other. Stnd cooy of r~rt to Rt91orwl Sutt V.ttr Control lo.lrf Offlct
_ _ _ V.ll(s) Ind Sprl119(1) me of Waterwo,.ks Name of Ooerltor N/A
- Va. Electric & Paver Co. - Surry ewl4r Va. Electric arrl PONer Co.
Posi tfon/Title-==~N~/~A~============:N:,:
Sfqnature N/A
..A:==========
O.te - - - - - - - -
Address P 0. Box 315 Population Served (Publfc'----1.Nuls:.A1.-_ _ _ _ _ _ __
Sµrry, Va. , 23883 Phone (804) 357-3184 No. of Connection" CPublfc) _ _N......,/A......__ _ _ _ _ _ __
t Uper1tion Pe1'11it Nullber (Publtc) ..N"'/.::.A=----------
Type of U(.e: P11hlic_ lndustri1l_x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If measurements are for* sfngle-lW!ter ffeld reading, list wells included fn field SWCB No. Owner No, _ _ _ _ _ __
SWCB No, - - - - - - Owner lo. - - - - - - -
SWCB No. - - - - - - - Owner No. - - - - - - - SWCB No. Owner llo. - - - - - - -
SWCB No. Owner No. - - - - - - - SWCB llo. Uimer No.-------
Heter re1dings 1re fn _ __;g~a1a.l.i..la!ollJns!.s.-------------- (gallons, lOOO's of gallOM, cubic feet, etc.)
Nott: If 1y1ta fs u,-ettrtd, tst1Ntt Pl'IPl91 o~Owner No. 1n boaes 111 lowr rl911t-llalld corner.
Heter Reading* Date Meter Reading* &lllons Water Level**-
Used St.Ute- l"-1110* ..
Clld of Lu t flon UI 997~/oo 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 /e> 03', 7oeJ ~z/ 1;,:,00
/
14 r 30 15 31 Tot.I I C.110llf Tot.II G,llOIII d *tcr u* tlae Hell d1y (prtftr1bl1 tncl of d11) tlktt1. rNd It tncl of non-~1119 period Our1 119 llonUI d,z/6.c>O Our1119 ~1rur z.49, 700 Ul111. rt1d It encl of IIHV)'*pu,llp111g period Toti I ()perat I119 Totll ()perattnt f taken 1n one 11111 1n
- f1t1d, spectf1 wfllclt wit - - - - D1y1 UIII Nontll zi DI.rs t1111 0ulr'ter t00
- All prh1ul1 or put,11c,lly-owned public wit.tr 1uppl1 17st.ea1 D,t 11 Avtr191 * ..11117 l,tr19t w1 UI He, 1UI Dep1rtl)fnt pen1t U.
Our Ing Montll z J S-<t Ourillg Ou*rttr 7'/ ~ Z-
GROUND WATER PUMPAGE AND USE REPORT t4onUI F433&u4~
S1ac~ IHpanm~nt o( Hcallh and Staec W11~r Con1rol loarfl . Quarterq{ Z l 4 ~
-~)C...._~ll(sl P11bllc. ~nc, copy tf rec,or-t to ~10flll Stitt W1ttr Control lot"' Office llld Cfrc:le One) llt9fon,I Stitt !w1IU1 ~rtaellt Office - County/Cfty Surry
- - - ~1119(1)
_ _ _ ~ll(s) 1nd Sprf119(s) lnd11str11l.
Ot11tr.
Sfftd copy of rtp0rt to ~IOflll St.It, Wlttr Co11tn1l lot1'11 Office Stnd co01 of l'fPOl't to llt9fONl St.Ile W.ttr Control lo&NI Offfct ----=-------
lfuie of Wa teNOrks Huie of Ooerltor ---;Z.:;"1/;;A.---------------
va. Electric & Power Co. - Surry Posftfon/Title _ _.:N~/r..A:---------------
- O..-M!r Va. Electric an:l Pc,,.,er Co. S1Qn1ture _ _ _ _N_'/;.,..A _ _ _ _ O.te _N_/A _ _ _ _ __
Address P O. Box 315 PQ9Ulltion Served (Publ1c'--.....4l!N1L./A14-_ _ _ _ _ _ __
- ....,,c_..;::2=3=88=3---- Phone
---=SUr=:..:rv:..L-1.<<-V..=-a=.;;.... (804) 357-3184 No. of Connection~ CPub11c) _ _N-1A..._________
t Uperetfon Penaft Jlulmer (Publtc) ... N..._/'""'A'---------
Type of U'-t: P11hlfc _ lndustri1l--X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 11e1surenents ire for I sfn9le-11eter field reading, list wells included fn ffeld SWC8 No. Oi.mer No.------- SWC8 No. - - - - - - Owner llo. - - - - - - -
SWCB N o . - - - - - - - Oi,mer No. - - - - - - - SWC8 llo. Owner llo. - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB No. lAifner IIO. - - - - - - -
Meter re1dings ue fn _ __,!g~a.a.1.i..l~o>llnsU!i!.--------------<v*llons, lOOO's of ga110M, cubfc feet. etc.)
Note: If systa fs u..-tered, est1Mte p.apa91
- SWCB No.3o-/ CJ- 51 ~ Owner No. B 1n boxn 111 lowr rt911t-llllld CCM"Mf'.
Date Heter Reading* O.te Meter Reading* &illons W.ter Level**-
Used suuc- i"-fflOH*
[lld of ust flollUI 'f S-t"8_ 7oD 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 17 ?ooooc. , ? Z3J 3.()0 14 ( 30 15 31 Toti I Ce 11Clflf Total G.ll lOIII
- leed _tc,. Slat tfae Hell day (Pf'1ftr1bly end of d*1 I Our tng """tit fz3/ 3oo Dl,rt119 Qu1rter /S-582./0D tllffl. rHd 1t tnd of IIOll*l)ulllClfng perfOd tel111. rt1d 1t tnd of MIWJ-P\IIIIP1ng per,ocr Toti I Optr1t1119 Total Os>,r1t1111 f t1l111 tn on, -ell 111 1 field, spectfy llfllcll ~11 ~~
- All ,,.1,1taly or i,vbltcellJ-owntd publtc w1ter supply systttia DlyI Ul 1s llonUI 29 0.11 Ults Ou1rttr wftll kulUI De~1rt11e11t perwfU. Dl1 ly Awtrl9t * .M i1 J Awtr191 1119 llolltll 27383~ Ovri"9 Ou1rt1r 259, 70 2-
°"'" /
WHtr So..ro:
GROUND WATER PUMPAGE ANO S1a1e ~partmenl or Huhh ind Stale W11er Control loar4 use REPORT 14onu. #:~~:
Qyuter Ii) 2 l 4
_....Jw}(.__Well(1) P11bllc. ~nc, copy 1f ,-.port to a.ttOIIII Stitt Water Control loird Office alld Tctrcle Ont)
Re9t0111l St.alt KtalUI Dtf)lrtM!lt Offtc1 - County/Cfty
- - - Spr1ft9(1) lnd11str111. Stftd coo, of report to ~tonal Stitt W.ttr Cont.1'111 loi'11 Offtct . Surry Other. Send co01 or rtt,0rt to 1~10flll St.alt W.ttr Contl'Ol loi'11 Office
- - - lltll(I) *nd Spr1119(s)
- me of Waterworks Name of Ooeritor -,t-:,-J/7iAr-------------
Va, Electric & Pc:Mer Co. - Surry Posftton/Tftle _ _"'i:N,1/r;.A_ _ _ _ _ _ _ _ _ _ _ __
o.M!r Va. Electric arrl Pa.ver Co. SfQniture _ _ _ _N_'/_A _ _ _ _ O.te _N_/A _ _ _ _ __
Address P O. Box 315 Population Served (Publtc' _ _--4lNu.l.1,;.AL-_ _ _ _ _ _ __
_ _.:Sur=::.::rv::..t..1<<<-.:V-=a:.:...-L.'....;:2::..:3:;..;;8;,,;:8:..::3'-- Phone (804) 357-3184 No. of Connection!; (Publfc) _ _N.......,/A _ _ _ _ _ _ _ __
Uperlt1on Penaft ~ r (Publtc) .. N.._/..,.A__________
Type of u~e: Puhltc + __ lndustr11l__.X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf 11e1sureaients ire for I sfngle-11eter field reading, 11st wells included tn field SWCB No. Owner No. _ _ _ _ _ __
SWCB No. - - - - - - Owner llo. - - - - - - -
SWCB No. Owner N o . - - - - - - - SWCB No. Owner llo. - - - - - - -
SWCB No. Owner No. - - - - - - - SWCB llo. Oitntr IIO. - - - - - - -
Heter readings ire in ___g~a!d.1..11-.o~ns~-------------- (gallons, lOOO's of gallons, cubfc feet, etc.)
Note: If 11st. fs unaeterld, estillltt pul!C)lge fn bo-a 111 1owr rtgllt-llalld COMlff.
0.te Meter Reading* Clllons WI ter Leve 1**-
Used St.ltfc- "-h..:1*** i Clld of u st ltontll 3.Z. ,::do ~ 00 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 3/ I 7 8 Joo /~S:-/300 14 r 30 15 31 Toti 1 S.llont Toul C..llOIII ad aeur sue ttae eacll day (preferably tnd of d11)
Durt 119 flon tll /%/.Boo Durt119 C),1rter /5"°~7 7o=
f Ukffl. rHd It end of IIOft-~1119 period If Ultll, rtld It tnd of IIHWJ*Pllaillf"9 period Tou 1 (lper1tt119
- *If *Ulen tn ont 11111 tn I fte1f, specify wlltcll well - - - - o.,, UI ts Non t11 z.9 foul Oper1t1111 0.11 Ulls Ou*rter ~C)
+ All prh1t1l1 or Mlfctlly-owlltd p~ltc water supply sysU.
wttll Hultll Depert.ent perwtts. 0.1 ly Awtrl9f .11111 lwtr1~
!Nr 1119 Nontll 5"'o~S- !Nri~ 0.,1rur z!,.._/2-8'
~di F.::iaku;¥-
~ter Sovn:.1: S1ace ~panm~nl of Hulch and St.aee Wacer Concrol loar4 Quarter/ii) 2 l 4
_ __..,}{.__ ~ll(s) P11bltc. ~lld copy of ~ r t to llegfon,I Stu, llattr Control ao....-i Offfct ,_. "tffrcle One)
Rt91onal Sutt HffllJI ~rUottlt Offfct - County/Cfty
- - - Spr1119(s) lnd11str111. Sl'lld coc,y of rtport to le91DM1 Sutt Water Control to....-i Office . Suny Other. Stnd co01 of rtl)Ort to 119101111 Sutt Water Control to....-i Off1ct
_ _ _ ~ll(s) incl Spr1119(s) lf*me of Wa ter-.orts Name of Ooera tor N/A ric & Pc:Mer Co. - Surcy Posftfon/Title -,N:;-/"A.-------------'--
Va. Electric arrl Pa,,,,er Co. Siqn.ture N/A O.te _N_fA _ _ _ _ __
Address P 0. Box 315 Population Served (Publfc' _ __...,N.,_/...,A.___ _ _ _ _ _ __
_ ___,Sur==ry~,_V.-=-a___* _,,"'"---'2___3_8___
83_____ Phone (804) 357-3184 No. of Connection~ (Public) _ ___.N~/.,.A..,.___ _ _ _ _ _ __
Uper1tfon Penrit NuiiC>er (Pw11c) ..a;N:Ll.uA.__ _ _ _ _ __
Type of ~e: Puhl ic + __ lndustrfl 1_x_ Other ( s p e c i f y - - - - - - - - - - - - - - - - - - - - - - -
1f 11111surenents are for I single~ter ffeld reading, 11st wells fncluded in ffeld SWC8 No. Owner No. _ _ _ _ _ __
SWC8 No, - - - - - - °""9r llo. - - - - - - -
SWCB No. Owner N o . - - - - - - - SWC8 No. Owner llo. - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB llo. - - - - - - Uifner NO.-------
Heter re1dings are fn _ __:;ig5,!a.... l,.lo~ns--------------- (g11lons, lOOO's of 911lons, cubic feet, etc.)
llote: If sysua ts u1111etered. tst1Mte pu111pt91 SWCB No. Owner No. 1n bous 111 lowr rl9llt*tlllld corntr, Date Meter Reading* Date Heter Reading* Glllons VI ter Leve 1**-
Used St1t1c- "-111a***
[lld of ust l'OnUI Zlf8S-o 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24
- 9. 25 10 26 11 27 12 28 13 29 2300900 /02. ~o 14 r 30 15 31 "
Toti 1 C. llcw Toul C:.llCNII
- -,NI attar Slat t1at Hell day (pr1f1r1bl1 tnd of d1y) f tlklfl. rNd ll tncl of 11011*pu111pf119 period Dur 1119 lbltlt /oz. c/-oo Durl119 (ll,1rtar /fd, ?'60 t1l1n. rt1d 1l end of lle1vy-pu111pf119 period Toti 1 0perlt111f roul Operatlllf f t1le11 111 one iotll 1n I fltld, SPK1fy ~lcll wll - - - -
l11 prh1Uly or putl11c,11y-o,,ned puoltc w1ter supply sysU.
111,, UI 1s Non t11 7-1' 111,s Ulls Ov1rttr d:,o wl UI HH 1 UI ~ r - n t peni1 ts. 1111 17 Aver191 . .11 I 1y btr19t Dur 1119 l'otltll 3:S-3 J Dur i 119 Qv,rttr 3 z_J-"Cl
- - - - - - - - - - - ~ ~ uHuUNO WA l EH PUMPAGE AND USE REPORT ~Ui W.t*r So..ru: S1a1e ~partm~nt or Health and St&&e W11~r Con&rvt loartl . Qu1rtercJt 2 l 4
_ _.X_ ~11(1) Pwbllc. ~M copy 1f rtflOrt to a.gfo,wl Sutt 1111.tr Co11trol loarcr Offlct 1"' f~le One)
Rt9lo,w I Sut, 11H IUI Dlp,rtN!lt Offfct - County/Ct ty Surry
- - - ~1119(1)
- - - lltll(IJ Ind Sprf119(1) llldustr111. Stnd coc,y of rtPOrt to Re9foiwl Suu W.ttr Co11trol 1o,a,.. Offfct Ottier. S1nd CDOy of rtPOrt to R,9101111 Sutt W.ttr Control 1o,a,.. Off1c 1 ----=-------
N1me of Wlter-worlcs Name of Ooerltor -.~~J/,;A;.--------------
Va. Electric & ~ Co. - Surry Posftfon/Tftle _ _ _N:f/r.Ar--------.'"'1------
o.,'14r Va. Electric aro Pc:,..,,er Co. Sfqn1tur, _ _ _ _N_,_/A _ _ _ _ O.te __ N_f_A_ _ _ __
Addr,ss P O. Box 315 Popul1tfon Served (Publfc'--~HLL/1,,A~--------
_ __,SUr==-=ry~,c-..:.V.=ac.;;..-4f. . . ;2=3:;..;8;..;8'""3____ Phone {804)357-3184 No. of Connection~ CPublfd _ _..,N...,./A....__ _ _ _ _ _ __
Uperltfon Perwft Nuaber (Public) .a;N,.._/.:.1A,___ _ _ _ _ _ __
Type of U(.e: Public!___ Jncsus trf* 1__x_ Other ( s p e c i f y - - - - - - - - - - - - - - - - - - - - - - -
1f irie1surements ire for* sfngle-11eter fteld re1dfng, lfst wells included fn field SWC8 No. Owner No. _ _ _ _ _ __
SWCI No. - - - - - - - Owner llo. - - - - - - -
SIICB No. Owner N o . - - - - - - - SWCB llo. Owner llo. - - - - - - -
SWC8 N o . - - - - - - - Owner No. - - - - - - - SWCB No. O.ner NO.--------
Meter re1dings ue fn _ _-..!J.gag.1r.l.1r.lo!.!ns!.!iil--------------- (gallons, lOOO's of gallons, cubfc feet, etc.)
Nott: If systaa ts u,..ttrtd, est1111tt !MIPIII p Owner No. G"' fn boau 111 IC*tr rf111t-h111d corner.
Dlte Gallons Date Meter Reading* &lllons WI ter Leve 1**-
Used Used Static" ~fft<>***
[nd of Lut l'onUI 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 g :?5 10 26 11 27 12 28 13 29 <Yo l'fj S-oc -Z lo 75"o~
14 ( 30 15 31 Tot.I 1 C. IIOllf Toul C..1111111
- Reed 11tUr HIit tfae Hell day (pr1f1r1bly tnd of dey)
Ullft, rHd It tnd of IIOll*Pl.-ofllCJ period Dur1 "' Nofttll z/c:,75bo Durtag ~lrtM 78'~f 7 0 0 f t1l1n, r11d 1t tnd of lltlYy-~fnt period Toll 1 Opernt111 roul Oper1t1111 If tlllfl fn one "'" fn I f1tld, SPKffJ llfllctl wll - - - -
11 prh1Ul7 or Ml fetlly-owned plA,lfc we tar supply sys teal 0.71 UI I s Noll U1 2--9 0.71 tll1s Ovarter 60 w1UI HellUI Depari.t11t perwfU. Dal ly Anr*te .... 11, ** ,,.~
- Our 111CJ Nofttll 72 ~72 Ovri,ig Ou*rttr /30911-
GROUND WATER PUMPAGE AND USE REPORT S1a1~ ~panmenl of H cahh and Sute Wa1~r Con1rul Boar_.
_ __._x.__ ~ 11 (, 1 P11bllc. ~IICI copy 1f ~r-t to t.gfo,wl St.ata llatar Control lotrf Offtu 111111 R191o,wl St.ate IIHIUI ~~rtaeftt Off1c1 -
- - - Sprf119(1) llld11str11I. Sfftd copy of rtPOrt to ~tonal St.at.I W.tar Control lotrf Off1ct Other. Stnd coo, of report to *191on,I St.ata W.tar Control lotrf Off1ct
_ _ _ lltll(s) and Spr1119(1)
- me of Witen,orlts Name of Ooera tor -,?-.,T/7 A;;---------------
Va. Electric & Pa,ver Co. - Surry Posftfon/Title __--;;N:f/r.A.--------------
N/A Nt'A Owlir Va. Electric arrl Pa,,,,er Co. SfQnatur*---------0.te - - - - - - - -
Address P,O. Box 315 Populatfon Served (Publfc' _ _-,1,,lNIL/&iA...._________
_ ___,Sur==-=ry:...-&,-.:.V"""a__.__._,-'2=3'-'8'-8~3---- Phone (804) 357-3184 No. of Connection~ (Publ 1c) --H~(A.i,,._________
Uper1t1on Perw1t Nuat>er (Publtc) ..,N::.tL..:.A=----------
Type of U(.e: Puhlfc + __ Jndustr1a1_.X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 11easurements are for* single~ter ffeld re1dfng, lfst wells included 1n ffeld swca No. Owner No. SWCB N o . - - - - - - Owner lo.-------
Si<<:B No. Owner No. SWCB No. ~ r llo. - - - - - - -
SWCB N o . - - - - - - - Owner No.------- SWCB llo. - - - - - - Oifner IIIO. - - - - - - - -
Heter readings are f n _ __:g:.i!a1a.l...l,..o~ns!.!liL-------------- (9111 ons, lOOO's of 9111ons. cubf c feet, etc. )
!Iota: If system fs uraettrtd, est11111tl pu!IIC)l91 SWCB No. Owner No. 1n boau 111 lowr rfgllt*llllld corner.
Date Heter Reading* Date Meter Reading* &anons WI ter Leve 1.. _
Used suuc- "-'Ina***
Clld of ust l'lonUI 370 1'8'°0 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 3703~ /,/o 14 r 30 15 31 Toti I ;. non, Total Gtl11111s
- le1d aeter Slat tfae HCl'I day (pr1ftr1bl1 tlld of day)
Ulfll, rHd It tncl of non-~1111J period Dwrf IIIJ llofttll /~o DwrllNJ C),1rter / 3<:b ~
t1l111. rt1d It tnd of IIHYJ*pullll)1 IIIJ period Tou I Oper, ti 119 rot.al Oper1t111t If Ultn 1n one well fn I ff11d, specff1 ..tilcll wll - - - - o.,s tll II Non tll
~ Dl,s t11f1 Quarter c{;,C>
Alt prfw1t1l1 ,, ~llcall1-owned p"'11c w1tar suppl1 systelll wftll Hultll Dep1rt.ent Pt"1ts. D,I 1, btrlCJI
- JI i 17 lwtrl~
Dur 111CJ Monti! s-- Dur i "9 Ou1rt1r 2--:z_
GROUND WATER PUMPAGE AND USE REPORT IU ltr So..n:t: Sui*~ !Hpanmml or Hullh end State W11~r Con1rol loar4 . Quarter~ 2 l 4 /
_ __..X,__ Wt 11 (,) P11bllc. Stnd copy of ~ r t to la,glon,I St,te 11,ttr Contr,il ao.,-, OHlct 1111111 frcle One)
- 19I0111l St,tt llff I UI Dt~rtaeftt Office - Cwnty/Cf ty
_ _ _ Spr1119(s) lnd11str111. SMCI copy of rtPOrt to le9ton,l St,te W.ter Contr11l to.1"111 Off1ct
- Surry
- - - Vtllh) *nd Spr1119(s)
Other. Stnd cooy of ~rt to R191orw1 St,tt W.ttr Contl"Ol lo.ar11 Off1ct ----=-------
- me of Waterworts Huie of Ooerator --;~~T/;;A.--------------
Va. Electric & Pc::Mer Co. - Surry Posftion/Title __~Ni"l/,;.A_ _ _ _ _ _ _ _ _ _ _ __
Owlt'er
~
Va. Electric arrl PONer Co.
N/A SiQnature _ _ _ _....;.._ _ _ _ O.te - - - - - - - -
Nt~
Address P 0. Box 315 Population Served (Publ1c 1 _ _--t.lNu.f.&.Aa...._ _ _ _ _ _ __
_ __.S=ur=ry'-'--'-'-V.-=-a=-'"-._.,~2--'-3_8__
83____ Phone {804) 357-3184 No. of Connect1on!I CPublic) _ _NU,,L,1/A~--------
t Uper1tfon Pen1ft flult>er (Publfc) ..LNu.l.:.iA1.-_ _ _ _ _ __
Type of Uc:.e: Puhlfc _ _ lndustrfa 1__x_ Other (specf fy - - - - - - - - - - - - - - - - - - - - - - -
Jf 111easurenents ire for* single-aeter ffeld reading, list wells included 1n ffeld SWC8 No. Owner No. SWCB N o . - - - - - - Owner lo.-------
S.CB No. Owner No. SWCB llo. Owner llo. - - - - - - -
SWCB N o . - - - - - - - Owner N o . - - - - - - - SWCB No. - - - - - - Qi,ner IIO. - - - - - - - -
Heter rt1dings Ire fn _ _ _;g~a>d...._1.lo~ns~-------------- (911lons. lOOO's of gallons. cubfc feet. etc.)
Nott: If system ts ur.etertd, estlNlt ~91 SWCB No. Owner No. 6 111 bons 111 ICMr rtgllt-llllld conwr.
Date Heter Reading* Dlte Meter Reading* &illons WI ter Leve 1**-
Used St.etic- Pua,f11<1***
Clld of Lut l'onUI 7 5' S-oo 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 7 8' 8'a,:::;, 3CJ<r:::>
14 r 30 15 31 Toti 1 &I 110ftf Toti 1 GI IIOIII
- lead *etar u
- t1ae ucll day (pr1ftr*bl1 lftCI of d*yl Dur t ng ll!Mltll .Bo<::::> DurfllCJ ~1rtar ~oO Ultt1, rNd n end of IIOll-p.-c,1119 period tel111, read at tlld of lle1vy-pulll)f"9 period Tota 1 Oper1tt119 Tot,I Clpfratt"I f ul.111 tn one -ell 111 a f1tld, specify wtitcll w11 - - - - o.,s tll f I Non UI ~ D171 tllfs Qulrttr 60 11 pr1w1ttl1 or put,lfcally-owned public w1ttr supply syslelll w1UI HHIUI Dep,rt.ent pera1ts. O.t ly Awtn91 * .it I IJ btr1,,e Our 1119 l'lolltll /CJ Ouri,ig Q,,1rt1r /c:>
GROUND WATER PUMPAGE ANO USE REPORT S111e Exputmcnl or Huhh and Sutt W11u Con1rof loar4
,v,llc, Stlld cop, tf r~r\ to ~ l ~ I Sutt V*Ur Co11trol to.r11 Offlet ,..,,
11910/\II Sutt HulU1 ~p,rtNftt Office -
l..Suitri;I, S~ <Oll1 of rtpOrt lo ~10,...1 Sult 11,u, Co11trol lo.** Off1<t O*.iwr. St...:! cco, of rtp0rt to 1t910,...1 Suu v.u, C011trol to.,. Offlct
- - - lltll(IJ *lld Wf"9(I)
"*lllfVa.of Electric W.tel"tl()rts
& Po,,,er Co. - Surry Ila~ of Ooerltcr 't-1/A Postt1on/Titlt -.:N;-;/;;.A-------------
Owlir Va. Electric arrl Pow'er Co. SfqnHur, N/A O.te __ N_/A Address P 0. Box 315 PopulHfon Served (Publfc' _ __.Nwlu;A;t.__ _ _ _ _ _ __
_ ___,S"'"'ur=ry...._,_V"""a~*~*--ac..23"-8___8__3.__ Phone ( 804) 35 7- 3184 No. of ConMc t f OM (Pub I tel _ __.N..._/uA:ai.__ _ _ _ _ __
"Ptrltfon Per11ft lluc>er (Publfc) ... .N:.1.l.::.:A,__ _ _ _ _ __
Type of u~e: Puhlfc*_ _ lndustr11l---X- Othtr (s~ffy _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 111e1surements art for I sfngle~ter fftld re,dfng, 11st wells fncluded 111 fftld SWCI llo. o-mtr No.------- SWCI No. - - - - - - !htner N o , - - - - - - -
SWCI No. - - - - - - - Owner No. - - - - - - - SWCB llo, o-mtr llo. - - - - - - -
SWCI lo, Owner N o . - - - - - - - SWCI llo. - - - - - - Owner IIO. - - - - - - -
Meter readings are f11 _ _~ga~l1...,l~onsai,;;z.._______________ (911lons, lOOO's of gallons. cubfc feet, etc. l loi.: If systa ts UMll!UrM, tst1MU ~!II SW\:8 No. (Nner NO, 1-1 I
111 llolff 111 to,.er r19ht-hlnd CONltf',
Dau Meter Rt1d1ng* 1>, lions w,ur Level ..... O.te Meter Rudtng* S.llons Va~r Level .. "
Sutl, 00 P'\IIIP111G- Used
[Rd of Lut lblUI 7- 7 f ;v::, o ~~
=,,*.
I 16 Sutic" l"-fr,aUe 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 g 25 10 26 11 27 12 28 13 29 z7r~.::, /~c::;,
14 30 15 31 Toti I C.ltOllf Tou I C. I IOftl
- lluf acter *
- t1at ttca ,., (prtftf'1bt1 tnd of dl1)
- If Ult11, rtt.i It tnd of -*PIIIIP1rig pcrlOf
~rl 119 "°"~ / 2--&J I!:;> D\ir I 119 ~ar ter z. 3 = c:::::>
- If Ult11, rtt4 It tnd of llt1v7-P1,-pf119 period Toi. 1 Opt rat f"t foul Op,frat1"t
.... ,, t1l111 1* one wll 111
- fltlf, s~lf1 wfllcll wn _____ o.,s CIiis NonUI 2!-7' DI.rs Ulfs Ov1rttr 4::> C>
t All ,rh1ttt1 or Ml1a117-owlltd pieltc w1ur 111P9ty s11t,-
wf U1 Nultll-Ot~rtllltnt Ptr.lU, 0.1 11 Artrl9f ..,. i 11 l,trtqt
°"' 1"9 llo,,tll
--=// Owrt"9 OsHttf 33'
GROUND WATER PUMPAGE ANO USE REPORT !bl di l="ca~u4o/--
Scace ~partm~nl of Hcalch and State Wacer Concrvl Boartl Qu1rttr tv 2 3 4
_ _.,,,.}{.__Well(s) P11bltc. ~nc, copy of ~r-t to R.gtONI Sutt W1ttr Contf'111 loa~ Offlct llld Tctrcle One)
Rt9I0111l Stitt Kt1IUI ~pu*tMtit Office - County/Cfty
_ _ _ Spr1119(s) lnd11strl1l. Send coc,7 of rtPOrl to R.g10ftl1 Stitt W.ttr Control loa~ Offlct Other. Stnd cco, of rtpOrt to Rt91orw1 Stitt W.ttr Cont1'111 loa~ Offlct
' Surry
- - - ~ll(s) Ind Spr1"9(S)
- me of Waterworks Huie of Ooer1tor N/A Va, Electric & Pc,.,ler Co. - Surry Pos ft fon/Tit h--=--=-~N~/:A-=--=--=--=--=--=--=--=--=--=--=--=--=-:N:,-.....A-=--=--=--=--=--=--=--=--=--=
e>w1-r Va. Electric arrl PCMer Co. Sfqnlturf N/A 0.te - - - - - - - -
Address P O. Box 315 Populltfon Served {Publfc' ____...N..,I...A._________
Surry, Va. , 23883 Phone (804) 357-3184 No. of Connection~ (Public) _ __,N>&.1/....,A_ _ _ _ _ _ __
Uper1tfon Penait Muaber (Publtc) N/A Type of U'-e: Puhlic +
__ 1n<1ustrf1L......X_ Other (specify ....,.-=-=----------
Jf 111e1surenents ire for I sfngle-aeter field re1dtng, list wells included tn field SWCB No. Owner No. SWCB No. - - - - - - Chffler llo. - - - - - - -
SWCB No. Owner No. SWCB llo. Oimer No.--------
SWCB No. - - - - - - - Owner N o . - - - - - - - SWCB llo. - - - - - - - D.fner NO.--------
Heter readings Ire in ___g::;i,a 11.:o~ns~-------------- (gallons,
...... lOOO's of ga11ons, cubic feet, etc.)
Note: If systaa ts urwettrtd, estfalltt puapa91 SWCB No. 1n bons 111 lowr rlgllt*Mlld COMlff, Date Heter Reading* 0.te Meter Reading* Gallons Ill ter leve 1**-
Used Sutt,- llluaifftll ...
Cnd of 16 LU t l1on tJI 27 8'C.5qc.,o 1 17.
2 18 3 19 4 20 s 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 Z'g4fo7 '=,oo ?,e;I 7c:,o 14 ( 30 15 31 Toll 1 C.110M Tott 1 Cit 11 OIII
- Read aet.r ,.., t1ae 11c11 day (pr1f1r1bly tnd of day) tlkP, rHd at tnd of IIOll*l)l-c,1ng period Dur f 119 lbltlt (pO/ 7o~ Durl119 l),arur 1z.7z ~o f tal1n, read 1t tnd of llt1vy-~fng period To~ 1 C)peratf119 roul C)perttfnt
- If tlltn In one "'11 fn
- f1t1d, specify wlllcll w11 - - - - -
t All prhately _or Plltllfc.lly-owned public water supply sys~
Dlys tlli I !loft tJI Z-7 D111 tll11 Outrttr ~c, w1UI HultJI Depart.ent peni1ts. Ott 17 Avert91 Dur 1119 Nofttll
- z. 0 7""' a"' _,. i 1, A,era91 Duri119 O.,uttr 2 I ZLJ7
., ..... ' , , , - -
- lJ*l,;;J
- .... '"""'~ '"'-..&....,~-==--,.--~
GROUND WATER PUMPAGE ANO USE REPORT JbntJI """"-':!!,:-'--,~..!.----
11* ttr Sovrtt: S1a1e lkputmue o( Huhh and St.ta Wa1u Con1ro, loar4 Qvarttr Z-~ J 4
_....Ax..__ '"" ts, ,~ollc. Stlll cop7 er rtport to a.t*-1 Suu Vtt.er Co11tt"11l loil"f Otftc, ,..,
lt91o,,.I Sl.lU llulUI L\tp.,rtN,o,t Off1ct -
"~ 1 ,'*,an.,
Covnty/CH;
-~~ ~0,1119(11 lftd!lttr!!I. !t<ld ccp7 cf roort lii lrjlo,,.i Sutt w.u, Co11tr,il lot** Office . Surry O*.iwr. Strwl c~, of rtport to ltgloiwl St,t, lut.er CCfttrol lo.ll"f Off1c1
- - - Vell(1) .,.., S,,1"9(1)
"*me of Witel"'IIOrts Na~ of Ooeruor _ 1t - ~ l / 7 i A , - - - - - - - - - - - - -
Va. Electric ' Po,,Jer Co. - Surry Posftfon/Titlt _ _""'i:N~/r.A:---------.-----
e>clir Va. Electric arrl Po,.ier Co. SfQnHurt _ _ _ _N_ 1
/_A____ O.te _N_JA_ _ _ _ __
Address P,O. Box 315 Populuton Served (Publtc' ___Nu.u/A~--------
_ _..S""'ur=-=ry-,_V. ___a___.___.,___2=38_8~3- Phone (804) 357-3184 No. of Connection~ (Public) _ ___.N.,.../'"'"'A.__ _ _ _ _ __
t Uptrlt1on Penaft llullber (Put>ltc) ...N"'"/...,A,_________
Type of U(e: Publ tc _ _ lndustr11l__x_ Other (SPK1fy _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 11e1surements art for I s1ngle-eeter field reading, 11st wells tnc1uded 111 fitld SWCI No. Owner No.------ SWCI No. - - - - - - o-.ner No.-------
SWCB N o . - - - - - - - Owner N o . - - - - - - - SWCI llo. Owner llo. - - - - - - -
SWCS No. Owner No. - - - - - - - SVCI llo. Oitner IIO. - - - - - - -
Meter rudings are 11 ---.!<J<i:;jS!.la..11.!.ons4.!iiL---------------C9*11ons, lOOO's of gallons, cubfc feet, etc.)
Iott: If 1ysta h 11,_ti,.M, ttt1Mti pui,ipa91 SWCB No. Z6/-l'/o-5"'o ~ C>cnir No.
4 hi bollft t11 lo,,er rf gllt*htlld CDf'Mf',
l)a~ Meter Re1dtng* &.11ons Water level .... O.te Met.er Rudt n,g* &. 11ons Vlter Leve, .....
'""'"i Sutt,** Used St.elf, ..
~
[1'd of I.Ht llofttll /0 ~3C:, 700 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 /o I 30 -f{:>0 'f3 / 700 yo=
Tot, I C.IIOIII fou I C:. llon1
- lo4 attar llal Cfaf NCI ft7 (1"tftt'llll7 tftd of d17J Dllrl Ill lbl&ll t!/3,70-= 1111,199 0,trt.er 3~5 ulf Uht1, rtd It tl'ld tf --"'°"1119 pcr1N
- ,, tilP. ru4 U tlld of IIHYJ*~'"' pcriO,
" .. If Ultfl 111 Ofte *II 111 I fltlf, ,pe<tf7 llfllcll 111el1 - - - - o.,,
Tote I Operetl11t UI Is "en UI 3/
rot.I c,p.,u1111 Dlt1 UIII Ovlrttr '1 I t All ,r1nul7.,. ,...llall7-owned ~lfc w,,i., suppl7 IJl&Na wiUI HHIUI Dt~r\Jlent perslts. 0.1 17 Anr19t
.3 C, z. .3
.HI ilJ t,,,,,.
Dur 1119 MonU1 0..11119 Ov1rttr 3 71~ -
.,.\,. I,,.,. ....
11,1,, S.O..rc:t:
tJ*~I GAOUNO WATER PUMPAGE AND USE REPORT t I t I " " I * * * ,....,
S1elt ixpartmtnl of Hul1h ind Sui. W11tr Co111ro, lou4
_ _....X.___ lit II (I J '**lie, Sf1" COPI 1f rt90rl to t.,t~I SUt, V11.4, C.11tl"OI lo,r,1 Offlc, ~
lt9IOMI St,t, Null.A Otp,rtac,,I Offtct lftd111tr11I, St<'ld co,7 1f rtPOrt 10 ktlol'ltl SUtt V.t,r C411tr,il lo.** Off1u
- - - ~l"f(II
_ _ _ 11tll(1J lrcl S,rl"f(II 0~11tr. Stlld c~, ,, report to lt9fol\ll SUl.f V.t,r Co,,trol to.,.. Offlct lf*mt of WHer.orts H,~ of Ooe r1tor _ ?-:;-l/iiA _ _ _ _ _ _ _ _ _ _ _ __
Va. Electric & PcJ,yer Co. - Surry Pos It 1on/T it I *--~N,i/r;.A 1 1_ _ _ _ _ _ _ _ _ _ _ __
-- --~ Co N/A N1'~
Ow14r Va. Electric arrl Power
- S1<1nHur*--------- O.t. - - - - - - - -
1.ddrtss P,O. Box 315 P~IHfon Served {Public'--~Nuls:.A.___ _ _ _ _ _ __
_ ---1S~ur~ry~,_V..:..:a=.c*:_.a*......:.2.::..38:c8,.,,3~ PhoM ( 804) 35 7- 3184 No. of ConMc t f on~ (Pub I tel _ __.Ni.J.luAaL-_ _ _ _ _ __
Up era t ton PtMlf t lt.c>e r (Put> 11 c) ..a,;N:.,,/...,A,.__ _ _ _ _ __
Ty~ of U~t: Puhlfc +__ l ndus tr11 I __x_ Ot.Nr ( Sl>e< 1fy - - - - - - - - - - - - - - - - - - - - - - -
1f aie*suresients .,.. for I sf119lt-11tttr fftld rtad1119, 11st _,lls fnc:luded hi fftld S\ICI llo. ~r No.------- swca No. - - - - - - o.iner 11o. - - - - - - -
SKI llo. - - - - - - - Own.er llo. - - - - - - - swca llo. Owner llo. - - - - - - -
SWCI llo. Owner llo. - - - - - - - SVCI llo. Oitntr IIO. - - - - - - -
Mtttr rudings lrt fl _ _-!ga~l,1..,l~onsd.!iL---------------C~llons, lOOO's of g*llons, cubfc feet, etc.)
lot,: U s,sta fl 11NlflfrH, t1t1Ntt ~91 SWU No. 3() -l9'o- - S:--1 e, Owntr llo. ..ZS 111 llo.lft 111 loo,er r19M-hud COMlff'.
Dau P',fter Rtid1119 1 ~llons WHtr ltve1°" O.tt Meter Rudfng* 6' 11ons Va tar Leve Jtt" Sutt, .. P~IIIG"' Used Sutt," 1,;.;1ftG*H tl'ld of Lut l"c:MIUI I 1 j'c,o cJC>O ~
.,,,,, 16 1 17 2 18 3 19
- 4 5
20 21 22
'7 23 8 24 9 ~5 10 26 11 27 12 28 13 29 14 30 15 31 ~o7/~o ?ZJ/~o Tot, I C.11oar rou I c:. I Ions
- ~H litW s
- tfat HCI f,7 (,reftr,blJ 111d If dlJJ "If tOtt1, rHf n '"' ,, --P\II01ft9 pe,10, Dwrf 119 lblUI 8Z.7/~ Dur1119 0.,1rw z3e53S-=o
- If tlllfl, rtM It Ind If l\tlYJ-~lllf Pft10f
""'If Ultfl 11 Ofte i,ell I* t fttlf, IP<<1f7 ljfilCII *II - - - - .,.,,
Tott I Operuf111 l"11 lblUI 3/ roul Operut111 DIJ1 Ulh Ol,1rtlf' '!I t All Jrh1t.1l7 ., Mlfult7-owlltd Pl,fillc ut,r suP9IJ IJlttlll 0.1 ,, l,tf'l9' .,. i17 *** ,.,.
wf UI Nu1 UI tltP'rtllut p1rwft1. .
Dur I119 "°" tll zt.~/ Y/7 °"""' o..,, ,,~ 1!.6L1 /Z..b
- .... ,~****"
GROUND WATER PUMPAGE ANO USE REPORT S111c ~put,:ncnl of Hulrh ind Sutt Wirer Conrrv' loaul
_ __.X._ Wt II (I J ,vtillc. Sfftld copy tf rt90rl to ~t°"'I Sutt lt1ttr Co11trol lo.l"f Otftc, 111111 l19fo,,,I St.tlt HulUI ~p,rtN"At Offfct -
- - - S~t119(1I ,,.,.,1tr111. S~ <091 @f ret;,¢rt to ~10,.,.; Sutt lllt.tr Co11lr11l to.** Ott1u Ot,,.r, Stnd coo, of rtpOrt to lt9fo"'I Sutt lift.tr C011trol to.rf Offtct
_ _ _ Wtlll1I ,,.., w-1119(1) llf*inr of W*ter-.orks Ha~ of Ooer*tQr _ 1t-:,l/;;A;---------------
Va. Electric & Po,.,>er Co. - Surry Posftfon/Htl*---;;Ni'l/'iiA._ _ _ _ _ _ _ _,--_ _ __
-- - Co N/A N1~
Ow14r Va. Electric arrl Po,,Jer
- Sf qnltur, - - - - - - - - - O.t.e - - - - - - - -
1.ddrtss P 0. Box 315 Popvlatfon Served (Publfc' _ _--'lNIL/s:.A.__ _ _ _ _ _ __
_ ___.S""ur=-"ry~,-'-V-=a__* -*~2'""'3---8___8-=3- Phone (804) 357-3184 No. of Connection~ (Publ fc) _ _Nu.u!ACL.__ _ _ _ _ _ __
Uperltfon Pe~it lluc)er (Public) ... .N~/..,_A..____ _ _ _ _ _ __
Ty~ of U(t: Puhlfc+_ _ !ndustrial_L OtNr (s~1f1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf me,sureaients 1rt for I sf~le~ter ffeld re1df~, 11st wells Included fn ff eld SWC8 No. Oltner No.------- swca No. - - - - - - Owner No.-------
SWC9 No. Qimer N o . - - - - - - - swca llo. - - - - - - Oltner llo. - - - - - - -
SWC9 llo. _ _ _ _ _ _ _ Owner N o . - - - - - - - S'ilel lie. Uitner AO. - - - - - - -
Mettr rudings ire f* _ __.,:ga~l~l~ons.a..!!il---------------C911lons, lOOO's of g1llons, cubfc feet, etc.)
llot.t: If 111i. h y,-ttrld, 11tfutt ~91 SW\:8 No. 3!-lfo-£2.. c Owntr No. ~ fa bo.lft t11 1°"'r rl9ht-hlftd Corntf',
I Date Htter Rudi~* ~llons llattr Lev11**H Dile Meter Read f ng* &.1lon1 Water Level .. "
Used S~tl, .. ,i,i,plft .. Used St.nf," ~, .......
[lld of WI/////I//////; 16 Lut lb!UI 3fl7% /oo 'lff////1//1/I ,,,
~ "
1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 l3~z7,9t,o,= /ofz.~
Tou I C. 1IORI
- lctf aettr , ... tfae Hell .,, (prtftf'1bl1 ~ of d11)
Tott I C. ltOllt
~rt 111 lloftUI /o~Z-~ei ~rf99 l)i,rter z,t.~<:J z.oo
- If UlP, rNf It tnf tf --""'°1"9 per10il
- If Ultti, rttf It tnd of lltn7-p,.,-pl119 ""OIi o.,,
Tou I 0perU111f foul Optr1tt111
" .. If Ultt1 ta one 11ett t*
- flt14, ,~1f1 lfflfcll wit - - - -
tllf ' "°""'
3/ D,71 Ulfl Ovtrttr ?/
t A11 ,,1uttl7 tr ~llult7-owllltd ~tic wn.1r s11P9l7 111ttta 0.1 17 Awtf'191 wfUI MHIUI Dlp,rt-,ut Ptrwfta.
°"' l"9 llontll 3/ 2-c./ 2- A ily lwt**9t Dwrt"9 o... ,u, z. tz33
- ~~
--
- I I I I "3:111 I I 1.,-q,
.,.~. , ' " *** lJ*a.;;J GROUND WATER PUMPAGE ANO USE REPORT
~___..}(.__ W.11(1)
Sr ate ~~r1mcnc or Huhh and Sutt Water Control loar4
'**lie. Sfnd cop, tf rt90rt to ~1-1 Sutt Veter C6fttr"tl loerf Otf1ct ,.,.
Quarierl"f) Z J 4
<Cfrdt One)
=
ltgf-1 Sutt KctlUI Otp.ertMftt Off1CI - County/Cft1
~~- S~1"9(1! l:>d.Hral. Sr-4 co,7 of rtPOrt lo ~1o"'II Sult V.ttr C6fttrvl ao.,11 Offlct Otiw,. Stlld coo, of rtPOrt to ltg1o"41 Slit., V.ttr Control loerf Offtct
- Surry
- - - w.111,1111d S9rf119(1)
"*"" of IIUer-.orts Na~ of OoerHor _ 1':;-l/iiA.:--------------
Va, Electric & Po,.1er Co. - Surry Pos1t1on/Titlt _ _1~Nn/'"i:A_ _ _ _ _ _ _ _ _ _ _ __
o,.14r Va. Electric ard Pa,oJer C.O. s1qnHurt _ _ _ _N_1/_A____ 0. t.t _N_J_A_ _ _ _ __
Addrtu P O. Box 315 Popy1H1on Sel"Yed CPub11c' _ ___,_,N"-/AAA..._ _ _ _ _ _ _ __
_ _..S=ur==ry.A,J.,_V.:..;a::.;*,.__._<<--=-23=8"-'8c..;:3"--- Phone ( 804} 35 7- 3184 No. of Connection~ rPub I icl _ __.N.....,I...A..__ _ _ _ _ __
Uper1 t 1on Ptrwi t "'->er ( Put, 11 c) ... N....I.._A,__________
Ty~ of u~e: Public t__ l ndus tri1 I _x_ Othtr ( s p e c i f y - - - - - - - - - - - - - - - - - - - - - - -
1f 111e1surements 1rt for I single-llfltr field re1df119, list wells included in fteld SWCI No. Oitner No. - - - - - - - SWCS No, - - - - - - Owner llo. - - - - - - -
SWCB No. - - - - - - - ~ntr No. - - - - - - - SWCI No. Owner llo. - - - - - - -
SWCB No. ~ntr llo. - - - - - - - S'wCI llo. ~ntr NO.-------
Meter re1din9s ire 11 _ _..,:ga;15a,li....li.:oons,l'ibL--------------- (911lons, lOOO's of 911lons, cubtc feet, etc.)
Iott: If srsta h 11N11CttrM, t1t1Nte ~91 SWCB 110. ()o.ntr No. J> 111 bozn tR Jo,,er rig~t-llud corMf'.
Da~
[IWI of U st 1
"°1\ UI Meter Rt1d1119*
2 3o~ 9'00 .. ~lions Used
~
11,t.tr level** ...
Sutt,** ,i,ic,1~ -
71, O.te 16 17 Meter Reading* S.llons Used v, ttr Leve 1.....
Sutt," ,,._,1 ........
2 18
- 3 4
5 19 20 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 l5 31 2 3~! /oc ;?o S-o=-
Toti I C.ll-, Toul C.llon1
- ~14 aei.r Uat lf* NCI .,, (,reftr*bl7 tfld of cr11) DI.rt 111J lloftUI ~o/~~-o Dl,r1119 ~lrlet' z.? 7,300
.. ., lllt11 0 rt.el *t ttif tf IIOft*"""°1119 pcr10,
- If t,l111. rod It 1nd of 11t1v7-puaip1119 pcr10f
.... ,, Ulen 1* Ont ,oell 1* I '1tl41, SPKlfJ iot1t,11 *II - - - - - - o.,,
Tott I Optr1t1111 Ults lblUI 3/
roul Or>trtUnt 0.71 Ulh Ou1rt1r 671
- All ,rh1Ul7 tr Mlfc.1U7*0lflltd ploflllc wit.er 1uppl7 111tt111 w1UI tcul UI Ot1>4rtlat11t perw1U. 11,1 17 Avtr191 .11i17 l,1,191 Dlir 1119 "°" tll 2.7/7 °"""9 Overt,, 3/ I £°'7
-.............. ~
GROUND WATER PUMP.AGE ANO USE REPORT 11,t,r Sovru: S111t ~par1mtnl of Hullh and St.t.t Wuu Conlrvl loar4
~__...)(.__ 11tll(1J '**ltc. Sffllll copy tf rt90r\ to R.tto-wl St,lt Val.tr Co11lrol ao.,.,. Offtc, *~
1t9t0ftll St.II.I NulUI Otp,r~l Office - Ccvnt;/C1ty 1"4uilflil. St..i co,7 oi rtPOrl lo ~10,,.1 St.llt W.ltr Co111.r91 to.,, Off1u
- Surry Oti.r. StllCI coo, tf rtPOrl to lt9to111l St,lt lltltr Control ao.,.,. Offtct
_ _ _ v.ll(sJ 1111t wt11tll)
If*~ of w.ierworts . N*~ of Ooerltor _ 11'~l/7iAr--------------
Va. Electric & ~ Co. - Surry Posftfon/Tit1*--~Nf7/A;.--------.<t"-N...-----
Owlir
- -Va.- - Electric arrl Pc,.,Jer CO. N/A Sfqn*tur, _ _ _ _..;.__ _ _ _ O.t.e - - - - - - - -
N1'A Address P,O. Box 315 Popu11tfon Served (Publfc' _ __...N~/A...._________
_ __.S=ur=ryJ.-&-,_V--'a=.___._<<--=23::..;8.....8'"""3____ Phone ( 804) 35 7- 3184 No. of Conntc tf OM t Pub 1fd _ ___,N~*luA1-_ _ _ _ _ __
Uperat 1on Per11f t lluc>e r (Pub 1f c) .a;N'""/.:.,A,__ _ _ _ _ __
Type of u~e: Puhlfc * - - lndus trf1 L .....X- Other (spec1 fy - - - - - - - - - - - - - - - - - - - - - - -
If ee1surenents ,,.. for I sfngle-eeter ffeld re1d1n,, lfst wells fr,cluded 111 f1eld SWCI llo. Owner No.------ SWCI llo. - - - - - - Oltner No.-------
S\itl llo. O.ner llo. - - - - - - - SWCI llo. - - - - - - Owner llo. - - - - - - -
SWCI llo, O.ner llo. - - - - - - - SWCI llo. o.tner IIO. - - - - - - -
SWl:8 No. l!>z. -/Cjt) - 71? Owner llo. c::
Date Meter Rudtng* 6'11ons Meter re1dings ire 11 --.::ga;tSUl...il.!.<ons~--------------C9fllons, lOOO's of g*llons, cub1c feet, etc.)
Water Level ....
lot.I:
0.tt If 11n* h u,..ttrtd, ,sttutt ~91 111 bean fa 1o,,er rlght-llud COl"Mf',
ICettr Re.,dfng* &.llons V*ter Level ....
[ltd of un 1
1wiu. ~0 19 r s--oe:> *-Jil'""'MM wd 16 17 Used St.Uc" l"--1""***
2 18
- 3 4
5 19 20 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 "fr/ IZ.o ?o= 'f'z_ I '-fa, o Toll I C..llOIII foul C.IIOIII
- lcN -ttr I ... ti* HCI C,7 (1"tftr1IIIJ tftd tf f11J 11 lf Ultt1, rHf U tnf tf -*Pl-.1'1 per1of ~rf "' floftta 'fZ/4hO Dl,r t "9 ~Ir ter 377~ Joo
... ., Ultt1 0 rtl4 It end of llttYJ-Pll'l!P1'1 per1of To~ I Dptr1 l111t To~I Optratf"I
.... ., Ultfl 11 one 11111 111 * ,1,1,. sPt<tfJ wtitcll wll - - - - - o.,, UI 1s !Ion UI 3/ Dl,r1 Ulla Ou1rt1r 9/
- A11 ,,h1t.1l1 " ,v&lfCAIIJ-Orntd Pl,61tc wH.er Iv~,, 111t...
Dl1 ,, btr191 l,cr19e w1"' Ntt1UI Dtp,rt.rout Ptl'l1b.
0..r 1119 "c>ftlll zf7z3
.11 il7 Dun "9 Ovtrttr . 9~_'-1</ I
., ..... '1r11 * *
- lJ*~I - .. ** *"'****~ THr_47~~:;._--,---
GROUND WATER PUMPAGE AND USE REPORT ~UI ~/.U-'~-::r..,t.._ __
S1a1t ~.,_r1mcn1 o( Hul1h and Sui. Waler Concrol loar4111 ~1rt.r
_ __,._X.__ Wt II (I I ,.,11,. ~rid cop, tf rt90r\ to ~l°"'I Sul.I V1t.1r C.011trol 1o,,.. O"lct 1,_.
lt910MI Sul.I KttlUI Ot~rtaf'!lt Office - Co\inty/C!t1
- - - SP,-lftt(I) I...Svstrul. SMO <691 of '!POrt tc !.."110,,.1 Sl4ti lwt,r C011V11I lotrf Qffict
- Surry Otlltr. Stnd coo, ef rtl>Ort t4 lt9lon,I Sul.I W.t.tr COlltrol ac,.,.. Offtct
- - - V.11(1) lftd Wlftt(I) lf*me of lilterworts Ha!!W! of Ooerltor - , t - : ; - J / 7 i A . - - - - - - - - - - - - - -
Va. Electric & Po,..,er Co. - Surry Posft1on/Tit1t __-;:N,;/r,;A~-------,c,,+,..--------
Owlir Va. Electric a.rd Pc,.,.,er Co
- S f q n H u r * -N/A - - - - - - - - O.te - - Nt'A Addrtu P,O. Box 315 Popuhtfon Served (Publ1c' _ __._,NIL/._A.._________
-~S=ur==-ry.J-&-._V"'"'ac..:*__.._,_2=3~8"""'8~3- Phone ( 804) 35 7- 318 4 No. of Connect 1on, (Pub I 1cl _ ..........N~(u:A:L...-_ _ _ _ _ __
t Uperatfon Pena1t "'->er (Publfc) ....N""/....A.___ _ _ _ _ _ __
TyPf of u~,: P11hlfc _ _ !ndustrfal___.X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf ~*surements lrt for I sfngle-efttr field re,dfng, list wells included 111 fftld SIJCI llo, ~ r llo, - - - - - - - swca 11o. - - - - - - Owner No.-------
swca No.------- ().ner N o . - - - - - - - swca No. Owner 11o. - - - - - - -
swca 11o. - - - - - - Owner No. - - - - - - - Ml No. Owner IIO. - - - - - - -
Meter rudings *re fl --~ga~l1w1l.i,ons{i.!,iit----------------Ciil10t1S, lOOO's of gallons, cubic feet, etc.)
llot.t: Jf systa h u,..ttrtd, tll1Mtt ~91 SWCB No. Owner No. C 111 !,ozn 111 l°""r r1ght,lllllld COMllf',
Dau Keter Rudfng* &.11ons Water ltvel'"'"H O.te Met.er Roding'" &. 1lon1 V*ur level ....
Used Sut1,"" ,IIIC)1~"' Used St.at1," l"-it11<1* ..
[lld of List l'lollUI 3703~ WI/II ff/~
,, ///I/I/b, 11 ~ "' ,,., ...,, 16 1 17 2 18
- 3 4
5 19 20 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 37/o/O ~~o Tot.I 1 C.110llt Tou I C. lions
- ~If *.tar u .. tfat HCI .,, (Pf'tftf'abl1 tftd of d11)
.. ., Ult11, rNf ll tlld tf - - ~ f " t pcriO, 111,rt
"' "°"~ ~fo Dl,rl119 f),1rtar 11'90
- If Ult11, rtM ll tnO of llt1v7-~f"t pc,,ocr
- .. If Ultt1 ta one 11ell 111 1 fltld, 11>t<ff1 wfllcll wl1 - - ' ' - - - - o.,, tll 11 lion U1 Tot.a I Optr1tt"'
3/ Total C)ptrUlllf D111 Ulls Ouarter 91 f A11 ,,hu.117 tr Mlfcall7-oi,lltd Mlle water suppl7 111te.
wfUI Heal UI Ot~rt11ut Ptrwtts, 0.11 7 Anr191 A il1 l,1r1q1 Dur 1119 No,, u, 2 Dur1"9 0.,trttr z2-
- ~ ;{/a
~
., * ._. *** ~ ..... tJ*a;,
GROUND WATER PUMPAGE ANO USE REPORT
_ _....x_ lit II ts, ,v.ltc.
S111t lxpar1mcnl o( Hc1hh and Su&e W11cr ConcrGI 10114 Sf"' COPJ ., rtpOr\ lo a.,to-wl St,U Veur CoAll"OI lo.rf Offlct ....
Quarter~ I J 4 (Cfrtle Ont)
=
lt9fOt11l SUlt HctlUI DifPHtiwftl Offtct - Count7/CH1
- - - Sprt119(1I llldu1trul, SIM <091 ef rtpOrt to l.-"'t10ft41 S~tf v.;., Co11trol So.** Ottict
- Surry 0~11tr. Stlld coo, ef rtport to lt9ton,I St,i. 11,Ur COfttrol lo.rf Offlct
- - - 11tll(1I ,,., wt119(1J lf*me of WHeT"tlOrts Na~ of Oce rltor -,~.,..l/7iA~-------------
Va, Electric & 'PoNer Co. - Surry Posft1on/Title _ _"iiNi'7/A;.--------....,,,_,__ _ __
Owlir Va. Electric arrl Po,.,e.r Co. S1Qn1ture _ _ _ _N....:1/_A____ O.t.e _N_J_A _ _ _ _ __
Addr.ss P O. Box 315 Populltfon Served (Publ1c' _ _ _NUL,j/ALA,.__ _ _ _ _ _ __
_ ___.S"-"ur=-=ryJ.-&.,_V..;..;a=*~*-=23:.;;8;..;:8;..;:;3_ Phone ( 804) 35 7- 3184 No. of Connect 1OM (Pub I tc l _ ___,N~/.....A...__ _ _ _ _ __
Uper1t1on Penait lluclDer (Public) ..._N:..c.l....,A,___ _ _ _ _ __
TyPt of u~e: Puhl 1c *_ _ incsus trt, 1-._x_ Other ( spec1 '1 - - - - - - - - - - - - - - - - - - - - - - -
1f 11t1surenents art for I s1ngle...,..ter field re1d1ng. 11st wells Included 111 fftld SWCI llo. Owner No. - - - - - - - SWCI No. - - - - - - Olffler llo. - - - - - - -
S~I No. - - - - - - - (),,ner No. - - - - - - - SWCI No. Owner llo. - - - - - - -
SWCI No, (),,ner N o . - - - - - - - Ml llo. ~ner IIO. - - - - - - -
Meter readings *re 11 --~ga~lull,!,onsaJiiiL----------------C9111ons. lOOO's of g*llons. cubic feet, etc.)
lot.a: If 111ta fl u.-ttr:td, 11ttNt.1 l)UIIC)l91 SWCB No. Owner llo. 1~0 Toti I C.11-, Toti I 1.t llOftl
- letf acter s
- tt* uc* ,., (,r1ftf'1,11 tf'ld of d11J
,.If tel111. rtU It tftd ef -*"""1111 ,erfOII Durt 119 lb!" I z_.L::)O Durt119 ~arter /8"'=0
- If tel111 1 rtld It tftd ef lltlYJ*PIIIIIPIIIIJ per,OII Tote I Dperu1111 ToUI l)ptrUlllf HHlf tlltfl fll Ollf llell fll I fltlfo IPf(lfJ llfll(II lle11 - - - - DIJI tll 11 !loft tll 3/ Di1' UIII Ou1rt1r 9/
f A11 ,,het.111 .,. M1tca111*owlltd Pl,61tc wit.er tuPll1J 1,,t...
Dlt 11 Awtr191 wlUI IIUltJI Ot~rt..e11t ltrwlts.
Dv '"' Nontll 39 AilJ l,trltt Dwt1"9 Ov.,ttr 2.-£)
.,."' * * , , , .... l J-1,;;J - . . ' ' *'-'****"
GROUND WATER PUMPAGE ANO USE REPORT II* ter Sowrtt: Suit lxpu1mtnt or Huhh and Sui. W,1,r Con1rO, loarlll
_ _.....)(.__11tll(1) ,.&lie. Sfncl cop, tf rt90rt to R.tt~l Sutt V1ttr Cofttrol lot~ Offtct ~
lt910ftl I Sutt Kol UI tltp.,rtllltftt Office Coa.:nt;/C1t1
- - - \pr1119(1I lnclwHrlll. S~ <091 of rtPOrl lo *~lc,.,4! S~ti -..ur ~11t.rol to.rt Off1u
- Surry O~~r. 5tlld co01 of rtport to lt9lon,I Suu ii.c,r C011trol lot~ Offlct
- - - ~11(11 Incl S9rl"9(I) llf*ine of WHer.orts Na111e of OoerHor -,?-:,-J/;;A,-------------
Va.
- - --~
Electric & Po,,Jer Co. - Surry Pos 1t 1on/Tit I '--~Nf-7/A..--------------
N/A N1'A o-.lir Va. Electric a.rd Power Co
- Sfqn,turt _ _ _ _ _ _ _ _ _ O.te - - - - - - - -
Address P 0. Box 315 Popul1tfon Served {Publfc' _ _--'JNIL/,..A...__ _ _ _ _ _ __
_ __,S=ur=-=ry,.._.,____ V-=a. . . _,,,____2"""3_8~8~3- Phone (804) 357-3184 No. of Conr.ect1oM (Public) _ _No.u..,IACA,.__ _ _ _ _ _ __
Uperat1on Pera1t ~ r (Public) .aN.....l..:..A=----------
Ty~ of u~e: Public~ lndustr1,1_x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 111e1surements are for a stngle~ttr ffeld re1dtng, 11st wells included 111 f1t1d SWCI llo. Owner No.------- swca No. - - - - - - Olffler No.-------
SWCB No. O.ner No. - - - - - - - swca No. - - - - - - Owner No.-------
SWCS No. O.ner N o . - - - - - - - Ml llo. Oitntr IIO. - - - - - - -
Meter re,dings are 11 --...:gad!il-lul~onsll.!lit..---------------C9allons, 1000'1 of gallons, cubfc feet, etc.)
lou: Jf 111ta h ulWtU,.N, ttlta.t.1 ~91 SWCB No. Owner No. 1-1 1111 t,ozn 111 1o-oer r19~t-halld corner.
Date P'ieter Re*d1ng* ~llons W*ttr Ltve1 ..... D.te ICeltr Rud1ng* &. llon1 V1ltr Level .....
Used Sutfc'" l'i,i,c,1111 " Used St.Uc;" ,,._,-1 .... ***
roo 71.
[lld of '"
16 Lin "°""' ZJ5"' ,.
l 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 I
11 27 12 28 13 29 14 30 IS 31 z77 300 /--It£) 0 Tou I C:. IICNII Tota I C.110llf
-f~e
- Inf aettr * - Uat HCI .., (,r,,,..,.,, tftd of ** ,, ~r1 119 lloflUI /~tP-~ ~r1111 0-.,arttr Hlf Uhft, rtU It trrd tf IIOft*p,,,ilp1119 per10,
- If Ullfl, rod It tlld of llf**J*p.,aip1119 per10C1
.. **If llllfl 11 Of'II 111tll 1R I fltlf, 1~1f1 llfl(C~ 111tll o.,,
Tott I Oper1t1111 UI ts !loft UI 3/
roul l)ptrU111f 9/
t A11 ,rhU.tlJ tr ~11ca11r*owlltd p~llc w1\.tr 1u1>91J 1,it,..
w1UI Kt11UI Otp,rt.ut PtnilU. 0.1 1, ** ,..,91 11,,., "'"
_.. ilJ lwtr19t
°""
Ovr 1119 IIQc, t II ~/ 1Nr1"9 Ov1rttr ~? -
- * * ,. *'-ltl*t" GROUND WATER PUMPAGE ANO USE REPORT S111e ~par1mtnl er Huhh and Slat.t W11u Con1rvt loar4
_ _,X...__ Wt II (s J ,.ollc. Sf1'!1 cop7 ,, rt90r\ lo ~lo,,, I St,t.t 1tu.1r C6ftl1"111 to.r,11 Olflct ~
ltglllfttl Slit.I KtellJI Ot~rtMnt Offlct ~nty/Ctt;
~ - - SP,..lft\!(J! !~~HrU!. S~ CGPi ;;f ri..O*i iO ~io,..i \Utt !let.tr (6,.tr111 lo.Ir* Olflct
- Surry 0~,,_,, Stlld coo7 1f rtPoOrt to ltglo,..I Sue. W.t.tr Control lo.r,11 Offtu
- - - Vtll(1J 61'1d Wl"f(I)
"*"" of wuer-worti Ma~ of OoerHor _ 11':;--l/'iiA~-------------
Va. Electric & Fewer Co. - Surry Pos1t1on/Title _ _. : N f : / r . A : - - - - - - - - - - - - - -
Ow141" Va. Electric and Pc,.,Jer Co. S1qnHur, _ _ _ _N....;1/_A_ _ _ _ O.t.e __ N_JA Address P 0. Box 315 Popullt1on Served (Publ1c' _ ____._Nul.... A..___ _ _ _ _ _ __
_ ___,Sur='-"ry~*--=-Va=-=-*---"2:..::3c=8=8=3- Phone {804) 35 7- 3184 No. of Con~c t 1on, ( Pub 11cl _ ___.N....,_,./A....__ _ _ _ _ _ __
Upel"lt1on Pel"ll1t lluc>er (Public) .a;N""/~A..._________
Ty~ of U(.e: Puhl1c~ lndustr1,1_x_ Othu (s~1fy _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If aie1surements ire for* s1ngle~ter ffeld re,d1ng, 11st wells 1nc1uded 111 fftld SWCI No. Oiitner No. - - - - - - - SWCI N o , - - - - - - ~ r No.-------
S1oC8 No. Owner No. - - - - - - - SWCI llo. Owner 11o. - - - - - - -
swce No, _ _ _ _ _ _ _ Owner No.------- SVCI llo. Oitner A O . - - - - - - -
Meter rudings *re 11 ---lga~li...11,.!,ons~L----------------Cs*llons, lOOO's of g11lons, cubic fHt, etc.)
l>wM r No. c.G>N~-no"' Iott: If 111f.a fs UNllftfrM, tst1Mtt ~91 SWCB No. :s1-r, 111 l)ous 111 IOWtr rfghl*llllld COMltf',
Date Heter Rud.1ng* ~11ons 11, ter ltve 1..... O.te Meter Reading* &.1lon1 V*ter level ....
Used Sutt,** )PUlll)1! - ~ed StU1c" ,-,.......
Clld of Lut l'lcwlt.11 2. Z" ..J.t,. 7 l.,,oo ~WIHAi 16 1 17 2 18
- 3 4
5 19 20 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 z~ o~7$0c 57'9yo0 c:. 1'0ftt Tote 1 C.lloar Tou I
- lu4 acttr 1
- tf* uc* ~, (,reftf'llblJ tfld of d17) ulf Ultfl, rNd It tnd tf --~1119 perfof Dl.tr1 "9 floflUI s-79 ~00 Dl.,rl119 ~art.er I ?.S--z_ Zoo
- If Ultt1, rtMI It tnd of 11<<1v7-~f"9 period Tott I Operetlllf fot,1 C)pfrUIAt
.... ,, Ultll 1* Oftf 11<<11 1* 1 fftld, IPK1fJ 1,fllcll wll - - - - o.,, Ul11 llonUI .3/ De71 Ulh Ov1rttr "1'1
- All ,,hettlJ tr ~lte1ll7-0rlltd p!Alllc **I.Ir luP91J wltll kulUI OtP'rt.-tnl Ptnilts.
,,,t,.. OIi 1, AYtf'l9I Ai 1, l,,,,,,
Dvr I 119 No,, l 11 /3 7o3 O.,r, "9 Ov1rttr :z.o, 3s;-f
... GROUND WATER PUMPAGE AND USE REPORT S1a1e IHpartmenl of Heal ch and Sute Waler Concrol Boar~
_ __..x.._ Well(s) P11bllc. ~nd copy of "J>Ol"t to leglONI St,te llat.e,. Co11tl"Ol to.MS Offfct 1 -,
- ,9to,ial Stlte HHIUI ~P'tMIII Office -
- - - 5PP'lft9(1) llld11strl1l. Seftd copy of rtl)Ort to ~ton.I Stile W.ter Control lotnl Office Other. Stnd cooy of nport to ltg1oiwl St.It. Wat.er Contl"OI to.~ Offlct
- - - ~ll(sl Ind Sprl"9(S)
'*me of Waterwo,.ks Naae of Ooer1 tor N/A Va. Electric & PcMer Co. - Surry Position/Title --.N~/;;A:--------------
Owlir Va. Electric am pa,,.,er Co. Siqn*ture N/A O..te _N_J_'A_ _ _ _ __
Address P O. Box 315 Population Served (Public' _ ___..,N"'-/A,..__ _ _ _ _ _ _ __
Surry, Va. , 23883 Phone (804) 357-3184 Ho. of ConnectfoM CPublfc) _ __,N.a.i(....A...__ _ _ _ _ __
Uperation Penlf t Nunt>er (Public) NIA Type of U(,e: Puhlfc + __ lndustrial-L Other (specify ......~ - - - - - - - - -
If 11easurements are for I single-meter field reading, 11st wells included fn field SWCB No. Owner No. SWCB N o . - - - - - - o-iner No.-------
SWCB No. Owner No. SWCB No. Oimer No. - - - - - - -
SWCB No. Owner No. SWCB llo. Oimer IIO. - - - - - - - -
Meter re1dings 1re fn ___g~a ........l.lo""ns..-.______________ (gallons, lOOO's of gallons. cubic feet, etc.)
Note: rf sys ta fs uraetel"td, est 11111 te puilll)l91 S~B No. 2&f- l'10-5oC. Owner No. fn bous fn 1owr rt911t-l'lllld corner.
O.te Heter Reading* Date Meter Reading* Cillons Wlter Level**-
Used suuc- ......:1no***
Clld of ust 1tont11 617729'00 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 !7?7,o<=>o /,+ /o~
~
Total iit11ClftS
- b14 *uar saae t1ae tacll d11 (prtfttabl1 tnd of day) t1k..-, retd It encl of non-puac,1119 per'1od Tou I Ca 11cw Durt "9 !loft tll /fI /-=c:::> Durl119 ~arlar' Z.~ ~ ~=o Ule11, rtad II tncl of lle1w1*pu111pt119 peP'iod Toti 1 Operattn9 Tot,I Operatlnt
- '12..
f Ukfll 1n on, 11111 tn a field, specify wfllcll wll - - - - Days tll Is Non tll 3z- Dl.ri Ullt Quarter t All prhat1l1 or Mltc.lly*ownecl puttllc water suppl1 sysu.i wf tll Heal tll Departllent perwtts. Oat 1y Awer191 .11 i IJ A,tra~
Our' 1119 Nontll ./ >/I Dwri"9 Qvaretr Z/7e>~
GROUND WATER PUMPAGE AND USE REPORT !bl UI "D ~ .::;,.,e- M ~ 1::, ~
S1ace IHpartmffll of Hcahh ind Sta&e Waler Con1rol Boarlil Qu*rtcr I 2 l ~
(Cfrtle Oni'}
~__._}{.__ llt11(sl P11bllc. ~IICI copy of ~l"t to ~lon,I Suta Vet.er Co11trol lol,.. Offlct 1 11111 Rt9t0111l Sutt Ht1IUI ~rtM!II Office - County/City
~ - - Sprl"9(S) lllduHrt11. Stfld copy of rtPOrt to ietlDflll Suta Wltar Co11t.rol lol~ Office . Surry Ou~r. Stnd coo, of rtPOrt to lt9torwl Stitt Wltar Control Bot~ Office
_ _ _ Vtll(s) 111d Spr1119(s)
IC*me of Waten<<>rks Name of Ooer*tor _ 1 ?-.,l7/A ; . - - - - - - - - - - - - - - -
- Va, Electric & Pa,ver Co. - Surry Posftfon/Tith _ _.:N-.:/r..A:--------------
0.,~r Va. Electric arrl Pc,.,.,er Co. SfqnUurf _ _ _ _N_1/_A ____ O.te __ N_/A
~dress P O. Box 315 Popul*tfon Served (Publfc' _ __.....N.._/.,,_A..__ _ _ _ _ _ __
_ __,S=ur=-=ry~,--"V""'ac..;...~'-"2""'3C--'8~8'--3_ Phone ( 804) 35 7-3184 No. of Connect f on!; (Pub 1tel _ _N......,/A...__ _ _ _ _ _ __
Uperltfon Pel"llft Mullber (PUbltc) .a.N..,./..;.A=----------
Type of Uc.e: Puhl fc +__ lndus tr1* 1 ___x_ Other ( specf fy - - - - - - - - - - - - - - - - - - - - - - - -
1' 111euurements ire for
- s1ngle-11eter field re,dtng, 11st wells included fri field SWCB No. Owner No. SWCB N o . - - - - - - - Owner llo. - - - - - - -
S"1:8 No. Owner No. SWCB llo. Oimer 11o. - - - - - - -
SWCB No. _ _ _ _ _ __ Owner N o . - - - - - - - SWC8 llo. - - - - - - - Uitner "°* --------
Meter re1dings 1re in _ __..,_,g:l,da""l..,l~ons~:..,_..-------------- (g1llons, lOOO's of g11lons, cubic feet, etc.)
llot.1: If 11st. ts urwettrtd, est1111t.1 ~91 SWCB No. 3o- 1 O - s I C. Owner No. "B In boaes 111 l°"'r r111ht-l1111d conier.
Date Heter Reading* 0.te Meter Reading* &lllons WI ter leve 1**-
Used suuc- ll'lanlfta***
[nd of Lut PlonUI df..../.t0z.(, 3 0 0 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 Y~z z 1 7-, cc:> Y.I /~// &,o=
/ I Tota 1 GI 110M Tot.II C..110III
,tftd meter Slllt time tech dlJ (pr1f1r1bl1 end of dtyl Ultfl, rHd 1t tlld of IIOll*l""'ll1"!1 per10d Our 1"!1 llontll s;1~1, 600 111,rlllCJ ~eri.r 1.l,Z~74=c:>
f Ultn, rud It tnd of llt1YY*l""'ll111!1 per1od You I Operatlft!I ToUI Operat1nt
- If-Ulen in°"' 11111 In* fitlf, sPtCHy wtiicll wll - - - - o.,s tlll s llon U1 3 "Z- Dl,s Ulls Ou1rttr 'f z.
- All 11rhat1l1 or pwllu111-owned plAlllc wet.tr supply ,,ntlia w1 UI Ht1 I UI Depari.tnt Ptl'llt U. Dlt IJ Awtra91 .,. i 1J lwtr1~
Dur I 119 llonlll Z5"~ ~~'? O..r i"9 Ouerllr 23//3"8'~
GROUND WATER PUMPAGE ANO USE REPORT lbltti 'l:>e-ee-~~e£ S1ace ~partmffll or Hcallh ind Sta&e W11er Control loartl Qu&rt.r 1 2 l (j)
_ _....:x;.__~11(1) (Cfrcle One)
Public. S.nd copy of l'f90rt to ~fOI\II Sui. V1ter Co11trol lolnl Offfct 1~
Rt9lon,l Stitt IIHIUI Oepolr'tNl\t Offfct - County/Cfty
- - - Spr111CJ(I) l"CSustrlll. Seftd copy of rtPGrt to ~Ion.I Sute V.ter Co11t.rol ao.,_. Offlct
- Surry Ot11tr. Stnd coo, of r,port to R,9101111 Sute V.ter Control ao.,_. Off1c,
- - - ~11(1) Ind Spr1119(1)
- me of Waten.oorll:s Huie of Ooerltor N/A Va. Electric & Pc:Mer Co. - Surry Posftfon/Title -,;N~/;;A.--------------
- Ow~~- -va:-Electric arrl Pcwer Co. SfQnlturP N/A O.te __ N_IA_ _ _ _ __
Address P O. Box 315 ,opulatfon Served (Publfc' _ _._..Nuls:.AL-_ _ _ _ _ _ __
-.--lSuro:::.=e.:,ry:.,.L...1,'-"V,-=a:..:.*-.L.<<-"2::..:3,:c.:8::....:8:;..::3~ Phone ( 804) 35 7-3184 No. of Connect f OM CPub 11c) _ _.,..N,,._./A....__ _ _ _ _ _ __
Uper1 t f on Per11f t Nurc,e r (Pub 11 c) ... N,...I....A.__ _ _ _ _ _ __
Type of u~e: +
Puhlfc _ _ lndustrf1l-.X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If aeasurenents are for a sfngle~ter ffeld readfng, 11st wells fncluded fn field SWCS No. Owner No. _ _ _ _ _ __
SWCB N o . - - - - - - - o-.ner llo. - - - - - - - -
SWCB No. _ _ _ _ _ __ Owner No. - - - - - - - SWCB No. Owner llo. - - - - - - -
SWCB N o . - - - - - - - 0.,,ner No. - - - - - - - SWCB No. - - - - - - U.ner N O . - - - - - - - -
Meter readings are fn --~g5,!a...l...,l~o:!.!ns~---------------<g*llons, lOOO's of gallons. cubfc feet, etc.)
llote: If system ts unaetered, nt1Nte ~91 SWCB No.3 / - / o -s-z c. Owner No. C... fn boaas 111 lo-er rfgllt-llllld corner.
Date Meter Read f ng* &allons Miter lewel**-
Used Sutfc- l"-fna***
Cnd of un l'onUI .3 / ';:j'f £;"2..00 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 3 2 , ~ lo, ;foo // c, IS-Z.tt>e> I Tou I CIIIOM Tou I C:. IIOIII Id aetar Slllt tlae t1c11 d*1 (prtftr1bl1 tncl of d11)
Ultt1. rHd ,t tnd of non-1N1111f119 per10d Durt 11CJ llotlUI 11°/~'Z.&>~ Durl119 Qu1rtar 8 3 L:. k, ~c;,C>
Ul111. rtld It end of IIHYy-pu-.pfng period Tou I Oper1t1119 ToUI Operatlnt If Ultn In ont i,ell fn I fltlf, 1pecffj ..tilcll wll - - - - Days UI Is Non t11 32..- Dl11 Ulh Ou1rter f-z_
t A11 prf,1taly or pvbltCJlly-owned public wit.tr supply 1yslt91 wf UI 11111 tll De1>1r*11t ptratu. Dlf 1y AwtrlCJe .itily A,tr19t Our 1119 Mofttll 31,72...5 Dur i 119 Q.itrttr fo'/367 7
- - -~,-----., ... .--o \J*O'IJJ GROUND WATER PUMPAGE AND USE REPORT l4otl di DeCd!?N/ ~ ~
S1ace lnpanmml of Hcalch ind Stale Wa1er Concrol loarlll Qu1rttr 1 2 J ~
-~>C.__w,11(1) Publtc. ~IICI cop, of ~ r t to lt9I01WI Sutt 1111.t,. Co11tr-ol ao.,.. Offtc, alld.
(Cfrcle One)
- ,9t0ftll Sutt HHIUI l>el)tr'tNl\t Offfce - County/City
- - - Sprt119(1J llldustr11l. Stfld cc,py of ,.,POrt to lt9ton,I Sutt Witt,. Co11trol aa.,.. Offtu . Surry Other. Stlld coo, of report to Rtg1onal Sutt V.ttr Contl'Ol loiri Offtct
_ _ _ lltll(s) and Sprt119(s)
"*me of Waterworks Na11e of Ooer1tor _ 1?-~~/7,A.--------------
Va. Electric & PcMer Co. - Surry Posftton/Title __--;;:N;'-;/r..A:--------------
C>.t~r Va. Electric arxl Pa,.,er Co
- N/A S1Qn1tur*-----'------ D a t e - - - - - - - -
Nt'A Address P O. Box 315 Population Served (Public'--~N....{.11,.AL.-_ _ _ _ _ _ __
---=Sur=c.e:IT:.L..L<<--=-Va=-:_.__.,r..-..:2=3-=-8.:::..83:::a.-_ Phone (804) 357-3184 No. of Connection" CPubl ic) _ _NU,,Lj/A14-_ _ _ _ _ _ __
Uperltf on Pen1f t Nuiit>er (Pub 11 c) ..N,../~A=----------
Type of u~e: Puhtt/_ _ lndustrfll_lL_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf eeasurements are for a single-ll@ter ffeld reading, 11st wells fncluded fn ffeld SWC8 No. Owner No. _ _ _ _ _ __
SWC8 No. - - - - - - - Owner lo.-------
SWCB No. Owner N o . - - - - - - - SWCB No. Oimer llo. - - - - - - -
SWC8 N o . - - - - - - - ~ner N o . - - - - - - - SWCB No. - - - - - - - Oifner IIO. - - - - - - - -
Meter readings ue fn _ _...:g;lla,4.,llt.,l~o.ans~--------------C9*11ons. lOOO's of gallons. cubic feet, etc.)
llote: If systa ts uMeterld, est1Nte pu11p191 SW\:8 No. Owner No. "J:> 1n bons 111 lowr r1911t-llaftd corner.
Date Heter Reading* O.te Meter Reading* Gillons V.ur level***"*
Used Static- Pua,111Q***
Cftd of u It "°" tll Zot':5 zoo 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 2 l04-I 00 '8 "81 t:f oo
' I Toti 1 Callon, Tot.II CilllOIII ad aeter SUit ttae Hell d17 (preferably tncl of d11l
~r1 119 Non t11 ~8'1 'fot:> ~,1119 ~arter Z. ~ '8, 4-oa tak~, rNd at tlld of IIOll-~1119 p,r1od f Ul111. rHd It tnd of lltoy-pu-s,1119 period Tou I Oper1tt119 - rot.ti Oper1t1111
- If Uktft 111 ont well tn I fltld, spectf7 wtilcll wll - - - - Dl1s UI ts Non t11 32- Da71 tlll s Quirttr 1-z-t All prfntel1 or Ml1ul17-owned PIAlllc w1ttr supply s7sU.
w1tll He1lt11 De~ri.nt ptrafU. Dl1 ly Awtr191 Our 1"9 llontll -z.. 77 B Jt ily Awtr191 Ouri119 Outrttr 2.'j 17
GROUND WATER PUMPAGE ANO USE REPORT !'ton U1 D E"c=c:M !Sq S1a1t' ~partmffll or Hcallh ind Stare W11t'r Concrvl lou4 . Qu1rter 1 z J©
~__..}C.___ Wc11(5) P11bllc. Sud copy of rtPOl'"t to le9fon,I Stitt litter Control lotnll Offlct tlld (Cfrcle Ont)
- 910ftll Stu, HetlUI ~rtN!lt Off1c1 - County/Ct ty
~--Spr1119(sl llld11str1tl. Stfld copy of rtPOrt to le9f0ntl Stilt lltttr Control lotre Offlct
- Surry Other. Suld cooy of rtPOrt to R191o,wl Sutt lltttr COfltrol lotnl Cfflct
_ _ _ W.ll(sl tlld Sprt"9(S)
-'lCiiiie of waterworks Nuie of Ooeritor _ 1?-~J/7,A.--------------
Va. Electric & PcMer Co. - Surry Posftfon/Title __~N ../r..A_ _ _ _ _ _ _ _ _ _ _ _ _ __
- - - Co N/A N1'1\
Ow~r Va. Electric am Pc,,.leX'
- Sfqnitur*-----"-----0.te - - - - - - - -
~drus P O. Box 315 Population Served (Publ1c' _ _-4lNIL/s;,A.__________
_ __,Sur==-=ry~*-V-=-a=.;_._,,<--=2=3..;:.8-=-83=--- Phone ( 804) 35 7-3184 No. of Connectf on!II CPub 11c) --H~/A......_________
Uperatfon Perwit Nuat>er (Publfc) ..N""/-=-A=----------
Type of U<.e: Puhlfc+_ _ lndustr1al---X- Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If ineasurements are for I stngle-11eter field reading, list wells fncluded in ffeld SWCB No. Owner N o . - - - - - - - SWCB No. - - - - - - Oiffler llo. - - - - - - -
SWCB No. Owner N o , - - - - - - - SWCB No. ~ r llo. - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB llo. O.ner IIO. - - - - - - -
Meter readings are in _ __;g!.l:asa.i..1.:lo!..!ns!.!ii!.--------------Cgallons. lOOO's of gallons. cubfc feet. etc.)
Note: If s1staa ts uNlltertd, est1Ntt pu11p191 1n boan fn 1owr rfgllt-llllld corner.
Dlte Meter lteadfng* Glllons Ila ter Leve 1**-
Used St.n1c.. Puai111a*-
Cnd of 16 u st "°"tll , '?. tI, 3 o S'"o o 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 7Z,34~Foo z, 7,¥/300 Toul Cilllons
- lead attar uae tfae ttch **1 (pr1f1rtbl1 tnd of d17) ttltn. rNd It end of IIOft*pyac,1119 period Tota I C.IIOM Dur1 119 lbltll z, 7,f 300 Dur199 Outrter "8' I:, Jj~ ==c Ulet1 0 rttd It tnd of he1w7-~fng period r ul.111 111 0111 well fn I fttld, specify wtitcll wll - - - - .,.,,
Tou I Clptrttf119 tllls lion U1 32-rota! Oper1tf"1 DI.rs Ults Outrttr '1--Z-
' l11 prh1ul1 or pvt,1fe11l1*cwned plA>I tc wtttr supply s7sU.
w1 tJI Hell tJI Dtptrtiatnt perwfU. Dai 17 Average * .11117 Aver*~
Our Ing !bit.II i'~ 8z z. Dvri"9 0..1rt1~ f.3.'17g
~
/
GROUND WATER PUMPAGE AND use REPORT lb'ldl "Dec.c""t E:,.E-"
S1ac~ ~partmenl of Hcallh ind Su&c Wacer Concrof loar4 Quarter I 2 J ~
_ __._.}{.__Wtll(sl P11bllc. ~no cop7 1f re,por-t to ie9lo,wl Sut.a 1111.tr Co11trol lotrf Offtc, , ..
(Cf~le Ont)
R19to,wl Sult KulUI o.p.rtMl'll Office - County/Cfty
- - - Spr1fto9(1) llld11strt1l. Stlld coc,7 of rtport to le910fll1 Sutt V.ttr Co11tr11l to.l'f Offtc1
- Surry Other. Str1CI cao, of r,port to 119101111 Sutt W.t.ar C011trol ao.r11 Offtct
_ _ _ Wt 11 (s I uld Spr I 119 (I) lf*me of Wa ten,,o,.lcs Name of Ootrilor N/A Va. Electric & Pc:Mer Co. - Surry Posftfon/Title --.N:./r;A;--------------
Owl4r- -va:-Electric arrl PONeI' Co. Sfqn1tur, N/A Date __ N_IA Address P O. Box 315 Populatfon Served (Publfc' _ _......._Nu.lLAL-_ _ _ _ _ _ __
_ ---1S::<,ur=--"ry=..J...l.'--!V...:::a:...:..-i.*--'2::.;3::..:9:;.::9:...:3:...- Phone (804) 357-3184 No. of Connection" fPubl fc) _ _NU,(.J/A~--------
Uper1t1on Pena1t Mullber (Publfc) .. N..,/=A..__________
Type of u~e: Puhl 1c +__ lnclus tr11 i__....x._ Other ( s p e c i f y - - - - - - - - - - - - - - - - - - - - - - - -
If meuurements ire for I s1ngle~ter field ruding, 11st wells included 1n field SWCB No. Owner No. SWCB N o . - - - - - - - o-.ntr lo.--------
SKB No. Owner No. SWCB llo. ~ r No.-------
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB llo. - - - - - - - ~ner I O . - - - - - - - -
Meter readings Ire 1n --~g~a~i...i~o~ns!iiL,._______________ (g11lons, IOOO's of gallons, cubic feet, etc.)
Noll: If 1ysta ts 11raettnd, tst1111tt puaip&9I SWl:8 No. Owner No. i= 111 boos 111 lo.er rl911t-llllld corner.
O.te Heter Reading* Date Meter Read 1ng* Gallons VI ter Level**-
Used St1ttc- l"8Dt11a***
Clld of Lut l'ontll 3~ 7 8' 2-0 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 r 30 15 31 3"" 9/ 0 ZC> /Zoo I
Toti 1 CIIIOftf Toti 1 Iii 11 OIIS
- llt*d *tar ,_, t1* Hell C117 (prtf1r1bl7 tlld of C117) t1ltt1, l'NCI It tlld of IIOll*P\IIIIP1f19 period Durt 119 llontll .{ 2-0c:::> Dur1119 Querier 4~qc:,
f Ultll, l'Hd It llld of llt1YJ*J)UIIIC)1"9 period Tot. 1 0pel'lt1flt rot1I Operut111 If tltlft 111 one 11111 111 I fttlel, SPKHJ llf!ICII well - - - - - Days Ul1S lblUI 3"2- Dl,s Ulh Qull'tlf' tf-z..
11 ,,.1,1taly or put>ll~ll7-owned put,ltc w1tar supply systltll w1UI KetlUI Dep1l'uat11t PtNIU. Dal ,, Awtrl9I
- JI i I, Awera91 Our 1119 Nolltll 3 '8' Ouri119 Quarter ~3
YtU /'f4!/
GROUND WATER PUMPAGE ANO USE REPORT "oodl ""I>c=-=MF.3.c~
Sr alt lxpartmtnl or Holch and State Wactr Concrol Board Quuur 1 2 l © (Cfrc1e One)
-~X.__ w.11 !1 I Pvbltc. Sfnd copy or r~rt to ~ton.I Sult ll1ltr Co11trol lot~ Offlct lftd lt9I01WI Sult HetlUI ~PH~t Ofrtc1 - County/Cf ty
_ _ _ S1><'t119(1I lftdustrtel, S~ c~, or rtport to ~toiwl StHt W.ltr Co11trol lotrcs Off1c, 0'.ller. Strid co01 of rt!)Ort ~ lttg1oll4l St.tc W.Ur COfttrol ao.~ Offtc1
- Surry
_ _ _ I/el 1(, I *na S,rl119(1) lf.sme of llaten.orks Name of Ooerltor _ 1?-.,l/7A;;;---------------
Va. Electric & PcMer Co. - Surry Posft1on/Title __-.:N.'./r;A:--------.------
-- - ~ Co N/A NJ~
Owlt'er Va. Electric and Pc1,oJer
- S1qnatur*--------- D a t e - - - - - - - -
Address P 0. Box 315 Popyl1tfon Served (Public' _ _--4.lNLL./AJA.__________
_ __,S=ur=-=ry,.._.,--"-V.=a--*_,,.____2~3_8_8_3_ Phone (804) 357-3184 No. of Connection" (Public)_._ __,N....,_./A.__ _ _ _ _ _ __
t Upention Per11ft Hullt,er (Public) ...N ...L~A=----------
Type of U(e: Puhltc _ _ !ndustrial__x__ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measurements are for I sfngle....eter field readfnq, 11st wells included fn ffeld swca No. Owner No.------- SWCI No. - - - - - - Owner No.-------
Sl<<:8 N o . - - - - - - - Oimer No. - - - - - - - SWCB No. - - - - - - Owner No.-------
SWCB N o . - - - - - - Owner No. - - - - - - - SWCB llo. Oitntr IIO. - - - - - - -
Meter readings are fn ---lga;t2..l1wll.!.Q.!!MJ2..--------------<11*11ons, 1000's of gallons. cubfc feet, etc.)
llott: If 11st.a fs 111111tttrtc1, tst1utt ~91 swce No. Owner No. 111 bo.111 111 lo...r r1ght-hllld corntr.
Da~ Heter Readfng* O.te Me~r Readtng* 6'1lons Ila ter Leve 1'*..
Used Stitt,.. IPumtM* ..
[ltd of Lu t l'lontll 7'6 2 . 0 0 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 lS 10 26 11 27 12 28.
13 29 14 30 15 31 7Y, z_oc::, * ~*d
- t t r ,.., t i
- Hell 01 (pr1fer1bl7 tftd of d17)
- Jf tO.t11, rNd It tl'ICI of 11011-p,,aot119 period
... ,, ttl111, rtld It tnd of IIHYJ-pyaip1119 period Toti 1 S.ltw Dlir t III flotl UI Tott I Optrtt1119
-o-Tou I Gt I Ions Dlir I119 ~trter - a:> -
foul Oc,er1t1111
- .. If Ut111 111 Ont 11tll 111 I fltlf, 111<<1f7 wfllcl1 well - - - - Dl11 tll ls Non tll - 52- D111 tllls Ou*rttr t:j'Z-t
- All prh1tal1 or P11t1llall7-owntd plAlltc wttar s11pp!7 171~11a 0,1 1, Avtr191 w1UI HulUI Depert.ifnt Ptrw1ts.
Our 1119 Montll - ~- .it i 17 "lur191 O..ri119 Ou1rt1, GROUND WATER PUMPAGE ANO USE REPORT !\>nth Dcce-~ ' 8 ~
W* tar Sour'Ct: S1a1e lkpartmcnl or Hcaflh and State Waler Control Board Qu1rter 1 2 3 t$) - -
(Circle One)
_-AX.__ Wt 11 (I) Public, ~no copy of report to lleg1oiwl SUtt W1ttr Control lo,rd Off1ct Ind R,gton,1 Sutt He1IUI ~Ptrtlleftt Offtc, - County/City
_ _ _ Spr1119(s) llldustr111. Send CoP1 of r,port to Reg1oiwl Sutt W.ttr Control lo.ircl Offtc, Other. s,nc1 co01 of r,port to llegtoiwl Sutt W.ttr Control Soird Offtc,
- Surry
_ _ _ Wfllh) and Spr1119(1)
"ame of Wa ter.orks Name of Ooera tor -,t-;-;-l/.,.A;;;----------------
Va, Electric & Po.ver Co. - Surry Posftion/Title __~N"/,.,.A_ _ _ _ _ _ _ _ _ _ _ _ __
e>wVer Va. Electric arrl Po.ver Co
- Sfqnature _ _ _ _ _ N/A
_ _ _ _ _ D a tNt~ e---------
Address P.O. Box 315 Population Served (Public 1 _ ___,.Nul""'A..,___ _ _ _ _ _ _ __
---=S~ur=.a,rv:...L-&<<--=-V,=a~._,L.....:2:..:3::..::8c..::8-= Phone (804) 357-3184 No. of Connection~ (Public) _ _Nu.L,j/A'4.-_ _ _ _ _ _ __
Uper1tfon Peraf t Nud>er (Public) N/A Type of U(,e: P11hltc + __ lndustrbl-X_ Other (specify .a.:.ia.:.:._ _ _ _ _ _ _ __
Jf measurements are for a single-meter field reading, 11st wells included fn field SWCB No. Owner No. SWCB N o . - - - - - - - Owner N o . - - - - - - - -
SWCB No. Owner No. SWCB No. Owner No. - - - - - - -
SWCB No. Owner No. SWCB No. lMner NO.--------
Heter readings are fn _ _ _.:.,g~a1.,1,l.,.l~o~ns~--------------- (gallons, lOOO's of gallons, cubic feet, etc.)
Note: If systa fs u1111etertd, est1aate PIIIPl91 SWCB No. Owner No. H 1n bous tn lower r1gllt-lllnd COMll1".
Date Heter Reading* Dlte Meter Reading* &illons WI ter Leve 1**-
Used Stlttc- "->tna*..
[nd of Lut ltontll 27"2..lOO 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 :?5 10 26 11 27 12 28 13 29 14 30 15 31 Z73.,t~ I c:>c:>O I
Toti 1 '-llonr Toul Glllons
- lleecl aeter suie ttae Hell cl11 (pr1f,r1bl1 tnd of d1y) II 000 t::.., zoo Uktn, rHcl 1t tl'lcl of non-,-p1119 period f t1k1n, r11cl It encl of 11t1v1*1>U11111"9 period Durt IICJ "°""'
Tote 1 Oper1t1111 Durt119 Qu1rter roul 09er1tt111
- If Uken 1n one ioell 1n I fftld, 1pectf1 wtiicll wll - - - - o.,s UI ts lion t11 3z.. 0.,s Ul1s Qu1rt1r 'f'Z-
- All prtntely or put,11u11y-owned putiltc wit.er supply S.Y'teli&
witll kt1ltll Oep1rt11tnt peraits. 0.1 ly Av,r1ge .11 i I 7 A,1r191 Dur Ing llontll 31 During Ou.rttr t,7
....... ' . ~ ...... lJ*l,;;J
......... , " \'Hr /tJ?9/
GROUND WATER PUMPAGE AND USE REPORT ~di Z>e~A/JB~
Scale tkpar1mcnl or Hullh and State Wa1cr Con1rol Boar4111 Quarter 1 z 3 ~
_ _..X_ ~ II (I) (Circle One)
Public. SfllCII copy 1f r~rt to ~1oiwl SUic Vtt,r Co11trol lot1'111 Off1et tlld lt9IOMI Sutt HttltJI OtP'rWftt Office - County/City
~ - - - Sp,-1119(1) llldu,trttl, S.,., cop7 of rtPOrt lo ~10,..1 Sutt lllter Co11trvl lotrt Offctt
- Surry Other, Stnd coc,7 of rtPOrt to t.91~11<11 Su~ ~tcr C0ntroi ~1'111 Office
- "*me 1).l/er of Witer,,orts Va. Electric & Po,,ler Co. - Surry Va. Electric arrl Pa,oJe.r Co.
Address P 0. Box 315 Name of OoerHor Sfqn*turt N/A Posftfon/Title ---.N:;-:/;;;A:-------------
N/A 0.te __
PopulAtfon Served (Public' _ __._,N"'-/.,..A.._________
---'SO<Cur=-::ry~,~V=a_,_._._,-=2=-=3c.::8...;:;8-= Phone (804) 357-3184 No. of Con~ctfon~ (Public) _ ___.N~/A.....___ _ _ _ _ _ __
N_f_A______
Up era t1on Penaf t lbt>er (Pub 11 c) .. N..,/,,:..A"---------
Type of U<.e: Puhlfc *_ _ lndustrfal--X- Othtr (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If me1surements IN! for I sfngle-tieter ffeld re,df119, lfst wells Included In fftld swca No. Owner No.------- swca No. - - - - - - Owner No.-------
SWCB No. - - - - - - - Oitner No. - - - - - - - swca llo. Oitner No. - - - - - - -
SWCB No. Oitner No. - - - - - - - SWCI N o . - - - - - - - Oifner N O . - - - - - - - -
Meter rudings ire Ill _ _ _;ga-.1.,1.:ons~---------------- (g111ons, lOOO's of g111ons. cubic feet, etc.)
Own N .::::,C,r-)S"T"fl;..uC,."i'LON Iota: If 11stea fl ur,.iettrtd, Ht1.. tt ~91 SWCB No. er o. -:s1-rc:: 111 boaes 111 lo,,er r19ht-hllld COl'Mf'.
Date Keter Re*dfng* G.11ons Wlttr Level**" Dite Meter Reading* S.1lon1 Vi ter Leve 1**"
lti,iip t 119" Used Stattc" 1,,_;, .......
[lld of 16 Lut "°""' Z(.. Jz4,r;-ot:>
,111/HI/Hf.l.
1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 g 25 10 26 11 27 12 28 13 29 14 30 15 31 27 I q S z.c:,o 470 I 7 0 0 I I Tota I C. IIOllf Toul C..11ons
- ~., acter uac tlat ttca ~, (pr1fcr1bl1 tfld of d11J 111,r 1119 "°" 47~ 7 0 0 D1,r109 ~,rter I t::.z I/ 7co
- If t1t111. rttd 1t tlld of --~1119 per10d UI /
- If Ultt1. rttd It end of 11t1,,-~1119 p,,,ocr Tota I 0perlt111f Toul C)pfratt11t
.... ., lll111 fa ont totll 111 I fttlC, IPKlfJ llfl1cll 111tll - - - - o., I tJl11 Nontll 3Z. Dl7' Ult I Ol,1rtlf' ~z.
- All ,,1utel1 or p,AltCA1l17-owntd p~lfc ~tu 1uppl7 11~teaa wflJI Ku.ltll Dtp,rtJocnt ptratU. Ott 1, ,htrll)I Ai 17 l,tr191 o.., 1~ "°"'" 1</,74"/ O..ri"9 o.. uttr 17 t.z 7 I
_...... , .......... " f.Hr !'ff/
... ~. , ,,.,. .... lJ*~J GROUND WATER PUMPAGE AND USE REPORT lfcntJI /lfhv~ ~ c7~
Sralt EHputmtnC o( Hutch and ~le Wactr Cone~ Boartll Quarter 1 z J ©
__X,,__ 11t II h I Pwbllc. ~ftd copy af rtl)Ort to lf110I\II Sui. Vlttr C.Ofttr,il lotr11 Offlct 111d (Cfrcle One) l191o,wl Slllu tlf1IUI Dti;i.rtMftt Office - County/City
- - - ~prt119(1J llldustrt*I. Seftd c~y of rtpOrt to ~lo"II Sutt Vilar C.011trol lotr41 Ofhct
- Surry Other. Set>CI co01 of rtpOrt to lt9101WI Sut, tut.tr COf!t~! S.0.;11)fflct
- "*me of 1/Uen,orts va. Electric e>wl/er Va. Electric cuu Address P O. Box 315
& PcJ,..,e.r
--..1 Co. - Surry l'oNer Co
- _ __,S""'ur=-=ry~,~V=a-=-.__,t..-=2=-=3=8-=-8=3- .Phone (804) 357-3184 Ka.,. of Ooerlt~r ---;?-:;-J/,;A.--------------
Pos ft ion/Tit 1e --~Nn/.,.A_____________
SfQn.tur, _ _ _ _._c... N/A Poput1tfon Served (Publ1c _ ___._,NIL/..,A.._________
1 t<lt~
_ _ _ _ O.te - - - - - - - -
No. of ConMct1oM CPub11cl _ ___..N.........,/A....__ _ _ _ _ _ __
Uper1t1on Peraft ~ r (Public) NJA Type of u~e: Puhlfc +__ llldustr111 _x_ Other (specify ..L!.£~---------
Jf ~*surernents are for I s1ngle-ll@ter field re1d1ng, 11st *ells included 1n ffeld swca No. a-mer No.-------
SIICB N o . - - - - - - - Owner No. - - - - - - -
swca No. - - - - - - Owner SWCB llo.
"°* -------
Owner No. - - - - - - -
SWCS No. Owner No. - - - - - - - SWCI !lo. ~ner IIO. _ _ _ _ _ __
Meter re1dings ire fn _ _....:ga~li..llo!oa.ans..i;;z__ _ _ _ _ _ _ _ _ _ _ _ _ _ (g111ons, lOOO's of gallons. cubfc ffft, etc.)
1oi.: If 11st. ts 1111DtUrtd, ttU.. u FUll)l91 SWCB No. v/ /6/t> _ S-"c<>wner No, A 111 llous 111 10"1tr r1ght-heftld corntf'.
Date Heter Rud1ng* 6111ons w,ter level**" Dile Keter ltead1 ng* &allons W.ter level**"
Used Sutt,** l,i,i,p11M1"' Used Sutt,- "-i11111* ...
[Ad of '///////1//////IJ un fiol'IUI rt. 6/~~o (//
'I////J/////I.*'
16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 '1'7 7 z..900 7~ Soo 14 30 15 31 Toti t C.11oru Toul C..110ftl
- llof -ter *
- tf* taca u, (pr1fer1bt1 tftd or d11) Dwr 111!1 ltoflUI 7~ ~.;e-"' Dwr1eg ~1rter Zs/ S-o=
- If t1te11 0 rttd 1t tt>CI of IIOft-""°1"'9 per10d
- If Ul1t1 0 rttd U tlld Of IIHYJ*p,,,ICl1"'9 PfrlOd Tot, I Operat1119 00 **Jf Ulen 111 one "'" 111
- f1tlf, SPKlf1 wtilcll wit _ _ __
t All ,rh1tel1 or M1fu11y-c:,,,ned pl.Citic w1i.r su~t1 s11tea1 Dl11 tll ts llontll zr Tout Opfrlt111f 0.11 tllh °""'" 6=
w1 UI ICtl.1 tll DtPirtlatnt pera1 U.
- 0.1 ty Avtr191 .it il1 l,tr19t O..r 1119 llofttll z. C:, "3 "is" O..rt"9 Ou1rttr 3 FS-8'
.,.\,,. , ,,..,. - -
- lJ*&:iJ
- * *
- I * ....,'* **R Ttu if-JI GROUND WATER PUMPAGE ANO USE REPORT ~Ui NO //6',"'1 (3 §""1:
vu,r Sovru: S1a1~ Cxpu1m(nl of Huhh and Sta~ W11~r Concrvl Boar4 Quarter 1 2 l (!)
P.~llc. St..s cop, ef rt90r\ to lf.tlOM I Sut.t V11.tr Co11tr"1>I ao,,... Olflu tlld (Circle Orie)
~~}(...__. 11111(1) lt9IOMI Sul.I HulUI Dfp.trtaflolt Offlct - County/City
- - - Sp,-1119(11 I...Su1trul. S~ c~, of rtPOrt to ~lol\l I Sutt V. !.tr Co11t.rol lot** Offtct
- Surry Ou,,r, Stnd coo, of rtport to ltglon,I Sutt~~, Cc:itrwl ao.,; OH1ct
- "'"" of wuer.orts CMM!r Va. Electric & Po,.,er Co. - Surry Va. Electric Cl.Ju Pa,.ier Address P 0. Box 315
_..,;i Co
_ ___,S""'ur=-"ry:...L..<1_..c.Va==-._.,<--=2=-=3..;:.8-=-8=3- Phone (804) 357-3184 Name of Ooerltor ---;1':;-1/,;A.--------------
Posftfon/Title __-.:N'f/r,;A;--------------
N/A S f q n , t u r * - - - - - - ' - - - - - 0.te - - - - - - - -
Population Served (Public'--~Hu..lLlA.___ _ _ _ _ _ __
No. of Connect1onc; CPubl ic) _ ___.N....,_./A.,.___ _ _ _ _ _ __
N1'1\
Uperatfon Penait Hullber (PUblfc) .acN:.i./.!..JA,___ _ _ _ _ _ __
Ty~ of U(.e: Puhlfc*_ _ lndustrhl--X- Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf ~asurements are for I single~ter field re,dfng, list wells included 1n field SWC8 No. Olimer N o . - - - - - - - SWCB No. - - - - - - Olmer N o , - - - - - - -
0.mer No. _ _ _ _ _ __
SWCB N o . - - - - - - - SWCB llo. Oiffler No. - - - - - - -
SWC8 N o . - - - - - - - Owner No. - - - - - - - SWCI llo. Oitntr N O , - - - - - - - -
Mettr readings ire 11 ---lga;&.1li..ll,.!,odns.!Oil---------------<S1*llons, lOOO's of gallons. cubtc feet, etc.)
Iota: If s11tea ts u1111et.trtd, ttt1Ntt puiip,91 SWl:B No. "3e> - 19 o - '5/ctMner No. I< 111 bol.H 111 l°""'r right*helld cOMltf'.
Date Keter Re1df119* ~llons W1ter level .." Dlte Meter Reading* Gallons ~tar level**"
~~111-* Used Sutt,- "'-'1 .... ***
[lld of 'Ill, 16 un "'°""' 'il't ?f//,300 .,,,
1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 is 10 26 11 27 12 28 13 29 'fc/t9U ~ o 1:t.lS-ooo 14 30 15 31 Tota I C. IIOftf Tou I C:.1 IOftS
- le14 *ttr u .. t i
- HU " ' (pref..-1bl7 tfld of dl1) Dwr 1119 "°"~ *7z1S-e>06 D1,rt119 ~trttr /3 0 f5"8"'=o
- If Ult11, rNCI u trod of ,_.,.,..,1119 period
... , , tlltfl, rttcl It tM of llt1Y7*SIUIP1119 Pfrlod Tou I Optru1111 foul Oc>tr*t111f
.... ,, Ultll ,. 011t wll 111 I fltlel, SPK1f7 wtilcll *11 - - - - o.,, Ults llonUI .z..., 0.1' UIII Qu1rttr bO
- All ,,111t.tl1 or i,wllca117-owlltd public w1tar suPCilJ ,,,,_
wt UI Hu.I tll DtPlrblent Ptral ti.
- 0.1 11 lwtf'l'Je _.. i 1, l,,,.,t Dur 1119 Nonth zl'8" 7j73 O..r1 "9 Qutrttr Z./'if zb.3
-.
- t I'"" I 1
Sracc lxputmcnl or Huhh an d StAtc W11~r Concrof Boaul Quuter 1 Z l ~
~__,,_>C.__ lltll(s) Pvbllc. ~ftCI cop7 er rt90rt to ~IOMI Sutt lltllr Co11trvl loi~ Offltt IIICI (Cfrcle lt9I0111l SUl.f Kf*IUI l)f~r~t Offtct - Count1/Cft1 l1'dustr1,1. S~ cop7 of rtPOrt to ~lo 1'111 Sutt IIIUr Co11trol lolr* Off1u
~ - - ~pt-1119(11 O~!Wr. Stlld co01 of rtPOrt to lt9foiwl Slilt lllllr Contrvl ao.t'f OH!ct
- Surry
- - - Vtll(sJ *I'd Sfrl"'J(I) lf*me of W*terworts Na111e of Ooerltor N/A Va. Electric & PcJ,yer Co. - Surry Po sft1on/Title N/A ai,.~r Va. Electric ard. Po,o}er Co. s f qnHurf N7A Olte lCl/1l Address P 0. Box 315 Pop,., l*t1on Served (Public' NIA
_-..:Sur=ry"-'--'1 _V.~a~.__._,"""'2--'--38_8~3- Phone (804) 357-3184 No
- of Con~ct1on, (Public) NIA Up erltfon Perwf t Kuat>er (Publfc) Jj_LA Type of U(.e: Public*_ _ !n<lustrf*l __x__ Other (specify_
Jf IM!Uurenents *re for I sfngle--11eter ffeld ruding, 11st well s fnclud~ fn ff tld swca No. o..ner No.------- swca No. <Nner No.
s.ca No. Owner No. - - - - - - - SWCI llo. Owner No.
SWC8 No. Owner No. - - - - - - - SWCB No. Oitner IIO.
Meter readings are fn _ __,:ga~l...11,!,Q.aDS~--------- (g11lons, lOOO's of gallons. cubfc feet, etc.)
lloU: U IJSla h ul'f!ltUrtd, tstluU ~91 SWCB llo.,3/ J9o S-z.c. Owner No. C 111 boaa 111 t°""'r rf9ht-llllld tonier, Date Heter Re1ding* ~llons WU.er Leve 1°" Dlte Met.er Rudtng* &.11ons llatff Level**"
1.._, ..... _
Used Sut1, .. I P'i,ap 1M " Used suu,..
hd of Lot f'IMIUI :Z?~'f'Z. t.Jo~ 16 1 17 2 18 3 19 4 20 s 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 51 S-,S'ZRo Z foZ.,300 14 30 15 31 Tou 1 C. llo,i1
- .... *tar *
- t111f fftll ~, (pr1f~1bl1 1ncl of d11)
Tota t Ca"°"' 1~.0230-0 111.ir 1119 lloftt.11 Dwrl119 f),trter 7 gs;- I "Z<::>c::::,
- ,, Ul.111, rNCII It Ind of --p,,,,,of119 jlltrtOd
- , Ullll, rtK It Ind of IIUYJ-puap1119 per10d Tou I l)per1tl11t
. rout Optrut111
.... ,, Ultn 111 0111111ll I* 1 ff1IC11, spec1f1 wfllcll wll - - - - o., s Ult1 llonUI 217 Dl.r, UIIS Qu1rttr ~o t All ,r1uul1 or ~ltcall1-owlltd p~ltc **Ur supplJ wt UI ICU 1 UI Otpartlafnt ptnat ts.
,,,t,.
- Dlt ,, .htrl9e .1til1 l,tr191 Our I 119 Non Ill /oo 07.:, Dwr1"9 Qvtrllf /Z.Z... .S-z...o
'J*l.;;J
,1*\,* * '" -~*
GROUND WATER PUMPAGE ANO USE REPORT 1/Htr Sovru: Srate lxputment or *Huhh and StAtc Water Control 8oar4
_ __,,.,X.._ llt II h I Pvllllc. ~ncr cop, tf rt90rt lo ~1oiwl Sutt ll'tltr Coftll"OI lotrf Offlet * ..,
l191oiwl Sult Holt.II ~~rtNftt Off1ct -
- - - ~1119(11 llld111tr11l, Send C09J of rtp0rt to ~lo,wl Sult litter Co11tr,il 1ot,, Off1c, Other, Stlld c~, of rtpOrt to 1,9101111 Sut, INttr Cont~! !o41"1 Offlci
- llf*me of lliterworts Va. Electric & Power Co. - Surry o.M!r Va. Electric arrl Po,.Jer Co.
Address P O. Box 315 Surry, Va. , 23883 Phone (804)357-3184 Na111e of OoerHor -,Z.:;'1/T,A.--------------
Posltlon/Title __~Nfl/r..A_ _ _ _ _ _ _ _ _ _ _ _ __
Sfqn*ture N
/A PopulHlon Served {Public'--~HIL/L<AL--_ _ _ _ _ _ __
Nt~
O.te - - - - - - - -
No. *of Connection< CPubl lc) _ ___.N..._/uA4-_ _ _ _ _ __
Uper1t1on Penaft Hult>er (Publfc) N/A Type of u~e: Public+_ _ lndustr1*1 ___x_ Other (specify ...,_....:..:.._ _ _ _ _ _ _ __
If 11e1sureinents ire for* s1ngle--cieter ffeld re,dlng, lfst ~ells fncluded 1n ffeld S1o1C8 No. Owner No. SWCB N o . - - - - - - Owner No.-------
SWCB No. Owner No. SWCB No. Owner No. - - - - - - -
SWCB No. Owner No. SllCI llo. u.ner IIO. - - - - - - - -
Mtttr readings ire fa _ _..;:ga:;12,l..,l~o.!!ns~--------------<s1llons, lOOO's of g111ons. cubfc feet, etc.)
llote: If srsta fs urwettrfll, tstlllltt ~91 SWl:B No. Owner No. -t::> 111 bous 111 lowr rlgllt*htnd ctlnllf',
Date Heter R"dlng* G.llons ll1ter Level**" O.te Meter ltudf ng* S.llons Viler Level**"
Used StAUc.. "->11111*-
lut l'Grttll I f.zrr
'" 7t:?o ~
- 16 1 17 2 18 3 19 4 20 s 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 IZ,6"/~~ ?'6 s-~
14 30 15 31 Toti I C.l11111t Toul C.llOIII
- leNI *w s-, t i
- uca ,., (Jlf'tftrtllly Ind of d11I
.. ,, Uttn, reed It tnd of 11011-p.,aipl119 jllfrlod
~r 1119 fton Ul 8"~ $00 Dllr 16CJ ~Ir ter 1 7fsoo
- 11 t .. lft, rtt4 ll tnd of lltoy-~f"t per,od Tou I Operu 1111 Tot.II Optr1t1"9
.... ,, Uttft la one "'" 111 1 ,1,1,, 1PKlf7 wtilcll wll - - - - Dey I tll I S llontll vJ DIJ1 tllls Outrttr ,bo t All ,"rh1tel1 or ~tlc,lty-owntd public wet.Ir supply s,,t_
Del 17 Anr191 JI ii J. l,e, 191 w1UI kHltll Clt~rtlatnt PtNIU. .
Dllr 1119 llontll Zf8'3 O..ri"9 0111rttr Z- 7f z._
Ttu l~f./
., ...... ,,,... - * * (J*l,.jJ GROUND WATER PUMPAGE ANO USE REPORT lb!UI Nova-~ a.z-~
11.cer Sowr,:e: S1ate lxputmcnc o( Hu Ith ind St.tt Water Control loar4 Qu&rttr 1 Z 3 (i)
__x.__ "'11 !'I Pwbltc. ~,,ci cop1 of rt-p0rt to ~loiwl St,t, Veter Co11lr11I to.rill Offln 111d (Circle One) h91o,.,. I Sutt Kte llJI ~P'rtaflolt Office - County/City
- - - Sp,-1119(1) lr,du1tr11l. S~ coP1 of rtPOrt lo ~lo,wl St,le V.ter Co11trol to.rill Offtct . Surry Othtr. Stnd co01 of rtport to lt91o,wl St,c, v,1.er Co,,trol ~rs!! Offfct
- IW*me of W&ter-..orts Owller Va. Electric & PcMer Co. - Surry
- - --~
Va. Electric arrl Paw1e.r Address P o. Box 315
_ __,S=ur=-=ry:....,1..........
Co V._a___.~,.__2~3_8_8-3_ Phone (804) 357-3184 Na1ie of OoerHor _ 1?-:;-l/7,A~-------------
Pos 1t fon/T it 1e __-iNf:/r..A:---------,,.,..,....,------
N/A S f Q n
- t u r * - - - - - - - - - ~te - - - - - - - -
Popul&t1on Served (Public' _ _-4lNIL/olllA,___ _ _ _ _ _ __
No. of ConMctfon~ {Publfc) _ _N........,/A...__ _ _ _ _ _ __
N1~
Uper1tfon Pena1t ltuwt)er (Pub11c) .&N:..c.1..!..A.___ _ _ _ _ _ __
Type of u~e: Puhllc*_ _ lndustr111__x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If measurements are for I s1ngle-aieter field rud1ng, 11st welh included 1n fftld SWC8 No. Owner N o . - - - - - - - swca No. - - - - - - - Owner 11o. - - - - - - -
SWCB N o . - - - - - - - O.ner No. - - - - - - - swca No. Owner llo. - - - - - - -
SWCB No. O.ner N o . - - - - - - - swca llo. Uifner IIO. - - - - - - -
Meter readings ,re 111 --~ga~li....li.:,,ol!_ns~--------------Cg*llons, lOOO's of gallons. cubic feet, etc.)
llote: If s1sta fs unwttrtd, tst1Mtt IUPl91 SWl:B No. JS° z -/tfo- ,
7/ P Owner No. =Water level .... 111 bous 11, 1o-er r 1gllt
- Ila 11d COl"ftef'.
Date Heter Rt1d1ng* Gallons O.te Meter Reading* S.llons W.ur level .....
Used St1t1c** Used St&Uc..
~t, c./~1000 ~
[ltd of Lut lbllJI ,, 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 t,ft.3oS"oo ~113.S-60 14 30 l5 31 Tou I C.1 IOftl
- ~tf *tar
- If n* tlat uc* 07 (,ref"°1bl7 tnd of d11l t1le11. rNd It tnd of __ ,._.,1"'11 period Toti I C.110III 111,r Ing !bill 31f3 S""'~ 111,,1119 Ql,,rur ~?3/ 7oc:::>
- If Ullfl, rud It tnd of ~01-~1"'11 per,ocr Tota I llper1t111t Tot.Al C)perat111t
..... ,, tallft fa one wll 111
- rtelf, 1P<<ff1 wfllcll "'fll - - - - o.,I lJI h llon UI q Dll1' UIIS Ou1rter ~o t All ,,h1tal1 u Plll)lfull1-0rned piiil tc **ter suppl1 ,,ueaa w1UI ICt&_l_UI Otp,rbotnt Pt,.lts. DII 11 Artr191 .it i 11 A,er191 Dur 1119 llotatll /o?J ~7 O.,ri"9 Ov*rter f y 1r&,2-
Tur 16Y:f/
GROUND WATER PUMPAGE ANO USE REPORT ~th /!lo Ve-At Be:7S:
S1.a1c ~putmcnl or Holch and Sute W11u Conc,V, loar4 Qutrter 1 2 l c()
~..,.J,.}C..__w.11(11 Public. ~lld cop, er r~rt to ~lo,w I St.au V1Ur C611trol to.~ Offlct 1114 (C1rt1e One) lt910MI St.at, Ht1IU1 OotPtrtatllt Office - Ccxinty/C1ty
~--~1119(1) lodu1tr11I. S~ cop, of roort to ~10,,.1 St.alt V.Ur Col'ltrol IOi** Offlct
- Surry Ot11er. Stfld co01 of r1POrt to 1,910"'1 SlH.! !uur Cont.ol ;.;.,.. OHict
- "*me of Wtten.orts Va. Electric & Power Co. - Surry Owller Address Va. Electric oa..1 P 0. Box 315
-......:1
_ __,See.:ur=.:ry~,__,_V-=a.:........,r..-::2:..::::3=8=8=3-Pa,,,,er Phone Co *
(804) 357-3184 Na~ of Ooerltor -,1':,l/TiA\_ _ _ _ _ _ _ _ _ _ _ __
Posftfon/Title __-.:Nf;/r..A:----------,,,-+.,.-------
Sf Qntture --~-_c...____N/A o. u - -
Pop,.,lttfon Served IPublfc' _ __....Nul....A.,.__________
No. of Connection,; CPublfc) -----H~IA....._________
Uperat1on Pel"llft Mult>er.(Pub11c) .&N,../.._A._________
N1"1\
Type of u~e: Puhlfc!___ Jndustrf*l__x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf ee*surenents tre for I sfngle~ter ffe1d reading, 11st wells Included 1n fh1d swca No. Owner No.------- swca N o . - - - - - - ~ r No.-------
si<<:a No. - - - - - - - O,tner No. - - - - - - - swca No. Owner No. - - - - - - -
SWCB No. Owner No.------- SWCB No. Owner IIO, - - - - - - -
Meter readings *re fa --~ga;1Sa.1lw1l~ons~--------------Cv111ons, 1000's of gallons. cubfc: feet, etc.)
lloU: If systea h unnettrtd, Htta.ett ~91 SWCB No. Ol,tner No. fl, boan 111 lo-er rfgllt*hllld conllf',
Date Heter Rud1ng* Dltt Meter Read 1ng* ~11ons ~tar Levelee" Used St.alt,.. ,,._;,...,u.
Clld of un "°"t11 3~~'f8'o 16 1 17 2 18 l 19 4 20 s 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 3~ 732,o I 8'7'b 14 30 lS 31 Tot.I I C.110llt
~rt 1111 lb!UI / F,ra Tou I C.. llCHIS Dl.,rt119 Q,.,11rttr '3~~~
Tott I Oper1t1111 Tot.II ~ratlllf o.,s Ulh llonlll z.7 0.11 Ults Ovarttr ~C)
Oat 11 Avtr191 A ilJ lvtr19t Dvr 1119 llontll d,s 111.,, i ..g Q,,u ttr C:,/
0
- ~
- 11 l ' \ o , 1 1 1 * * "
Tttr 1/<Pf I _
GROUND WATER PUMPAGE AND USE REPORT lbltJI 4:PV~M~~
W* ltr Sowrt I: S1at1 ~partmtl\C or Hullh and Sutt Water Control Boar4 ~arttr 1 2 J (!)
_-..A}{..__ Wtll(1J Pwbllc, Stlld cop1 1f rt-pOrt lo ~lo,wl Stu, IIHtr C.011trol lotrf Otflc, ,.., (Cfrtle One) lt910fttl Sutt HulUi ~P'rtN<lt Office - County/Cft1
- - - SPf'l"9(1J llldustrul, S~ cop, of rtpOrl lo R.vlo/\11 Sutt W.ttr Co11ll"Ol lotrf Offtc, . Suny Otlltr. Strid cao, of rtpOrt to 1,910/\II Sutt ii.ttr COfttrol ~~ OHie;
_ _ _ lltll(s) *lid S9rf"9{1)
- lf*IIII!
Ow'l4r of WHer.orks Va. Electric Address P 0. Box 315
& Po,..,er Co. - Surry Va. Electric arrl Po,..ier Co.
'S=-ur=.,ry:..,_,1'--'-V~a""'"._,._2~3_8_8_3_ Phone (804) 357-3184 Na~ of OoerHor -,?-:;-1/,;A;.---------------
Posttfon/Tith _ _~N;';/r..A:--------,....------
S1QnHure _ _ _ _N_1/_A____ Olte __
Popu!Ufon Served (Publtc'---..Hul.,._A.__ _ _ _ _ _ __
No. of Connection~ (Public) _ _........
Up era t ton Pe r11f t lut>er ( Pub 11 c) .a;N"'L~A,._________
N_f1't.
N(A....__ _ _ _ _ _ __
Type of U(e: Puhltc*_ _ lndustr111---2L- Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If eeasurenents ,re for* sfngle~ter ffeld rud1ng, 11st wells included 1n field swcs No. Owner N o . - - - - - - - SWCB No. - - - - - - thffler No.-------
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB llo. Owner No. - - - - - - -
SWC8 No. Owner No. - - - - - - - SWCil llo. - - - - - - 0.ner IIO. - - - - - - - -
Meter readings ire 1n _ _-1ga~li...ll.!>oi!ns.!!il..--------------Cg11lons, lOOO's of gallons. cubfc ffft, etc.)
Iota: U systa ts uNDettrtd, ,u1.. u ~91 SWCB No. ()o.ner No. 4 111 boza 111 1°'"'r rfght*hllld corMr.
Date Heter Rei1dfng* 6'11ons ll1ter level**" O.te Meter Reading* &11lon1 Vlter level .....
StH1, 00 }P~fllll" Used St.tt1,.. "-1""....
Cftd of ult l'lontll 73'~o ~ 16 1 17 2 18 19 3
4 20 5 21 6 22 7 23 8 24 g 25 10 26 11 27 12 28 13 29 78 'Z.AO~
~
14 30 15 31
- lleM attar laat t i
- HCI .., (~tftr1bly tftCI of d11)
Toll I C. IIOllt DI.or f 119 floft UI
~
Tou I c.. "°"'
111.,,199 l).,rur C)
- If u1,11. rNd It tftd of 11011-puapl119 pcrfOd
- If Ule11, rtld It tnd of lltlYJ-~1119 p,r10d Tou I 0perlt111f
.... ,, llltn 11 Ont 11ell 111 I fltlf, SPKff1 wfllcll ,-ell - - - -
t All 11rh1ttl1 or ,wl1ally-owlltd p~llc w1ter sul)CIIJ 11\ltta o.,I tit h llon UI Z-J Tot.ti Operat111f D111 Ulls Outrltr ~o w1UI Ntel UI Dtp,rtiaut Pt,..tts. DII 11 A*ff'l91 ,11 ii,. l,tr19e 0..r 1"9 Montll -0 O.,ri"9 Quarter 0
-* .............. "' /,'!% I ft-ar
., ..... ,,,.,. - -
- lJ*l,;J GROUND WATER PUMPAGE AND USE REPORT ~tll /f/'Ot/'671,,/ B ~
S111e lxpar1mcnl of Holch and Sutc W11u Conlrol Boar4 Quarter 1 z J Cl:)
(Clr-cle One)
_ __...x.__ '"" h, Public. ~lld cop7 1f rtp0rt to ~1°"' I Sutt Veur Co11tt"OI 1otr11 OH1u elld atglon,I Sutt HetlUI l>t~rtacftt Office - ~nty/Clty
- - - Sp,-1119(1) llldustrlll. S...., CoPJ of rtPOrt to lt<a10ftll Suu li'lur Control loer, Off1c,
- Surry Other. Stnd coo, of rtPOrt to lt910,,.1 Suu Veur Contt"OI ~!'!! OH!c;
_ _ _ llellh! '"" S,*!"9(!)
N*me of wuer.orts Name of OoerHor N/A Va. Electric & Pc,.ver Co. - Surry Position/Tith --.N:;-:/;;;A:--------------
--- - Co N/A 1 Nt'A
().,l/er Va. Electric arrl Po,o}er
- S1qn.ture Cite--------
Address P 0. Box 315 PopulHlon Served (Public' N/A Surry, Va. , 23883 Phone (804) 357-3184 No. of ConMctlon< (Public-) ----N~,-A~--------
t Uperat1on PeraU Nuaitler (Public) ....N"""/... A,__ _ _ _ _ _ __
Type of u~e: Puhllc _ _ 1nc1ustr111_x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf 11e1surements are for a stngle-aeter field re1d1ng. list wells Included In fh1d swca No. Oltner No. _ _ _ _ _ __
SWCI No. - - - - - - - Owner llo. - - - - - - - -
SWCB No. Owner No. - - - - - - - SWCI llo. Owner N o . - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - S\ICI No. o.tner IIO. - - - - - - - -
Meter readings *re 111 ___ga~...,l.lons,c..,---------------- (g,11ons, 1000's of gallons, cubtc feet, etc.)
Iott: If systa Is uraettred, tst1utt ~91 SW\:8 No. Owner No. ; / 111 ~.lft 1n l~r r19ht-llllld COM'II\",
Heter Rtad1ng* W*ter lev11**tt O.te Meter Reading*
- -~
Date &. 11ons S.11ons V.ter level .. "
Used Stat1,.. "'-t11C1***
[lld of ust l'onUI z~ 8 7oc::::> 16 1 17 2 18 19 3
4 20 s 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 2.7z/ o~ ,3 /C/0 14 30 15 31 Tou I C..110lll
- lof *tar ,.._ tlat ttca dty (Pf'tftf'1bl1 encl of d11) nu Ule11, rttd 1t tncl of IIOft*,.,..,11NJ period Tott 1 C.IIOllf Dl,r
'"' lblta 3 "7'tc:>O D1,r1"9 l).,1rter S-z...o=
- If UU11 0 rtMI It tnd Of IIUYJ*pua!pfll9 per1od Tou 1 Optr1tt111 Tot.el 0ptrlt111f
-Hlf ll\111 111 Ont ,..11 111 I fltlf, lpe<lfJ ,,Mell -ell o., s tit 1s lloll U1 Z-7 DIJI Ulh Qu1rttr 60
- t. All 11rh1u1, or pv<<,ltul11-owntd p"61tc _.u, supplJ 111tta1 DII ly Awtf'l9' wl UI llul UI llepertiaut p,,.1u. A i1 J l,tr191 Dur 1119 Nontll //7 O..ri"9 Ouerlt~ ~
'fHr /99/
., .... , ' " - - * \J*l,;,J GROUND WATER PUMPAGE ANO USE REPORT lbltJi ~E~8P'.\
S111e lxputmenc or Hollh and Sut.e Waler Con1rul Boaul Quarter 1 Z l ©
_ ........X.__ 11t 11 h I ,.111tc, StllCI copy tf rt1)0rt to la91o,wl Sutt llattr Control to.111 Offlct ll'td (Circle Orii) lt9f0t\ll Sutt Ht1IU1 ~P'rtNftt Office - Count1/Cft1
- - - ~P,1"'9(11 l...:fuHrlll. S~ CoPJ of rtport to ~lo-wl Stilt "4ttr Control So.** Off1u
- Surry 0~,,.r. Stnd co01 of rtport to lt9fon,I Sllt.e "4ttr Control to.111 Offfct lf*me of Wlten.iorts Ka~ of OoerHor _ 1 f:;-l/11A . - - - - - - - - - - - - - -
Va. Electric & Po.oler Co. - Surry Posft1on/Titlt _ _""i:Ni°'./r..A:---------'T"+...-----
Owlikr Va. Electric ard Pc,.,.ter Co. S1Qn&ture N/A 0.te __ N_/A Address P O. Box 315 Popul&tfon Served (Publfc' _ ___..Nu/.&A..__________
Surry, Va. , 23883 Phone (804) 357-3184 No. of Connect1oM {Pub11cl _ _NUL,I/A.....__ _ _ _ _ __
Uper1tton Penaft llutiber (Publtc) ~N!:.L/~A!______...;___
Type of u~e: Puhltc + __ lndustrf1l__x__ OtMr (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 111euurenents ire for I sfngle~ter ffeld reading, 11st wells Included fn fhld swcs No. Oiimer No. swca No. - - - - - - !hmer No.-------
swca No. (),mer No. SWCB llo. Owner llo. - - - - - - -
swca No. Owner No. SWCI llo. u-ner IIO, - - - - - - -
Meter re1din9s ire 111 _ _.Jga:I.S3.Jlull.!.ol!ns&..._ _ _ _ _ _ _ _ _ _ _ _ _ _ (911lons, lOOO's of 911lons. cubfc feet, etc.)
lot.e: If systea ts ureitttl"fd, estlNt.t ~91 Own er No * .:::::oNs~c..-r,oiJ SWCB No. 51 , e- In boaes fn l°"11r rl9ht*llllld corner.
Date Heter Rt1dtng* 6111ons ll1ter leve1°*- O.te Meter Readf ng* &.11ons ~ter level ....
p Used Used StUfc.. ,.. _1AQ*<Nt tlld of fltttt~IT//1/J/I~
LHt "°"UI :z.G. zz I e:roo .,, fH 16 1 17 2 18 3 19 4 20 s 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 ~7z4c;;oo SoZ<:.o=
14 30 15 31 Tot.I I C, lion, Tou I Gt I Ions
- ~ .. 11tUr , ... t i
- HCII .., (pr1ftt"lbl7 tnd of d11J Our 1119 floftU $"02..~oo Ourlog ~,rter I/~/ oo.o
- If tll111, rt..S u end of IIOfl-pu,ilp1ft9 period
- If t,l1n, rud at end of llt1w1-~1119 per1od Tot.a I Oper1t1og rot.al Oper1t1111
°"' o.,I &o
" .. If ut111 111 wll 1* * '1tlf, s~HJ wtllcll 111tll - - - -
t All i,rh1ul7 tr pwllall7-owned Pl'll1c wit.tr suppl7 w1 UI NHIUI Dt~r~nt p,,..1u.
,,u- Ulls KonUI OIi 11 Awtt"19t Z-9 Dl,i tJII s Ou1rt1r
,11il1.lur191 Dur 1119 "°"t" r733/ Durii,g Owuttr lf/g'3
GROUND WATER PUMPAGE AND USE REPORT :fontll ec..-:z:.:::,#~-1;
~ tcr So.ire,: S1a1~ IHpartm~nc of H ulch and Suec Wac~r Concrol Board Qu*rter 1 2 l tT)
- (Cfrtlt One)
_ _...X.__ We II ( s) P11bllc. ~IICI copy of rt1)0rt to a.g1o,wl Stltl lltttr Co11tl"OI eo.r11 Offfet 1 ,-i h9to,wil Stitt ~*IUI ~ r ~ t Offtc1 - County/Cfty
- - - Sprl"9(S)
- ll\d11strtal. Send copy of rtp0rt to ~fOflil Sutl V,tfr Co11trol lolrd Office
- Surry Ot1~r. Stnd ccoy of rtf)Ort to 1,9toiwl Sutt V,ttr Control Bo.rd Offtc1
_ _ _ 1/fll(sl 1nd Spr1119(s)
*me of Waterworks Name of Ooeritor N/A ric & Power Co. - Surry Pos ft fon/T it 1e - , N : . ' / T i A \ - - - - - - - - - - - - -
Va. Electric ard. Po,,.ier Co. Sfqn*tur* N/A Oil~ __N_IA _ _ _ _ __
Addrus P O. Box 315 Population Served (Publtc' _ ___.,.Nul~A:a._________
Surry, Va. , 23883 Phone (804)357-3184 No. of Connections CPub1fcl _ _Nuu1A.-________
uper1t1on Peniit Hunt>er (Publtc) N/A Type of U(.e: Puhltc ~ Jndustrhl--X_ Other (specify --=----------
Jf measurements ire for* s1ng.1e-Nter ffeld rHding. 11st welts included fn ffeld swca No. Owner No. swce No.------ Owner 11o. - - - - - - -
swca No. Owner No. SWCB No. Owner No. - - - - - - -
swca No. Owner No. SWCB No. Otilner IIIO. - - - - - - -
Mettr rHdings ire fn ---'9:;l!a.s.l...l,..o~nsUll :._______________ (g11lons. lOOO's of 911lons. cubic feet. etc.)
Noia: If 111tea ts u,..tel"N. tsttlllu puap191 111 boaes 111 IOi.lr rf9llt*llllld COt"ftlf'.
DAte Heter Reading* G11lons o.u Meter Reading* &lllons VI tar Leve 1..-
t,i, of "4 Used 16 Used St1t1c-
'~t-*-
1 17 2 18 19 20 5 21 6 22 1 23 8 24 9 35 10 26 11 27 12 28 13 29 14 30 15 31 ft fl,¥oe, /r5:"'oo c::>
Toul C.IIOftl tar , ... t i
- HCII .,., (pr1f~r1bl1 tftd ttl, rttd It tnd of IIOA*~1"9 period o, dlyJ Tou I S.110Rf Durf 119 lloftUI /S-S-oc::>0 Durl119 Qu,r~ I S-5"' o~C>
- ten, r11d at end of 11tlYY*Pll'll>1"9 per10d Tota I Optrut119 Tot.II Ot,erntnt
... t1t1n 111 one 111111 111
- f1tlcl, IPK1fy .tilcll 11ell - - - - 0.,1 Ults NonUI di 0.11 t111s Ov1rt1r 3/
t All prh1u1, or ~1tcall7-ownN publ1c **tar supply 11ste111
- wi UI Hu I tll Oep1r1111tnt pu..1ts. 0.t ly htr191 ... ii, .. ,,.91 Ovr 1119 Montll S-Oc:>0 O..r, "9 011trt1r S-eoo
"<>nth ~C-7'o.2!>??f S1a1c lkpanmflll of Hcallh and Sc.~ W11cr Conlrol 1!011rd Qu1rter 1 Z J ~
(Cfrtlt One)
_--,,;;.X.__ lit II h J Publtc. ~IIO copy tf rfi)Ort to R.9fOMI St,U llettr Co11trol to.rd Offlct 1..i Rt9ID111I Sutt MHIUI 0.p,rtMnt Offfct - County/City
_ _ _ Spr1119(s) -llldustrlll. Stnel coo, of rtpOrt to le9fD111I SllU ltettr Control ao.l"CI Off1ct . Surry Otller. Stncl coo, of rtPOrt to lt91on,I Sutt lttUr COlltrol So.1'11 Off1ct
_ _ _ W.ll(sl 1nd Spr1119(s) of Water-worts Naine of OoerHor N/A ric & Pc:Mer Co. - Suny Posft1on/Titlt - . N : . / r . A . - - - - - - - - - - - - - -
Va. Electric an:i Po.Yer Co. Sfqn,ture N/A ~te __ N_IA Addrus P O. Box 315 Population Served (Publfc 1 _ ___.,,Nul~A~--------
Surry, Va. , 23883 Phone (804) 357-3184 No. of Connection~ f Publ fc) _ _N....._./A~--------
t Uperat1on Pera1t Humer (Publtc) _N_I_...A___________
Type of U'-t: Puhlfc _ lndustrf1 l _x_ Other (specffy - - - - - - - - - - - - - - - - - - - - - - - -
If IIW!4Surements ire for I sfngle~ter ffeld re1d1ng. lfst wells included fn f1t1d swce No. a.mer No. _ _ _ _ _ __
swca No. - - - - - - - Oalner No. - - - - - - - -
SWCB No, - - - - - - - Owner No. - - - - - - - SWCB llo. O,,ner No. - - - - - - -
SWCB No. Owner N o . - - - - - - - SWC8 No.------- ~ner IIO. - - - - - - - -
Meter re1dings 1re 1n _ _ _g~a~l.,.l,,,.o..,ns=--------------- (g11lons. lOOO's of 911lons. cubfc feet. etc.)
llot.t: If sysua fs u.-itttred. tst1Mt.t ~ , .
SWCB No. 3o- 1~ o- 51 C. Owner No. 8 tn bons 111 loo.er r19llt-llllld COffitr, Date Heter Read1 ng* Dlte Meter ltt1df 1'19* Gillons Water Level .. _
USed St1t1c- "-111G***
16 1 17 2 18 19 20 5 21 6 22 7 23 8 24 g 25 10 26 11 27 12 28 13 29 14 30 15 31 'j'~ <J//,3oO S-?3o ?oo ToUI C.IIOAI
- t1r ,.., t111t HCII 11., (pr1f1ubl7 Ind o, d1, J rot.a I C.11Dftf Dur1 "9 llofttll s-- ? 8'(') 8' oc. Dur1119 Ql,uur S" 8'?o J?o e:>
- ,>fl, rNd 1t tnd of AOfl-Pl'ICl1"9 period t111, rt1d 1t tnd of 11t1w7-~f"9 period
.... ,, UltA IA OM 11111 111 I ,1,lf, s1>1<ff7 w!l1CII well - - - - o.,,
Tou I Optr1t1119 tll 1s !loft tll 31 rot.II Opfratl"f 0.71 Ulis Ou1rt1r 3/
t A11 prfnttl7 or ~lfc,117-owntd public **tar suppl7 s,,u.
wtUI Ht1IU1 Oep1r1Jlle11t Ptra1U. O.t 17 Awtr191 _.. i 1J l,tr19t Our 1119 Montll l~'f 703 Dur 1 "9 Qua r ttr /8'tf 70 3
GROUND WATER PUMPAGE ANO USE REPORT ~di tt?c...700 e-1' S1a1e IHpartmffll or Hulth and State Wa1er Con1rvl Boar_. Qu4rter 1 z l(!)
_ __...X.__ Wt I I ( s J P11bllc. ~nc, CDP! tf "f)Ol'"t to R191on.tl Sutt IIU.tr Control Boif"d Off1ct ....
(Cfrcle Oni) b9I011AI Stat, KHIUI ~rtMftt Office - County/Cf ty
_ _ _ Spr1119(sJ
- fl\duHrU1. Send COIIJ of ttPOrt to ~1on,I Sutt W.ltr Conlr111 loil'"III Offtct . Surry Other. Stlld coo, of rtPOrt to lt9to111I Sutt V.ttr Control Boird Off1ct
_ _ _ W.ll(s) *nd Spr1119(sJ me of Watel"WOrl::s _ Name of Ooerltor N/A
- a. Electric & PcMer Co. - Surry Posft1on/Tftle --;;N-;-/"A.-------------
- ---~ Co '/A Nt'A
().(l/er Va. Electric aro POHer
- Sfqn,turt N O.te - - - - - - - -
Addrus PO. Box 315 Populatfon Served (Publfc _ _--'JN1L/£1A.___ _ _ _ _ _ __
1 Surry, Va. , 23883 Phone (804)357-3184 No. of ConMctfon~ CPublfd _ _Nu.ulA...__ _ _ _ _ _ __
t Uperat1on Pel"ll1t Kufft>er (Public) .,..N:.c.l~A:.___ _ _ _ _ _ __
Type of u~e: Puhlfc _ Jndustrf4 I __x_ Other ( s p e c i f y - - - - - - - - - - - - - - - - - - - - - - - -
If measurements ire for* s1ngle-11eter ffeld re*dfng, 11st wells fncluded fn fftld swca No. Owner No. _ _ _ _ _ __
SWCB No. - - - - - - Olffler llo. - - - - - - -
SWCB No. Owner No. - - - - - - - SWCB No. - - - - - - Owner No. - - - - - - -
SWCI N o . - - - - - - - Owner No. - - - - - - - SWCI llo. - - - - - - - O-ner NO.--------
Meter rHdings ire fn _ __:g~a5iLl..l.loi.:os~---------------(g11lons, lOOO's of 911lons, cubfc feet, etc.)
Note: If 111 tea 1s UIVlf tend, H t111tt,1 Pl'IIPl9' S"'B No. 31 J'?O - S'Z:C.Owner No. ~ fn boxes fn 1~r rt911t-llllld con11r.
Dite Heter Reading* Gillons ~ter Lev11*-- Date Meter Reading* &lllons Wit.er level**-
dl/lJj' ~~
IIYlll)1n .., Used Static.. 'l'lal t na* ..
Clld of Lut l'cWIUI z/.z4c/o~& ,,. 16 1 17 2 18 3 19 4 20 5 - 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 z~~1Z'foo 9 ,,jej-3 'foe.
Tou I C.IIOftf Toul ei,l10A1 ter s~ ttae ,,ca dlJ (pr1f1rtb17 tlld of d*1I p, rHf ,t tlld of non-l)UIICl11WJ per1od Our 1ng "°11U1 -'I- ~if 8' 9&t::i Our t 119 l),ar ter 44~g 900
- &lift, rttd It tnd of IIHYJ*Pl-.if "9 period Tot, I Opcr1t1119 rot.al Oper1tl"f
" .. If t1t1n 1n Oll:t *II t11 a fltlf, sptc1f7 .tl1cll wl1 - - - - o., I UI h Non UI ..3/ 0.11 Ul1s Ov1rt1r 3/
- All prh1t.el7 or pvt,l1call7-owntd publ1c water suppl7 s,s~
wl U1 Hu I U1 Oep1rt111ut ptn1t ts. Oat IJ .AYtrl9I .1til7 btr19*
Dur I 119 Monti! 1.-/3 S-/,3 Our1119 Outrttr /~3S-/3
- (;jnl ..... ~ lJ-~)
GROUND WATER PUMPAGE AND USE REPORT SI.air lxpanmffll or Hullh Ind Sutt Waarr Control loartl
~_.:X:......_ Wtll(1) P11bltc. ~nc, copy 1f ~rt to bg10MI Sutt Wei.tr Co11trol loa~ Office elld l19t0ftll Stitt H11IU1 ~rtaeit Offtc1 -
- - - Spr1119(1) lndustrUI. Stftd copy of rtpOrt to ~10l'ltl Stitt W.ttr Co11tNI lol"1! Offtc1 Other. ~nd CO(lJ of r~rt to Rtg1on,I Stilt W.ltr Control Bou'f Offtu
- - - 11tll(1) *nd Sprtr,g(I)
~ of Waterworks ~ 1 of Ooer1 tor --;~:;-1,,A.---------------
va, Electric & Po.ver Co. - Surry Posftfon/Title _ _.:N..:./r.A~-------------
Owl4r Va. Electric an1 Po,oJer Co. Sfqn1ture N/A Olte __ N_JA Address P 0. Box 315 Population Served (Publfc' _ __.Na.,,l.s:.A~--------
_ __,Sur=-==ry'-'--"",_V..c.a=--._.,'----'2'"""3_8_8___3_ Phone (804) 357-3184 No. of Connections {Public) _ _...,,N~[A~--------
Uperatfon Perait Nuiltler (Public) ... .N.._/.:.:A.__ _ _ _ _ __
Type of Uc:.e: Puhlfc*_ _ lndustr111__x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measurements ire for* sfn9le-t1eter ffeld rud1ng, 11st wells included fn field SWC8 No. Owner N o . - - - - - - - SWCB No. - - - - - - Owner lo. - - - - - - -
SWCB No. Owner No. - - - - - - - SWCB No. Owner llo. - - - - - - -
SWC:8 N o . - - - - - - - Owner No. - - - - - - - SWCB llo. - - - - - - Uimtr I O . - - - - - - - -
Meter re1dings 1re tn --~g~aa.l""l~ons,{Ui;i._______________ (g11lons, lOOO's of g1llons. cubfc feet, etc.)
llota: If system ts ur.etartd, est1Nta ~
S~I No. Owner No. b 1n boxes fa low, r1gllt-llt..S corner.
Date Heter Read1 ng* IQ ter leve 1*.- 0.te Meter Re1d1 ng* C..llons Vi ter Leve 1**-
Used Stltfc- "-'fna*-
Clld of Lu t l'lon t11 I ~~S-7d 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 /~2!.tf / e>O ~3 (!)00 Toti I £1110ftf Total t..llOAI Ourf 119 llon tll ~,3 c,OO Dwr 1119 l),ert.er ~,3oQC)
Totj I Operu1119 roul Oper1tf119 0.11 tllt I Non tll 3/ O..rs tll ts (!ulr ter .3 /
0.1 ly Awere91 ,11111 A,1re91 Our 1119 Nontll .,._3 OC!>O Our i"9 Ou1rt1r 3 ooc::>
GROUND WATER PUMPAGE ANO USE REPORT l\:>n th _..;;t::?,:._c::.:_~....;:o;...=e,;..;;~~-
S1all' ~putmenl oC Health ind Su&e Wall'f' Con1rof lloarllll Qu1rter 1 2 l (,1f)
~___..,}{.__Wt11(s) Publtc. ~nd copy of rt90rt t4 leglONI Sutt I/at.tr Control loal"I\I Off1ct ,.,
(Cfrcle Oni)
- Rtg10ftll Sutt NttlUI Dfptrtatftt Offfct - County/Cfty
- - - Spr1119(s) Industrial. Stftd C09J of rtPOrt t4 ~IOIIII Stitt Water Control lotr-41 Offict
- Surry Other. Send coo, of ~ r t to *,91on,I Sutt Wat.tr Cont~l loar-41 Offict
_ _ _ W.ll(s) *nd Spr1119(1) me of Wa ter...or ks Hue of Ooerltor -,?-:-.'l/,;A.--------------
- Va. Electric & Pc"'1er Co. - Surry Posftion/Tftle _ _"i"N.i/r..:A_ _ _ _ _ _ _,,__,___ _ _ __
e>,,,ller Va. Electric ard pc,..,er Co. Siciniture N/A O.te __ N_IA _ _ _ _ __
Address P O. Box 315 Population Served (Publlc'--..-Nu.{.£CA..__ _ _ _ _ _ __
Surry, Va. , 23883 Phone (804)357-3184 No. of Connection~ (Public) _ _N ~ / A ~ - - - - - - - -
+ Uperatfon Per11ft Nu!iber (P\llb11c) _N...../...,.A.__________
Type of U<.e: Puhlfc _ _ lndustri1l_:.X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If etasurements ire for I sfn9le-11eter ffeld re,dfng, 11st wells included fn ffeld SWC8 No. Owner No. SWC8 No.------ Or.Iner lo.-------
SWCB No. (),mer No. SWCB llo, Oliffler N o . - - - - - - -
SWC8 No. Oltner No. SWCB llo, Omtr IIO. - - - - - - -
Meter re1dings 1re fn _ _....;ga~l...1.:0.ans~--------------C~llons. lOOO's of gillons, cubfc feet, etc.)
Nolt: Jf systa ts ~tend, est1-tt puap191 SWCB No. /~2. -l9t> -7/POwMr No. F 1n bolfl 1* 1 ~ r1911t * .._ corMr, Date Heter Reading* Gallons W.ttr lev11*-- 0.tt Meter Readfng* C.llons VI ter Leve 1..-
Used Static" '--1-* ..
'{/////////"
Cnd of Lut l'lolllll ~3 t f J'f'e:>O ~H~~ 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 ~(, 48'70(:)~ Z 7?8' 2.eJv Tot.I I ClllOAt Toul C.11Ms attar HIit t1ae ttcll d*J (pr1ftr1bly end of d1yJ 1l1t1, rttd It tlld of IIOft*l)ullCl1 ft9 period Dur 1119 l'on tJI Z 7'?f.t z.e,o Dl,T1 .. ~arter 27?8' z..e;o tll111, rttd at encl of 11t1w,-puap1119 per1ocl Toti I Oper1tl119 fot.11 Oper1t111t If t1le11 in one_ wll tn I fl1ld, specify lifllcll wll - - - - Dey I tll11 llonUI ..3/ Dl,s Ulh Quarter -3/
- t All pr1,1ttly or putillc,lly-owntd public **tar supply syst.elll wt UI Hu 1 lll Dtpartlafnt perwf U. 0.1 ly Awtr191 .MilJ A.. tr191 Ovr 1119 Mofttll '8'9 9,4z. Ovrillf Ouart1r ?761'~"2-_
GROUND WATER PUMPAGE ANO USE REPORT l\:>nUI t?~ 7o.c5 S7f S1a1~ ~partm~nl o( Ht1llh Ind State W11tt Conlrol lloar4 . Quuur 1 2 l (f)
_ . . .x...__ ~11<11 Pwblfc. SellO copy 1f ~ r t to it.gfon,l Sutt ll1ttr Control lo&rd Offlct 1..,
(C1~1e Oni)
Rtgfor,el Stitt llftlUI ~Ptrtaeftt Offtc1 - County/City ll>dustrf11. Stftd COl)J of rtpOrt to le9f0t\ll Sutt W.ttr Co11trol lo.1"11 Offfct
- Surry
- - - Sprlft9(1l
_ _ _ ~ll(s) Ind Sprf"9(1)
Ottier. Stlld cao, of ~ r t to lt9ton.1l Sutt W.t.tr Control brd Offlc, ---..=:-------
me of Waterworks Name of OoerHor ---;1':-;-J/,,A.--------------
va.
--- - - -
- c & PcMer Co. - Surry Electrl Position/Title N/A
--~,.--------WICVN/'""'~------
0..,M!r Va. Electric arrl Power Co. Si QnHure _ _ _ _ _ N.c../_A____ Dlte __n_n_ _ _ _ __
Addrtss P O. Box 315 Population Served (Public'---..iNLL/AOA...__ _ _ _ _ _ _-'--
_ ___.Sur==ry~,--'-V=a"'"'.-'-'. . a2c.. c3~8_8___3_ Phone (804) 357-3184 No. of Connection~ (Public) --H~IA'4-________
Uperlt1on Pena1t Nuat>er (Public) ..N ....I...A.___ _ _ _ _ _ __
Type of Uc;e: Puhli c + __._ 1ndus trii 1_x_ Other ( s p e c i f y - - - - - - - - - - - - - - - - - - - - - - -
1f aeasuresnents are for I s1ngle--11eter field re,ding. 11st wells included 1n field SWC8 No. Owner No. _ _ _ _ _ __
swca No. - - - - - - Owner 1o. - - - - - - -
SWCB No. Owner N o . - - - - - - - SWCB No. Oi,,ner lo.-------
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB llo. Oimer NO.-------
Meter re1dings *re 1n _ __;g~ae.1.i...l~ons~iiE---------------C~llons, 1000*1 of 911lons, cubic feet, etc.)
Nott: If int.a fl u..ettrtf. estilllte ~91 SWCB No. Owner No. "F fn boaes 111 1CMr rfpt...lld COMllf'.
O.te Meter Reading* Dite Meter Readf ng* C.llons wuer lev11--
Used St1t1c- "-1-*-
[Ad of _I I.Ht flolltll 5'- 't° [ ~0 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 3~S-Cf8o /~oo Tou I GI I IOftl
- Ur 1,- ti* HCII **1 (pr1f1r1bl7 tnd of d*yJ 1l1t1, rNd It tnd of 11011-pu111pt119 period Tot.I I C.IIOIU Our 1"9 !lofttJI / ~00 D1,rt99 l),,rter /Yoo t1l1n. rttd It end of 11t1w7-~f119 period Tott I C)ptrU1"9 - rout C)ptr1t1"9
- If Ultn tn one 11111 tn I ff,1,. 1pectf7 llfltcll wit - - - - o., I UI ts llon tll 3/ ~JI ui11*0u1,ttr 3/
+ All p,1,,u1, or Pllbltc,117-owned put,ttc w*ter 1u1>9l7 171la91 wf tll Hu 1 tll Dtptrt.ent pu11t u. 0.1 17 Avtr191 Our 1119 Montll S-"ii' .11 i lJ A,e,191 0..r i 119 Qv,rttr ~o
GROUND WATER PUMPAGE AND USE REPORT Yeu /'97'/
l4on di t!:) C-7'"0 ~~
II* t, r So,.,rc,: S111e ~partmenl or Hullh and Sulc Wa1er Con1rol Board Qu1rtar 1 2 J (!)
_ _j.x.__ 11, 11 1, > Pvblfc. Sf,., copy of rt90rt to l,,glor..l SUU V1t,r C1Mt111l So.~ Office 111d (Cfrde One) ltglon,I Suu Ku!Ui ~i;..rtaeftt Off1c1 - County/Cf ty
- - - ~~rl~(I) ll'>CluHrUI. Se<,c1 c09y of rtpOrt to ~lorwl SUtf V.Ur C4ntrol So.rd Off1et
- Surry Other, Send coo, of rep0rt to ltgloM! Sut: 11.tir tootrvi to.r11 Offlct
- Name of llatel"wOrks Va. Electric & Po.-Jer Co. - Surry Owlle r Address Va. Electric arrl P O. Box 315 Pc,...rer
_ __;S=c.ur==..,'[V=..,...,'---'V.c..::ac..:.---L*--=-2.::..3-=-88=3~~ Phone CO*
(804} 357-3184 Name of OoerHor ---;t-:-;-7/7,A;;---------------
Posi t fon/T it l e __---.N-.'-/r.A.-------..............- - - - ~
N/A Sf qn* t u r P - - - - - - - - - - O.te - - - - - - - - -
Popu I at f on Served ( Pub 11 c' _ __...N.JJ/uAi__________
No. of Connect f On!. (Pub I !cl ___.N.1JluA"'----------
N/.A Uper1t fon Peraft Huiit>er (Public) ....N,..,/""A,__________
Type of u~e: Puhlfc *_ _ lndustrf1l_.x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measurements are for I s1ngle~ter field re,dfng, list wells Included In field SWCB No. Owner No.------- SWCI No. - - - - - - Owner No.-------
SWCB No. Owner No.------- SWCB llo. Owner No. - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB No. ~ner "°*-------
Heter readings are 1n ___:ga~-1.. lo~ns:u----------------<gallons, lOOO's of g1ltons. cubfc feet, etc.)
llote: If 111te11 fs 11naettrtd, estfuu IUll)l91 SWCB No. O....ner No. G 1n boaes 111 l~r r191tt-hlllCI corner.
Date Heter Reading* Ga 1lons Watar Leve1°- O.te Heter Reading* ~tar Level**-
a
&.lllons Cnd of Lu t rton t11 782-~o WBA , , Used ~utlc" I 16 Used Static" "-i1na*-
1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 . 30 15 31 7a~o - ~-
- lle*d atter ,.., t111t t*c- day (prefft'*bly tnd of d*1I Toti 1 ;.11°"'
Dur1 "9 llonUI - ,r::, -
Toi.I C..11ons During Qutrter
- o-
- If Uhn, rHd U tnd of ll()ft*pullp1"9 ~r1od
- If t*len, rt1d il tnd of 11t1vy-P.,.Pf"9 period
- If Ultn tn Ont ioell 111 1 fftld, 1peclf1 ...,tell w11 - - - -
All prh1tely or pvb11u11y-owrwd pwllc w*ter s11ppl7 11'~
Tott 1 Optra tf 119 o.,, 1111, Non tll ~, Tot.II Os>er*tlnt Dt,s tllls Outrter J/
O.f ,, ,lvtrl91 ,,.91 vi tll He, I tll Otp1rt11e11t Pfl'III ts.
0.,r f "9 llontll - o-
..11 i 17 ....
0.,rir,g Ouarttr
., ...... I iilnll blr*O l J-&O)
- '-"'" Tt.r if tf/
GROUND WATER PUMPAGE AND USE REPORT lb\UI ~?-7~,4,lf w, tt r So..ru: S1~1c lxpartmcnl of Hu Ith and State Waccr Con1rot Board QIJ1rter 1 2 l *4 Pwbllc. ~nd copy of r~rt to t.<.llon.1 SUt.t lltt.tr Co11t~I Sotr'd Off1ct lf'Wf (Clrtle One)
~~}{.__Vtll(s) lt910ftll SUt.t Hult.JI ~~rtMftt Off1ct - County/Cl ty
- - - SP...1ft9(S) lndustr111. St11e1 copy of rtPOrt to ~1ollil SUU lilt.tr Contnil Sot,.. Office
- Surry Ot~r. S*nd cc,oy of rt:>ort to l~g1i>Nl $t,i.. V.t.tr Cont~I So.r,1 Offlct
_ _ _ lltll(s) 1nd Sprlng(s)
"ame of Water-.,orts N.i~ of OoerHor N/A va. Electric & :ec,..ier Co. - Surry Position/Title -,N:,/,;A~-------------
o..ller Va. Electric arrl Po.ver Co. S1Qn1turt N/A O.te __N_/_A______
Address P O. Box 315
- Popu I* t ion Served ( Pub 1i c' ____.N.,_.luA~---------
Surry, Va. , 23883 Phone (804)357-3184 No. of Connect ion!. (Pub l fc) _ __..N...,/""A"-----------
+ Uperulon Perwit Nullt>er (Public) ,&N....L~A=----------
Type of u~e: Public _ _ lndustrill_x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 111easurements are for* single-i!W!ter field re1d1ng, 11st wells Included 111 field SWCB No. Owner No. _ _ _ _ _ __ SWCII No. - - - - - - - Owner No.--------
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCII No. Owner No. - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB llo. - - - - - - Oimer Ro.--------
Meter readings ue 111 ___9~al,d..,.1,.lo~ns~---------------C9a11ons, lOOO's of gallons, cubic feet, etc.)
llott: If 17slell fs 11111ettrtd, tst1Ntt ~99 SWCB No. O..ner No. J 1n bo.us t n 1CMt" rf 9'tt *MIid corner.
Date Heter Reading* W.ter level*.- 0.te Meter Read! ng*
---~
~11ons Gallons Va ter Leve 1**-
Used St1t1c- 1,...;1,..,...
Crtd of Lot 11MUI -z.l,~ 900 16 1 17 2 18
- 3 4
5 19 20 21 22 6
7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 2.{,~ 7 0 0 /8'- f!!:;J Toll I '-lloiu Tou I Gt llC1111
- lud atter s111t tl111 11c11 o, (pr1fcr1bl7 tnd of d17) ~rt "9 "°"UI / ge:10 ~r181J C),1rt.tr /~(!:)O
- If ut111. rHd It tnd of --Pi-o1119 period
... If tlllfl, rud It end of llt1v7-puapt119 period Toti I Opert ti "t
.... ,, ut111 111 one 10tll 111 1 fltld, specify wt.tell -ell - - - - o.,, UI ts IIOfl th - ,3/ Totll Ol)erlllllf O.,s Ulls Ou,rt1r 3/
- All pr1,1ttl7 or P\IC)11e111y-owned public w1ttr supply s7slelll w1UI Huhll Dep,rt11e11t l)fnalts. 0.1 17 .btr191 .i1il7 Avtr19f Dur 1ng llofttll ~ Owri"9 0.,1rllt' s-~
- *
- I'-' I I. I " ' YHr lf9/
GROUND WATER PUMPAGE AND U'SE REPORT ~th pc..7b 6$ffl W,ttr ~r1:t: S1a1t' ~p.artmt'nl of Heallh and State Walt'r Conl~ Board Quuur 1 2 3 ~
---"}{..__Well(s) Pvbltc. ~nd copy of rt90rt to l~10NI Sutt ll1ttr Co11trol lo.l...s Offtct Ind (Circle One) ltglllftll Stilt He1lt.11 ~~rtN!ll Of'1ct - County/City
_ _ _ Sp,-1119(1) l"<l11Hr11l. Sencr copy of rtp0rt to ~to~I Sutt ~ttr Conll"Dl ~rd Off1c; Ot~r. Stnd coey ~t rtl)Crt to =tv1o"'i Sutt 114ttr Control ao....s Offlct
- Surry
- - - iltli(sj Ind Spr1"9(S) l'(c1,ne of Waterworks Na~ of Ooerltor -,?-.,.l/7A;;;---------------
& flo.ler Co. - Surry
-Va.- -Electric
-- Posftfon/Titl*---.:N~/r..A:-------__,,-,___ _ _ __
N/A N/A Owller Va, Electric arrl Power Co, Sf QnUur* - - - - - - - - - O.te - - - - - - - -
Address P 0. Box 315 Population Served {Publfc'-----i.::Hu.{s;.A..___ _ _ _ _ _ __
_ _s:a:.ur=ry~,L.-.CV:...:a::..:*~*--=2.::.3..::.8..::.8.=..3_ Phone (804) 357-3184 No. of ConnectfOM (Pub! le) --.uN..,_/A....._________
Uper1tfon Perwft lulber (Public) ...N.,../~A=----------
Type of u~e: Puhllc+_ _ lndustrhl_L Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf 11easurenents ire for I sfngle-eeter ffeld re,dfng, 11st wells included fn fftld SWCS No. Owner No, _ _ _ _ _ __ SWCB No. - - - - - - - Owner No.-------
swce No. _ _ _ _ _ __ Owner No. - - - - - - - SWCB llo, Owner N o , - - - - - - -
swce N o . - - - - - - - Owner N o . - - - - - - - SWCB No, Owner IIO. - - - - - - - -
Heter readings ire fn _ __;ga~.. l ..lo~ns-_______________ (g,llons, lOOO's of g11lons, cubfc feet, etc.)
llotAt: If systaa. fs 11raettrtd, tSt1Mtt JIUIIPl91 Owne N ..:.orJs-r~u""'--noN In bo&11 fn loooer r19llt-lllnd Cornet'.
SWCS No, r o. s,-re Date Heter Reading* &.lions V.ur level*.- Dlle Heter Reading* &lllons Viler Level ....
Used St.ltfc" t,IIICll114-' Used StAt1c.. .,;;;;;;-fllQ*-
Cnd of LHt Plontll 'Z !,'::;-7 3 S-o o 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 Z6ZZ.{~oo tb4'K4Do
- ~*d attar , ... tfae uc11 d1y (sw-1fer11>>ly tfld of d*yl
- ff ut,11, rttd It tnd of 11011-P1-of"9 period Tot.I I C.110llf Dl,r f ng llonUI "' ...t8 i"'o c:
Tou I Gt lions Dl,rf119 Ou*rur /p~e, ¥00
- If Ult11, rttd It tnd of lltny-pu111pf119 period Tou I Operu I llf Toul Operat111f
-**If Ultll 111 ont iotll 111 I fltlf, S~1fy wfllclt *11 - - - - 0.ys tll fs !Ion tit - 3/ Dl)'1 t.llfs Ou1rt1r $/
t *All prh1tAtly or put,llully-c:wntd 1>1,ellc w*tAtr supply S)'lt.e91 wftll Httltll Otputioent perwfts. 0.1 ly Awtf'IIJI .J1ily lwtr19t Dur 1n9 Monti! z.a? / &> O.,r i "9 OMuttr z_o~/~
;G~Ri:uio:iiuj;::NirOlWW~A~T"°iERR°""iP>IU~M~PPJA~G;E~A;N;-;:D;;-;US;;E
_ __....x.__ *11, 111,,
s,~1e ~partment of Heahh and Stace Warer Con1rvl Board P11bllc. StllCI copy of r~r-t to bglo,wl Sutt V1t.1r Co11tl"Ol Solnl Offlct ,11111 Ovui.r 1 Z L
(J)
(Circle OM) 4 =
l*9lcwl Sutt llfflUI ~~rtNtit Off1ct - County/Cfty
-~~ Spr1119(s) ll\d11str1,1. St11e1 coo, of rtPOrt to le9IOMI Sutt ~t.tr Co11tr11l lo4r-d Office
- Surry Otti.r. Strid co01 of rtp0rt to lt91011tl Sutt ~t.tr C011trol 9o1,.. OHfct
_ _ _ W.ll(sl *nd Spr1"9(S) of Wa ttrworks Name of Ooer1 tor N/A ric & PcJ,.ler Co. - Surry Position/Title -,N"/7:A;.;----------------
Va. Electric arrl pc,,yer Co. SiqniturP N/A Dlte _N __
i"A Address P 0. Box 315 Population Served (Public' _ __..Nul..cA:i._________
Surry, Va. , 23883 Phone (804) 357-3184 No. of Con~ct1on" (Publk) _ _N~(A~--------
Uper1t1on Pera1t Hunt>er (Publfc) NIA Type of U\e: P11h11c +__ 1n<lustr11I--X- Other (specify ..........:._ _ _ _ _ _ _ __
If ineasureinents ire for I s1ngle-Nter ffeld re,ding, lfst wells Included fn fftld SWCB No. Owner Ho. SWCB N o . - - - - - - Oaffltr llo. - - - - - - -
SWCB No. Owner No. SWCB llo. Otomer No. - - - - - - -
SWCB No. Owner No. SWCB llo. ~ntr N O . - - - - - - -
Heter retdfngs ire fn _ _..;g~asa.1.ll.:o~nsU2---------------Cg11lons, lOOO's of 91110M, cubic feet, etc.)
llota: If 1y1taa ts umtttred, tstiNtt ~99 SWl:B No. z.f- /9o -S-oc::Owner No. A fn boos 1n lo.r rf9ht-llilld CONlff.
Date Heter Reading* 611lons ~ter ltvtl**'*'* Dlte Meter Readf ng* Gallons V1ter level**-
-"-~
Used St£t1c .. P"""fn,-* Used St.lttc.. "'-1-***
Clld of Lut 11onUI 'i' <i? <i?S' 3 o D ~~ 16 1 17 2 18 3 19 4 20
. 21 5
6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 91~r100 ZG? lf"OO Tot.I I &I 110ftf Tot.a I C, 110ftl ttr Slat tlae HCII dlJ (prtftf'1bl1 tnd of d11) 111 1 rHd It tlld of IIOft-PYIClf 119 periOd Ourf "'i.u. Z~ ~ ?co Our1119 ~1rter z.t.7/ 3"0CJ
.* . 1t11t, rud et tlld of IIHYJ'*pulllpf 119 per10d Tott I Oper1 ti 119 Toul ~r1tlllf t
- If t1t,11 111 ont .. 11 In I fftlf, spteffy wtifch --.11 All pr1nttly or pVblfc,lly-owntd public **tar 1uP<<)lJ' systeaa O.y1 UIII NoftUI 3/ 0.y, UI 11 Qv1rttr 3~
wiUI HulUI Oep1rt*Ht puwtU. 0.1 1y AYer19t .11 i ly A,tr,91 Dur f ft9 Mofltll 7//35 During 011,rur 7,f~ S"
_ _...,X..__ Wt II ( s) Pwbllc.
GROUND WATER PUMPAGE ANO USE REPORT S1.u~ ~partrM-nl or Hulch ind Stace Wa1u Coner-vi Board Stl'ld cop11f rfi)Or-t lO le1fONI St.Ht llattr Co11trol to&rf Offfct .,..
()Jut.tr 1 2Q) 4 (Cfrtle One)
=
- ,91Dftll Sutt MNIUI ~~rtatftt Offtc1 - County/Cfty
- - - Spr1119{1) *l"<lustrt1I. St/Id coo, of rtPOrt to le1fONI Sutt V.t,r Co11trol lo,sr-4 Office
- Surry Other. Stnd co01 of rtPOrt lO *,9101111 Sutt V.ttr Control ~,.., Offlci
_____ Wtll(sl 1nd Sprf119(s) of Wa te!"'cOrks Name of Ooer* tor _ 11';:;--T/TiA~-------------
a, Electric & Po.ver Co. - Surry Posftfon/Title _ _1N:,-/r,Ar--------,1n"+:,.,._-----
e>.M!r v a. Elect r l. c cuu --...1 n.-.~- Co rvw-=.
- N/A S f < 1 n
- t u r t - - - - - - - - - - OUe - - - - - - - -
Nt'A Address P O. Box 315 Population Served (Publfc'--~H..._/,._A.___ _ _ _ _ _ __
_ __:S:::.:ur=-..:ery=-.L.J,[_!V,--=a:...:..-Lt..-=c...2=:..38~8""'__
3 Phone (804) 357-3184 No. of ConnectfoM (Pub11c) _ __,N..._/._.A~--------
t Uperatfon Pe,..1t Nuiit>er (Pub11c) ..,N_,_liA=----------
Type of Uote: Puh 11c _ _ l n<lus trfl 1--~- Other ( spec1 fy - - - - - - - - - - - - - - - - - - - - - - - -
1f eeasureinents ire for I sfngle-.ieter ffeld re1dfng, 11st wells fncluded 1n ffeld SWC8 No. Owner No.------- SWC8 No. - - - - - - - Oi,ner llo. - - - - - - - -
SWCB No. Oitner No. - - - - - - - SWCB llo. Owner No. - - - - - - -
SWC8 No. Oitner N o . - - - - - - - SWC8 No, U-ntr NO. - - - - - - - -
Meter re.dings 1re fn ___g.;i>i>a.l,.l,..oc:..:ns ......_ _ _ _ _ _ _ _ _ _ _ _ _ _ (g1llons. IOOO's of g1lloM. cubic feet, etc.)
llote: If S)'Sta IS UNleUl°t'd, tstillllt pu111199 SWCB No. Z, - /!::o -.5o~Owner No. tn bo1n 111 l°""r rtgllt-llllld COMIIP, DAte Heter Reading* Dlte Meter Readf ng* C.llons Wit.tr Level**-
Used Sta Uc.. l"'-i1na* ..
16 1 17 2 18 19 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 f 37~/DO z.19000 Toti I ;a 110ftf Tot.a I GI llOftl tar, ... tfae ttcft d11 (pr1f1r1,11 efld of d11J
, rHd ,t tl'ld of non-~flllJ periOCI Dur 'Z I ? ,r:n:, e:> Durlog (),1rter ~2' ff; 3'0 0
'"' llofttll
. . 111 0 rt1d at end of IIHwJ-~1119 period
.... ,, Ul111 fn Ollf *II tn I fl1lf. spectf7 ..tlfcll .,..11 - - - -
Toti I Oper1tf119 o., s UI Is lion U1 3/
rou I Op,re tt"'
0.11 UII I Qv1rttr b<
t A11 prhU.elr .or pwllcall1*owned publtc w1tar suppl7 s7sle99 . 0.1 1, A_werlCJt w1UI Kt1IUI Oep1rt11ent perwtU. .,. i IJ l,trt91 0..r f ng Noftlll 7 Ob S--- 0..r, "9 Outr ur 7~:z-0
S1.11~ tkputm~nc or Hcaflh and St.ate Wac~r Concrvl 8oar4 Quutar 1 zl'f),
(C1rcl'e6ne)
_ . . .x. . . *_ we"<, 1 P11bllc. Sflld copy,, rfPOr-t to ie9IONI Suu lllttr Control ao.r111 Offlct lllf Rt9fon,I St.alt HttlUI O.p,rtNftt Office - County/City
- ~ - ~Pr1MJ(sl . lndustrltl. Stftd c097 of rtport to ~lon,I St.au 14Ur Co11tr11l lo.1'11 Offftt
- Surry Otner. Stncl caoy of report to Rtg1oNI St.at, w.ur Control Sotrd Ofrtu
_ _ _ Wtll(sl u~ Sprf119{s)
- ,une of Water-works Name of OoerHor N/A ric & PcMer Co. - Surry Pos1tton/Title - , N : , / " A . - - - - - - - - - - - - - -
Va. Electric arrl pa,,.,er Co. Stqnature N/A o.te NJA Address P O. Box 315 Surry, Va. , 23883 Phone (804) 357-3184 Population Served (PubHc' _ __..,N,.../._.A...._________
No. of Connection" {Pub1fcl _ _Nu.u!Au,.__ _ _ _ _ _ __
+ Uperllt1on Per111t Huilt>er (PubHc) ...N...,IJ.._A..___ _ _ _ _ _ __
Type of u~e: Puhl1c _ _ !ndustr1a1__.X_ Other ( s p e c i f Y - - - - - - - - - - - - - - - - - - - - - - - -
lf aieasurenents are for I s1ngle-11eter field reading, 11st wells included 1n f1eld SWC8 Ho. Owner No. SWCB No.------ !Mier No.-------
Sl<<:B N o . - - - - - - - Owner N o . - - - - - - - SWCB llo. - - - - - - Owner No.-------
SWC8 Ho. Owner N o . - - - - - - - S\iCB No. - - - - - - - Uifner NO.--------
Meter readings are in ---:.i9:),>a.,..l...,l,,,.o;:.,ns..._______________ (gallons, lOOO's of gallons. cubic feet, etc.)
llow: Jf 11st. ts unaettrM, estwtt ~91 SW\:8 No. Z 9 -/5'0 - ~o c Owner No. A 111 boau h J~r r19)1t-11111d corner.
Date Meter Reading* Gallons Wattr level*_. Date Meter Reading* &lllot1S W1 ter Leve 1u -
Sutic" P'IIICI f 119-' Used St.a Uc- IP\ai111Q***
End of 16 lUl l',ontJI f37_//oo I 1 17 2 18 3 19 4 20 5 - 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 f 5".r/; loo /~J 3oO Tota I &tllOM Toul Gtl10fts aeter SAllt tfae ,ecll d*1 (Pf'tftr,bly tnd of d*y) /~7 Durt119 Quarur h~h /oo
~. rHd It tlld of IIOfl*P\IIIIPfllCJ period le11, rud It tnCI of IIHYJ-~1119 per10d Dwr1 119 "°""'
Tot* I Optr1t!nt 300 Toul Operu1119 t,ttll Ill Ollt iotll !11
- f1t1d, IPK1f1 ...t\lCII 111tl1 - - - - Days thh MonUI 3e;, Da71 Ulfs Ov1rt1r 'Yr;;-
t A11 pr1Yl\.11J or publtc,117-ow~ put,11c w1tar supply sys~
- wfUI Hu1UI Oep1rt111t11t peratu. Dal 17 AYtr19t AilJ A,trt9t Our 1119 "°ntll ~5'77 0..r i "'9 Ovtr ttr ~fob
GROUND WATER PUMPA GE ANO USE REPORT S1a1~ ~par1m~n1 of Hullh an d St.ate W11~r Control loar4
!%>nth Qv1rter 1 Tc.;Tr
~~
_ _,.X.__ II~ 11 ( s J P11blle. ~IICJ copy of r~rt to Re91on,I Stitt Vat.tr C411trvl ao.r11 Offfct IN (Cfrcle )
l1910NI Stitt twtlUI ~p.er~ t Offfct - County/Cfty
- - - Sprt119(s) *lnd11strt1l. Stfld coc,1 of r,p0rt to le9loIWII Stitt V,t,r C411trol lo&ro Office
- Surry Other. Send CDOy of rtPQrt to l191on,I SUlt V.ttr Control lo,a~ Office
_ _ _ W.ll(s) *nd Sprl"9(S) of Waterworks Ha N of Ooer* tor N/A ric & PoNer Co. - Surry Po sf t fon/Tit Je N/A va. Electric and Pa,..,er Co. 5fQn1turf N7A Dile N]~
Addl"ess P O. Box 315 Po pulat1on Served (Publfc' NlA Surry, Va. , 23883 Phone (804) 357-3184 No
- of Connection~ (Publfc) NIA
+ ~ er1t1on Perait Nu=t>tr (Publfc) tU6 Type of U\e: Puhl fc _ _ 11'\dustrf.t 1-....X_ Other (specify_
Jf measurenents ire for I s1ngle-11eter ffeld re1dfng, 11st well s included 1n ffeld SWCB No. Owner No. _ _ _ _ _ __ SWCB No. Or.mer No.
Sll.:8 No. Owner N o . - - - - - - - SWCB No. C>wner No.
swca N o . - - - - - - - Owner No. - - - - - - - SWCB No. O.ner IN>>.
Meter rHdings ire fn _ _-.:;;:1g"'"a""'l,.l.:.cO:£.Jns=c...--------- (g1J1ons, lOOO's of g111ons, cubic feet, etc.)
Note: r, system h uMetem, 1St1Ntt ~ , .
SWl:B No. '3 c, - I 'f o - $°I c.. Owner No. "6 111 !loan 111 I ~ r 1gllt-llllld COl"fter.
Datt Heter Readfng* Dile Meter Re1dfng* Glllons wuar Level .. -
Used Stattc.. "-nt-flQ*-
16 1 17 2 18 19 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 ~17~~S"oo f 327 /oo Tota I S.IIOllf Tou 1 Iii I IOftl
- . t e r s~ c1ae ucll d11 (prefercbl1 end or d11J Dur1 "9 llollUI 9 :3Z7 /00 Durl119 Quarter 'J 3"2- 7 /0=>
'"* rHd It end of 11011-pu111p1119 period
- &lift, rt&d ll end of ~e1v1-~1119 ~r10d Tot* I Operu1119 rota! Operat111t
.... If t,t111 111 one wll 111 1 field, SPK1fy wtlfcll liftll - - - - Di11 tllf I llon UI 33 Di,i tllfs Ouarttr 33
- All pr1w1tal1 or i,vbllcall1-owned publ1c w1tar supply systeaa wf UI lltl I tll Dep1rt,1t11t ptraf U. 0.1 ly Anr191 .11 i 1, ,.,,,191 0..r f 119 Kofttll Z8'Z.'-3 f O.,r1119 011*rttr 28 2.!-3 &J
GROUND WATER PUMPAGE ANO USE REPORT ~ th :::ru L.- ' (
S1a1~ [kpanment of Health and Sta~ Wa1~r Conrrvl Board Quirt.er 1 Z ~ /4
_ ___...x._ Ile 11 ( s J Pwbllc. ~nd copy of "90r1 to ft~IOM*I Sutt llattr Colllrol to.rd Offlct alld (Cfrcle One)
- ,9tonal Sutt IIHIUI ~p,rtNftt Office - Cnty/Cfty
- - - - Spr1119(s) . lftdustr111. S~ cooy of rtport to fte910flll Sutt V.ttr to11tN1l io.l"d Offfct
- Surry Ou~r. Stnd cooy of rtPOrt to llt9lorwl Sutt V.ttr COlltrol loi"1 Office
_ _ _ W.ll(s) and Sprt119(1) me of Waterworks Name of Ooer1tor _ 1'::;-l/A ~ - - ~ - - - - - - - - - -
1 11 ric & Pc:Mer Co. - Surry Posftfon/Tftle __1 N:i""/71Ar--------,1CT"M------
--..:i Co N/A Nt'A Va. Electric cua..i PONer
- Sf Qn1 ture - - - - - - - - - - O.te - - - - - - - -
Addrus P O. Box 315 Population Served (Publlc'---..iHLL/..1.;.Aa.__ _ _ _ _ _ __
_ ___.S~ur=ry,,__.__.,.__,V-=a:..:;*_.,-=2"'-38_8___3_____ Phone (804) 357-3184 No. of Connection~ (Publ fcl _ _N...._./A.__ _ _ _ _ _ __
Uperltfon Per11f t Nuat>er (Publ le) NIA Type of U<1.e: Puhlfc t_ 11\dustrflJ--X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _- _- _-_-_ -_ -_ -_ -_ -- _-_-_
Jf measurements ire for I sfngle~ter ffeld re1dfng, 11st wells fncluded fn ffeld SWC8 No. Owner No,------- SWCB No. - - - - - - Owner llo. - - - - - - -
SIICB No. - - - - - - - Owner SWC8 No. Owner No. - - - - - - -
No.-------
SWCB No. ~r "°*-------
SWCB No. 0-ner IIO. - - - - - - - -
Heter readings 1re fn ___g..,.,a.... l ...lo"'"'"'ns,,._______________ (g11lons, 1000's of g11lons, cubic ffft, etc.)
Nott: If s11ua ts u..-ttrtd, Ht1Ntl ~ 9 '
SWCB No. 3 I- I 9o - 5"" z.. C Owner No. fn t,ous* 111 la.er rfgllt-hllld conwr.
Date Heter Reading* Olte Meter Reading* &lllons Vilar leve1**-
Used Static- !"-fftQUI Clld of Lut NontJI Z I Zt:j 7 9-0 o 16 1 17 2 18 19 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 z{-07/ ooo 2 773 ~00 Tou 1 Gillon, Toul C.IIOftl tar sa.e ttaa tic* day (prtf~1bl1 tncl of d11J tt1, rNd ,t tncl of IIOII-P-IIIP1119 period Dlirf "9 llofltll Z 77 3 ~OG> D1,rt119 Ql,arter 277 3 ~Oc::::>
- 1*1n, read At tncl of 11,1,7,pu.pl119 period Toti 1 Operatfng Total Operattnt
.... f tallR 1n OM "'" In I fltld, IPK1f7 .tllcll 'dll - - - - D171 tll 11 Mon tll 33 D111 tllls Ou1rt1r ..33
- All prh1ttl7 or pw1full7*0WIIH puC,llc wit.tr 1uppl7 s71U..
1111 17 A,er191 .>4i1J btr191 wlUI Hteltll Oep1r1-11t perw1U.
Our 1INJ Month 8/o~r O..rl"9 011trttr g-_,/ of-'f
GROUND WATER PUMPAGE ANO USE REPORT !!ton tJi ..:;Tv L ;/ ,
Su,ce ~partm~nl o( Hullh and Suc.e Wac~r Concrul Board Qv1rter 1 Z &
(Cfrcle Ot,e) 4
_-.A.X..__ I.le II (,) Pvbllc. ~l'IG copy of rtP(>rt lo l~10NI Stilt Waltr Co11tr-ol ao.n1 Offfct 11111 llt9lon1l Stitt KHIUI ~rtM!ll Office - County/City
- ~ - - Spr1119(1J *Industrial. Stftd CoPY of rtpOrt to le91on.l Stitt W.ttr Co11trol to.r-ci Office
- Surry Other. Send ccoy of rtpOrt to 1,910~1 Stilt W.ltr Control ao.rf Office
- - - lltll (1) *nd Spr1119(1) of Water-worts Name of Ooerltor N/A ric & Pc:Mer Co. - Surry Posft1on/Tit1e - , N : , / ; ; A ~ - - - - - - - - - - - - -
Va. Electric an:1 Pc,.ver Co. SfQnltur* N/A O.te N/A Address P O. Box 315 Population Served (Publfc' _ ___..Nu.l..a.AL-________ --------
Surry, Va. , 23883 Phone (804)357-3184 Ho. of Connection" (Publfc) ____N_,,_,/A..._._ _ _ _ _ _ __
t
- Ul)er1t1on Pena1t Mulit>er (Public) ... .N..._/...,A.___ _ _ _ _ _ __
Type of U(.e: P u b l i c _ !naustr1411--X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measurements ire for I s1ng1e-11eter field re;id1ng, lfst wells tncluded 1n ffeld swca No. Olmer No. SWCI N o . - - - - - - Owner No.-------
SWCB No. Owner No. SWCB llo. ().mer No.-------
SWCB No. Owner No. SWCB No.------- Uitner NO.--------
Meter readings 1re tn ___g:;;,:,,oa.. l ..l::.:o:!..!ns
_______________ (g11lons, lOOO's of 91l1ons, cubic feet, etc.)
Nott: Jf 111ta ts ul'lllft.tnd. tst1Mt.t pu11p,&91 SWCB No. Owner No. p fn boxa 111 IO!iler rfgllt*llllld CONllf'.
Oat~ Heter Read fng* Glllons Wlter level*.- O.te Meter Readf119* Gillons Water level**-
Used St1t1c- '"--t-***
Clld of LHt l10ntll /cJ6CJ 600 16 1 17 2 18 3 19 4 20 s . 21 6 22 7 23 8 24 9 :?5 10 26 11 27 12 28 13 29 14 30 15 31 I 31S:-7e,o 32.S-/Ot!?
Toti I I.I I lORt Toul C.IIOAI atttr saae t1at tecll d*Y (pr1ftr1bly tlld of dly) Our1 119 l'lotlUI 3 z_,S- / o o Dl,rl09 ~1rCAr J2-s- /60
"'* rNd It tnd of IIOll*PYII01"9 periOd
- "* rttd It tnd of 11t1w7-pu111p1119 per10d Toti I Oper1t 1119 roul Optrllfllf
"**If tiltll 111 Ont 11111 111 I fltlf, IPKtfy llfl1CII ~11 0.111 UI 1s Non t11 33 0.1' Ull 1 0,.,1rttr 33 t A11 prh1t.tly or pwllully-owfttd putil1c wetar supply 171lt111 wi U1 Hu I tJI Otp1rt11e11t Ptl"III U. 0.1 ly* .her191 Dur 1n9 Monti!*- 18' ~ Z -
Jt I I 1 l,tr19t Ovr 1119 Ou1rttr :r g_s-~
GROUND WATER PUMPAGE AND USE REPORT '%)n~ ~~
S1Ht' ~~nm~nl of Hullh ind St.lite W1:11ev Con1rvl loartl . Quirt.er 1 z4 (Cfrclt One)
~-'}{~ ~11(1) Pub I le. ~ncf copy of ~ r t to t.g lo,wi I Sutt Vlttr Co11trol ao.n11 Off let lllf
. Rt9fOt11l Sutt ~tlUI ~rtNrtt Offl(I - County/Cf ty
~ - - Sprl119(1) llldustrlll. Stnd coc,y of rtp0rt to ~lon,I St.Ht V.ttr Contr11l ~,... Offlct
- Surry Othtr. Str.d coo, of rtpOrt to ltg1o,wl Sutt V.ttr Control ao,,... Offtc,
_ _ _ llfll(sl 1r-d Spr1119(1) me of Wattrwrks Nall@ of Ooeritor --;1'~J/7,A;.---------------
- .J1.Vj;la.-.1_.,E...._lects.x..!::.:r~1~*c:c.-.!&~F'c:1,yer..:::.:.:~..,,~Co::...._-___:S:..,ur=--ry-=------ Posftfon/Title _ _-;;N-:f/r.A.---------,,N""'tM'Jt.------~
e>wl.!r Va. Electric arrl Pa,,.'er Co. Sfqnatur, _ _ _ _N_'_/A _ _ _ _ O.te - - - - - - - -
Address P O. Pox 315 Population Served (Publfc' _ _......,N.._/A..<A.___ _ _ _ _ _ __
_ __.Sur==ry~,__,_Va=..;._.~--"2:..;:3'--"8-"8"""3_ Phone (804)357-3184 No. of Connectfon!II CPublfc) ___NI.M..I/A..__ _ _ _ _ _ __
Uperatfon Pen1ft ~ r (Public) ...N ..../.._A...___ _ _ _ _ _ __
Type of U<.e: . Puhlfc + __ !ndustrf1l--X__ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf 11e1sureinents are for I sfngle~ttr field re1dfng. 11st wells included 1n fftld SWC8 No. Owner No. _ _ _ _ _ __
SWCII No. - - - - - - Owner lo. - - - - - - -
SWCB No. Owner N o . - - - - - - - SWCB llo. Owner llo. - - - - - - -
SWCB N o . - - - - - - - Owner N o . - - - - - - - SWCB llo. Oimtr IIO. - - - - - - - -
Heter re1dings 1re fn _ _...:g;15aa..li:..l~ons.a..l:!ii---------------C~llons. lOOO's of g.l_lons, cubic feet, etc.)
llote: If systa ts u..ettr"td, Ht1Ntt ~
SWCB No. /5'2.. -190 - 1n boan 111 lowr r1gM-~IICI corner.
Date Keter Reading* 0.te Heter Reading* C.llons VI ter ltve 1**-
Used St1t1c" P\a,f,,.,...
16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 S-e, b 3o oo~ 2 722. 700 Toti 1 C.11* Toul GIIIOAS aettr saae tlat Hell d17 (Pf"tftr,bly encl of d*1I u,1, rHCI ,t tncl of IIOII-Pl-o111CJ period Dur1 11CJ llollUI z7zz. 700 Dur 1119 1)1 Ir tet' 272-'2.. 7 0 0 1t111, rud at encl of llt1*1-~1119 period Tott I Open ti 119 Ultn 1n one iotll 111 1 f11lf, 1Pte1f7 1.tilcll wll - - - - o.,, Ul1s llonUI 33 rou 1 C)pfra t1 "I Da 11 tllf s Quarter 33
-f All ,r1wuel7 or publfct11J*OWlltd P\Allic w1ttr supply S)'Sltaa w1 UI Hta 1UI Otpari.tnt penal ts. 0.1 17 Awtrage .11111 lvtrt~
Our 1119 Moll tll '8 ZS-o C,. Dur i "1 Outrttr '8 Z- S-00
..... , ""' ;,--(>, lJ*&....,
GROUND WATER PUMPAGE AND USE REPORT !fton di _ _...;:U:..f:.;;;._'-11----
S1.11~ Cxpartm~nl of Hrallh ind Su~ Wac<< Conrrol loar4 l 2&c
_ _j.}{.__~11(1) P11bllc. ~,., copy 1f "'90r-t to ~loiwl Sutt 11,tt,. C.011tl"OI S.C.t"41 Offlct h9lon11l Sutt IIHIUI ~r'taellt Off1c1 u*
(Cfrde One)
_ _ _ Sprl119(sJ County/Cfty lllduHr11l. Stftd coc,y of rtpOrl to ~101111 Su~ ll.ltlr C.011V"OI lott"41 Off1ct
- Surry Other. Stnd coo, of ~ r t to lt91o"'I Su~ W.ttr COfltl"Ol 8o.at"41 Off1ce
_ _ _ lltll(s) *nd Spr1119(1J
~ of Waterwo,.ks Kuie of Ooer1to,. -~Z...l7 /A..---------------
Va. Electric & PcMer Co. - Surry Posftfon/Title _ _.N-f/r.A.--------.-------
0.'14r Va. Electric arrl Po,,.,er Co. Sfqn1tur, _ _ _ _N__/A 1
____ O.t.e __N_/_A______
Add,.ess P 0. Box 315 Popul1tfon Served (Publfc' _ ____,_Nu.l.a...A.___ _ _ _ _ _ __
_ ___,S=ur=-=ry,...__.,--=-V=a~*-'~2'-=3'"""8""""8"""3_ Phone (804) 357-3184 No. of ConnectfOn'- CPublfc) _ _NUL,/AiCL-_ _ _ _ _ _ __
Uperltfon Peraf t Nuat>er (Pub ltc) ...N....,/.._A._________
Type of U'-e: Puhlfc + __ lndustrf1l__x_ Other (specffy _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf 11easurements 1,.e for* sfngle-uter ffeld r'Hdfng, 11st wells fncluded fn ffeld SWC8 No. Owner No. SWCI N o . - - - - - - Owner lo.--------
SWC:8 No. Owner No. - - - - - - - SWCB llo. - - - - - - Owner llo. - - - - - - - -
SWCB No. - - - - - - - Owner N o . - - - - - - - SWC8 lo. Oimer "°* --------
Meter readings *re fn _ __;g:;l!a.i..l._l...:a..::ns~--------------<Vlllons. 1000's of 911lons, cubfc feet, etc.)
Iota: If ,,,i. Is UlllleUrtd, Ht11utt ~
SWCB No. Owner No. F fn bolff 111 l~r rf9M*Mlld COl"ftlr.
D.!tt Heter Reading* Gallons !Qt.er Level*.- O.t.e Meter Readfng* S.1lons Ill ter leve 1.. -
Used St1t1,- 'P\aifM*-
Cnd of 16 Lut PlontJI 3S-7330 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 3.S-8' 381) /DS-0 Toti 1 Cillcw Toti 1 Ca IIOlll 11tUr saae tfae HCII d11 (prtftr1bl1 Ind of d11) 1lffl, rHd 1t ,,., of --~1119 per'1od Dwr 1119 lloflUI /o S-o Dl,rl119 l),1rter /o 'S".o Ul111, rud It tnd of 1111,,-~1119 pe,-1oe1 Toti I Oper1tf119 rot.al 0perlt111f If Ultn 1n one '"'" 11, 1 f11IC1, 1p,c1'y wi1cll i.ell - - - - Day I Ulls NonUI 33 Dl,r1 Utfs Qvirttr 33 t All pr1,1u1, or put,llcall1*owntd public **tar supplJ ,,,r.e.a w1tJI HUltJI Oepjrt;9ent Ptralts. 0.1 , , ,btrlljlf .11ily A,trl!lf Our 1119 Nontll 32.- Our i"9 Ovtrlft' Jz.
d_L.;;.."7';"--*---=-
%Jon tJt _ _.,.._/__
S1ac~ O<<-panmtnl or Hullh and Su~ Waler Concrul Boar4 Quui.r 1 2 l 4
_ _.....,){.__ W~ll(s) Pwbllc. ~ftCI copy,, rlH'Ort to ~IOMI Sutt 1111.tr C411tr,il ..,.,.. Offfct ll'f (Cf~le Ont) h9fon,I Stu.a NttlUI ~p.arbNftt OH1ct - County/City
_ _ _ Spr1119(sl . !nd111tr111. St11d copy of rtoort to le-9101111 Sutt W.ttr C411trol 14.1"11 Off1c, . Surry Other. Stnd CDOJ of "1)0rt to h910111 I Sutt W.ttr COlltr,il ao,,.. Off1ct
_ _ _ V.ll(sJ Ind Spr1119(s)
~:~ of W~ter.,orics Name of Ooer1tor _ 1?-:;-l/7iA,-------------
va, Electric & Po,oler Co. - Surcy Posft1on/Tit1e N/A lier Va. Electric arrl Po,.;er Co. S1Qn*turt ---;;:N,;1/r,;A:------"--.-.--,Nl'T""J,,...A_ _ _ _ __
Addrus P O. Box 315 Population Served (Public' NIA
..,. \.C - - - - - - - -
Surry, Va. , 23883 Plione (804) 357-3184 No. of Con~ctfon'l CPubl 1c_l_ __.N~/A.&_--------
uc,ent1on Peraft Hud>er (Publtc) N/A Type of u~e: P11hlfc !___ lndustrhJ--X_ Other (specify --~---------
If 11easureinents *re for* s1ng1e-cieter field rud1ng, 11st wells fncluded fn fteld SWCB No. Owner No. SWCB No.------ Owner llo. - - - - - - -
SWCB No. Owner No. SWCB No. <>.mer N o . - - - - - - -
SWC8 No. Owner No. SWCB llo. Gilner IIO. - - - - - - - -
Meter re1dings ue fn ___g:;;i.a,.....l_.l... o;,.,ns=--------------- (g11lons. lOOO's of g1l1ons. cubic fNt. etc.)
Nott: If lyltA!a fS U!'Mlt,-.d, tstiallt ~ge 5WC8 No. Owner No. 6 111 bo1as 111 lo-er r1911t-ll&lld corner.
Date Heter Reading* Cite Meter leadfncJ* 6111ons '111 ter Leve 1**-
Used St.attc- IP\ai1-* ..
£/Id of ust r10nt11 ~1 z__oo 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 7?/ao 2. "3 '1 e:, e, Toti I C.11 OIII ter ,.., tfae ttcll dtJ (prefer1bl1 end of d11J Tou 1 ;.110ftf Ol,r 1119 ftotlUI :Z 3 1'0 e:, Dur1119 l)itrur Z3 900 fft, rNd U tnd of no11-P,..,.P1"9 periOd 1len, rt1d 1t end of lltlYJ*P\111111119 per10CI Tot* I Opern t 119 roul Oper1URf f Ulen 1n one -ell fn I f1t1d, SPKlfJ wfl1CII wll - - - - o., I Ult I llontll 33 D111 tllh Quarter 33
- All prhattlJ or pvc,lfull1-owned public w,tar 1u1>9IJ systeaa 0.1 IJ Anr191 _,. i 11 lwtrt9t w1 tll HU I tll Otp1rt,aut Ptl"ll1 U.
Oo.ir 1119 Montll 72.~ O.,ri "9 011trttr 7 z.r.f
e I I I"" I I ** r-\
THr~L-;/fe'r--,t-~..:../~~~
GROUND WATER PUMPAGE ANO USE REPORT Mon di __>{;::o..,:cJ~f-=-=,.G/~--
S1a1c lxputmcnt or Hcallh ind Sute Warcr Con1rol Board Qu .arter 1 Z(14 (Cfrcle One)
-~X.__ 11t 11 ort to Rtgiorwi Sutt luttr Control Sofrel Off1ct
- Surry
_ _ _ lltll(s) Ind Spr1119(1)
~ame of Water,;orts Name of 0Derltor --;?-.,-l/7 A ; : - - - - - - - - - - - - - - -
Va. -
--- Electric
-~ & Pc1Ner Co. - Surry Pos1t1on/Title __--.N-.'"/7iA;---------.er-+4------
N/A N/:A Owlrer Va. Electric arrl pa,,.,er Co. S1Qrwtur*--------- D i l e - - - - - - - -
Address P 0. Box 315 Population Served (Publ1c _ __...,NLL/AaA._________
1
_ __,S=ur=.:ry:..L-L,__,__Va=.:...._.,L.....:2=3-=-8-=-8=3- Phone (804) 357-3184 Ho. of Connection" (Public) ____N tA~--------
Uperat1on Perw1 t Nuat>er (Public) .a.N..,/~A=-----------
Type of U<:e: Public+_ _ lndustr1al_L Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measurements are for a single-eeter field re,d1ng, 11st wells fncluded 1n ffeld SWC8 No. Owner No.------- SWCB No. - - - - - - Owner No. - - - - - - -
SWCB N o . - - - - - - - - . Owner No.------- SWC8 No. Owner No. - - - - - - -
SWCB No. 0-ner No.------- SWC8 No. tAitner IIO. - - - - - - -
Meter readings 1re fn --~ga~lr...l~oens-....______________ (g,llons, lOOO's of gallons, cubfc feet, etc.)
llou: If systa 1s ul'IDtttred, est1uu puill)l91
-SWCB No. Owner No. 1n boan 111 10\ler r1gllt*hllld COl'ftff.
Date Heter Reading* O.te Meter Reading* Gillons VI ter Leve 1H "
Used St.Ute- ,,._,11111*-
16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 Z.~2 300 ~ /Dt0 Total GtllOIIS
- letd *tter u* that t1U **, (pr1fer1bl1 tnd of d11J
- 1r tllt11, rHCI It end of --~1"9 period Tote 1 C.1111111 111,r fng l'lollUI '.,//t:>~ 111,rtng Quarter -,t /a.:::,
- If tel111. rtlCI at end of lltnJ-~1119 period Tot. 1 Clpfrat1111 Total Opcrtt1nt
" .. ,, tilffl 111 one 11tll 111
- f1t1CI. spec1'J Wlfcll wll - - - - Diy s tllf s Roll tll ..33 Di,i tllfs Quarter .33
- t All prh1ttl1 or ,u&1fct11J*Olfned p\Al11c wit.er supplJ 1,ittaa Dil 1, lYer191 wfUI Nttltll Otp1rt1111ent ~111fts.
Dur fng Nofttll ;z.f ..,. ilJ l,er19t O.,ri119 Ouuttr /Z .j
- *'* .,..., ** I"'\ Yeu * /'?'f
, /
... - ~
- tjr,a ~** ,J-&:;,;J GROUND WATER PUMPAGE ANO USE REPORT lbn th ::ru '-i IIHt r So.. re, : s,~,c CHpu1mcnr of Hcallh and State Water Con1rul Board Quui.r 1 2 (j 4
-~x..__ 11,11c,1 P11bllc. ~nci copy of r~rt to ~ton,I Sutt ll1ttr Co11trol to.l"CI Offlct llld ltg1on1l Sutt HulUI ~p,rtat,it Office - County/Cfty (Cfrcle One)
- - - S~l119(1J lndustr111. S~ cop7 of rtl)Ort to ~101111 Sutt W.ttr CGntrol lolrd Office Surry Ot~r. Stnd co0y of rtl)Ort to ltg1on,I Su~ ii.~r Cont~l lo.NI Offict
_ _ _ lltll(sl And Spr!"9(S)
N,une of llater.orks Na111e of Ooerltor _ fi:;-l/7iA~--------------
1
\Ta. Electric & PcMer Co. - Surry Pos1tion/Title _ _-;:N;'J/r;;A_ _ _ _ _ _ _H'7'.-------
<>wl4r Va. Electric arrl Pc,,,Jer Co. SiQn.tur* _ _ _ _ _ N_/A
_ _ _ _ O.te __N_f_A_ _ _ _ __
Address P O. Box 315 Population Ser-ved (Public' _ _-"'N..._/.._A.__________
_ __.S=ur=-=ry:...,....o,--'-V,"'--a........,...___2=3....8___ 3_ Phone (804) 357-3184 No. of Connection" (Public) _ _Nu..t.,/A~--------
8....
Uperation Penait Nulllber (Publfc) ...N,..,/.::.aA,,__ _ _ _ _ _ __
Type of U(,e: Puhlfc + __ !ndustrial__x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf 111easurements are for* s1ng1e-ceter ffeld reading, lfst wells included fn ffeld SWCS No. Oiitner Ho, _ _ _ _ _ __ SWCB N o . - - - - - - - Owner No.-----------
SWCB No. Owner No. - - - - - - - SWCB lo, Oiitner N o . - - - - - - -
SWCB N o . - - - - - - - Owner N o . - - - - - - - SVCB llo. ~ner 110. - - - - - - - -
Meter readings are fn ---'ga_.1...1...,oo<:ns-=---------------Ciillons, lOOO's of g11lons. cubic feet, etc.)
n..- No C:::::...NS.~cJc..-r-iol\l llote: If systa Is 1111Dttlt"ld, esUutl IUIPl91 SWCB No. u,,rrer * -:s1-re: fn bous tn !!*tr r1911t-llllld COt'ftff, Datt Heter Reading* !Ater leve.l**H Date Meter Reading* G.lllons lqter level ....
Used St.tttc" l"->11111 ...
[lld of Lut "°"tll z</3/,//a 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 ztf7s-~ t.oo 4~z 5"oo Tou I C..110ftl
- llud *tt1r , . . tla, HCII dlJ (pr1ftr1bl7 Ind of d17J Tot.I I Cl 110llf Durf 119 flontll ,14z.. Soo DurflMJ Qy,rur # z. S""""c:> 0
- Jf t1t1n, rttd 1t ,ncr of IIOft*~lng p,rlod
- If t1l1n, r11d It end of llt1v7-puapfng period Tou I Clptr1t1111 Tot.II Oper1t1111
..... , Ultn 111 Ont "'II 111 I ,1,1,, 1pe<if7 llftlcll wll - - - - o.,s tll ts Non t11 33 0.71 Ulls Quarter ,33
- . All prh1t1ly or pvblfcally-awntd publfc w1t1r supply 17'\1111 witll Hul_UI Otp1rt11ent Pt,.fts.
- 0.1 ,, Avtrll)e .11 il7 l,er191 Our 1119 Montll /,3-¥o"f 0..,rin, 0111rt1r /37',o~
GROUND WATER PUMPAGE AND USE REPORT Srur lkp.utmrnt of Hullh and St.ale W11rr Con1rol Boartl 1 2 d) 4
_ _..,X._ w~111s1 P11bllc. StllCI cop1 ,, rmrt to *~10MI Sutt Wet.tr C.011trol to.r,11 Offtc, 1-,
(Cfrcle Ont)
- ,9to,wil Sutt KttlUI ~P.,.~t Offtct - County/Cfty
- - - S1>rl"9(S) *lft<111strl1l. Stftd copy of rtpOrt to b91on.l Sutt W.t.tr C.011trol to.I'd Offlct
- Surry Ottier. Strwl ccoy of rmrt to h*gtorwil Sutt II.et.tr Control loui Offlct
_ _ _ 11,ll(s) 111d Sprl119(s) 6""
~
- Electric of Water...orks
& Pc:Mer Co. - Surry Name of OoerHor N/A Pos1tfon/Title - . N : . / " A _ - - - - - - - - - - - - - -
e>,.,V@r Va. Electric and Po..1er Co. SfQnlturt ---,;N~1/l'iiAl____O._te_--,Nll:T'J+l*A------
Addrtss P O. Box 315 Populatfon Served (Publfc' _ ___.Nul..o..A._________
Surry, Va. , 23883 Phone (804)357-3184 Ho. of Connectfon!i CPublfcl _ _..,.N.,_./A.....__ _ _ _ _ _ __
+ Uperltfon Pen11t Huli()er (Publtc) .N.... V...A._________
Type of u~e: Puhlfc _ _ lndustr11l--X- Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measurements ire for I s1ngle-11eter ffeld re1dtng, list wells included in field SWCB No. Owner No.------- SWCB No. - - - - - - - Owner No.--------
SWCB No. - - - - - - ner No. - - - - - - - SWCB llo. Owner No.-------
SWCB No. O.,ner No. - - - - - - - SWCB No.------- Uifner IIO. - - - - - - - -
Meter re1dings ue in --~g:ida.cl.-1.:.:o~os~-------------- (g11lons, lOOO's of g11lons, cubfc fttt, etc.)
Nott: If systa ts urwettnd, tst1Ntt ~91 S~B No. 3o -l'f o- 5"/C. Owner No. B In bou1 h lowr r1911t-1'111d COl"ftef'.
Date Heter Reading* G1 l 1 ons Wlttr Level*._ O.tt Meter lleadf ng* Gillons W* ter Leve 1**-
"""" f lt4- Used St.attc- !~f11Q***
Clld of Usedfl///////./J -
iUJ r,IJII/.//J
"' ~ 16 Lut r.onui 6%78~~c:> ~, ~
1 17 2 18 3 19 4 20
. 21 5
6 22 7 23 8 24 g ~5 10 26 11 27 12 28 13 29 14 30 15 31 1t,t:,zt,, 733 7'i?~/ 233 Toti 1 Gallon, Toul C..IIOIII ter S&at t1ae ,1cft d*y (pr1fer1bl1 tfld of day)
"
- rHd It tnd of IIOft-p,,aci1119 per10d Dl,rl 119 llotltll 7 '8'<-/1 z 3 3 Dl,rl . . (),art.Ir /7/~g333
. . t Ill, rtld It tnd of ~IYy-~1119 per10d
- ,, ut,n 111 Ol'lf " ' " Ill I fltld. SPKtfJ wlllcll wll - - - -
- All prt,1t.1l1 or pVblfCJll1-owned public wet.Ir supply systeaa Tota I Opertt 1119 o.,s Ulls NonUI 3/
Totll Opernhit 0.71 tlll_s Ou1rttr r:,,/
wl U1 HH I tll Oep1rt.,flll Ptrwl U. O.f ly Anrage ..,. i 1y l,tr19t 1 Our 1119 Montll zs-z, 6/J:f-3 °"""9 Ov*rttr Zt,,'tz~s;-
- f RE.AJ:>INq 13r\SE1) ON IZ MoN~s p~-rA - -
8/i:fo- 7/f/.
GROUND WATER PUMPAGE AND USE REPORT :bn tti .A7;GcJ s 7 S1a1~ ~panmtnl of Hullh and St.le Wa1~r Control Board Quarter 1 Z cf) 4
_.....JJX.__ .,, II ( s) Pwblfc. ~no copy of rt90rt lo lt110l\al HH1 ll1tar Colltrol 10.,'f Offlct 1iw1 (Cfrcle One)
Rt9lon1I Suta tw1IU1 ~P.,.tNflt Office - County/Cft7
- - - - SprlftCJ(S) *lfldustr111. St/Id coe,1 of r,p,ort to b9IOf\ll Sue.a V.tar Coftt.rol ao.r11 Offlct . Sun:y Other. Stnd CtiOJ of rtp,Ort to b91orwl Sutt V.tar COfttrol lolr'11 Offlct
_ _ _ _ V.ll(s) *nd Sprt119(s) of Wa tel"WOrks Na111e of Ooeritor N/'A ric & Po.ver Co. - Surry Posft1on/Title -,N:./"'A.--------------
Va. Electric ard Pc,,..,er Co. Sfqnlture N/'A O.te __N_f_A______
Address P 0. Box 315 Populufon Served (Publfc' _ __.Nul..1.A&-________
Surry, Va. , 23883 Phone (804) 357-3184 No. of Connection~ CPubl fc) _ _.,.N.,_./A..___ _ _ _ _ _ __
+ Uperat1on Pen11t llu!liber (Public) .... N,.._/....,A..___ _ _ _ _ _ __
Type of U\e: P11h lf c _ lndus tr11 I ___x_ Other Cspecf fy - - - - - - - - - - - - - - - - - - - - - - - -
1f measurenents are for* s1ngle~ter ffeld readfng. 11st wells fncluded fn ffeld swca No. Owner No. swca No.------ Owner 11o. - - - - - - -
swca No. Owner No. swca llo. o.mer No. - - - - - - -
swcB No. Owner No. SWCB No.------- ~ner NO.--------
Heter readings are fn _ _.....;g~a!ii!,l,.l.lo:..:nsl.!:lit_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (g11lons, lOOO's of gallons. cubfc feet. etc.)
!Iota: If systea ts u..-tlrtd, nt1111tl ~91 SWCB No. 3 I - 19'o - 5 :z.c. Owner No. C In boau 111 lowr rl911t-llind COMlff.
Dau Heter Read 1ng* Gillons W.ter lev11* ..... Oite Heter Readf ng* Gallons Wat.tr level**-
l'iaiplM-' Used St.1t1c- '"-i1M*-
Cftd of 16 Lut t'onUI z/07/00,.., I 1 17 2 18 19 4 20 5 - 21 6 22 7 23 8 24 9 :?S 10 26 11 27 12 28 13 29 14 30 15 31 :zt/o 7/000 -- ci-ttr ,.._ tlllf ,1c11 dlJ (pr1f1r1bl1 end of 01,J
,11, rHd u tncl of r,o,1-l>'JIC)lll9 period Toti I C.llon, Dllr1 119 ,tonUI - o- Toul C.IIOAI Dur 1119 Ou Ir tar 2773/boo ll111, rud at encl of 11t1w1-~1119 per1ocl Toti I Opernt119
.... ,, tlltn 1n 0111111111 1n I fltld, specify Mfllcll ~11 t All prluu1, or put,llull1*owntd public w1t1r supplJ 111tea1 o.,s UI 1s Pion tll ..3/
rot.al Orllratt119
~Tl Ul1s Q..,1rt1r &:>/-
w1UI kUIUI Otp1rt.nt Ptl"lllts. 0,1 ly Awtr191 .>ti I 7 A,tr191 0..,r 1"9 Kontll
-- o- D..tri~ Oulfttr ~,3 3_~8"
GROUND WATER PUMPAGE AND use REPORT ~Ui Au6u57 s,ac~ ~partm~nt of Hullh Ind Staie Wat~r Control Boud Qu1rur 1
- 2 (1) 4
_......,X.__ W*ll(s) Pvbllc. SfftCI copy of ~r1 to lt,gfONI Sutt Vtttr' C.011t'1II lo.lrf Offtct 1 ~
(Circle One)
- - - SPr'1ft9(SI l*9I0111I St.Ht IIHIUI ~r'1afftt Offtc1
- lnd11Strlll. St!IO copy of rtPOr't to ~tonel Sutt IIU.1r C.011tn1l Other. Stnd coo, of rt90rt to l*gton,I Sutt W.ltr COfltr-ol 1o,a,.., OHfct
'°"' -
Offtct County/City
- Surry
- - - Wtll(s) ,nc1 Spr1"9(S)
- me of Waterwo,.ts Hal!W! of OoerHor N/A Va. Electric Owlrer -
Va. Electric & Pc,.,Ter Co. - Surry
--..l c1H-..1 pc,...ier CO
- Position/Title ___
S1qnaturl'
.:N;/~A~============~=============
N/A 1
"*te Nt'A P O. Box 315 NIA 119 --------
Add r us Population Served (Public' Surry, Va. , 23883 Phone (804)357-3184 Ho. of Connect1on'i fPublfc-)----N~/1..LA~-------
Uperltfon Pen11t Kullt)er (Publtc) NIA Type of u~e: Puhl le+_ _ lndustrfaL..Jl_ Other (specify -------------
If r.easurements are for a sfngle-lll'ter ffeld re1dtng. 11st wells Included fn field SWCB No. ~ r No. SWCB N o . - - - - - - - <>.mer llo. - - - - - - - -
S.<<:8 No. Owner No. SWCB llo. Owner llo. - - - - - - -
SWCB No. Owner No. SWCB llo. 0-ner IIO. - - - - - - - -
Heter re,dings o1re fn ___g..,,a,...... 1_.l,.,_ons.___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (go1llons, lOOO's of 9o111ons, cubfc feet, etc.)
Note: If systea ts u.-ttred, tst1Mte ~ 9 1 SWCB No. Owner No. y fn bou1 111 lor,,er rtgllt-tlllld CorMV.
Dau Heter Reading* Olte Keter Reading* &lllons V1ter Level**-
Used St.Ute.. "-tna***
[nd of LUt l'ontll / 3 8'<::'7 0 0 16 1 17 2 18 19 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 / S-'f~~e)C, Z.o 'f 70(:)
Tot, I C. I IOftl 5: 3 ~
Toti I &.a 1IOllf ttr s1a1 ttae ttcll d*1 (pr1fertbl1 tlld of dly)
,,., rttd u tl'ld of IIOfl-p,,ac,1119 per,ocr O..r f 119 lloftUI :zo.? 70c, 0.,,11119 Qvnur 8""00
. .111, r'ftd It tnd of llt*w1-~f119 period Toti I ~,.*tlllf
- 1, t
tattn tn one _.11 fn
- fitld, IPt<tf7 -.felt wll - - - -
All Pr'hltely or put,llcally-owlltd Public **tar luP917 sysu.a 0..11 tllil NonUI 3/
roul ~rltfftl Di1' tJ\11 O,,trttr 6-i with HulUI !)ep1ri.ent perwtu. 0..1 17 Anre(Je ... , ,, ... ,,.9t Dur 1119 14ontll ~ 76s;- D.,r1i,g Outrttr 3' 3 ~t:,
Si.ate lxpartmenl o( Hullh and Sta~ Wa1cr Con1rol Boar.. 1 2(])4
~_..:,C...__Wclt(,) Pwbllc. ~"° copy of ~ r 1 to bglo,wl Sutt Wat.tr Co11trol IOll"d O'fftc, 1-,
(Cfrtle One) ll19IONI St.U.t He1IUi ~putatnl Off1CI - County/City
~ - - ~pr1119(sl lnduHrf&l. Send copy of rtp0rt to lt'gt0111l Sutt Wit.tr Colltrol 1o.,,.. Offtca
- Surry Other. Sfr.d coo, of rti,0rt to lfg1oNI Suu \I.It.tr Control to.rd Offfct
- - - IHll(s) Ind !>prl119{s)
H*me of Waterworks Name of OoerHor --;:~:.l/,;A.---------------
r Va, Electric & pc,,..,er Co. - Surry Posftfon/Title _ _~N.,/,:-A_ _ _ _ ___,....,.,_ _ _ __
Owller Va. Electric arrl Po,.Jer Co. S1Qnlture N/A O.te _N_lA _ _ _ _ __
Address P O. Box 315 Population Served (Public' _ __....Nu.f.... A.__________
Surry, Va. , 23883 Pl'ione (804) 357-3184 No. of ConnectioM f Publicl _ __.N~luA.__ _ _ _ _ __
Uperat1on Perai t Nuaber (Public) ...Nu.L.:.:A=---------
Type of Uc:.e: Puhltc + __ lndustr111__x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
lf Masurements ire for
- sfn9le-11eter field retdfng, 11st wells included 1n field SWC8 No. Owner Ho. SWCB No. - - - - - - Owner lo. - - - - - - -
S'9(B No. Owner No. Swtl llo. Owner N o . - - - - - - -
SWCB No. O.tner No. SWCB llo. - - - - - - O.ner I O . - - - - - - - -
Meter readings are 1n ---=9i;j!a.,_l"""'l~ons.e.="----------------C~llons, lOOO's of ~ttons. cubic feet, etc.)
SWCB No. /$2-1'70 - 71 P Owner No.
Datt Meter Reading* Gallons c-Wlttr ltvel*._
llott: If systta ts 11Mtwed, nt111itt ~
Olte tn tloqs 111 1Glllff rtgllt-1111111 corner.
Meter Reading* C.11ons Vlter level .. -
SI/a-Used Static- i"-itna*H
'Ill (nd of un 1tont11 S'o t, '3oe,oo ,,, 16 1 17 2 18 3 19 4 20 s 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 ~fZ'35""000 'i" 'e; 5",:;,c;, 0 Toti I C. IIOAS
- lea, aetar 11111 t1* ttcll I
'*Y (preftr1bl7 end of d11) ltfl, rHd ,t tlld of IIOfl-pu11pt119 period Tot.I I 5-llcw Our 1"9 llontlt 'j? hO~e;,t::>t!> Dur I119 1),1 r tet' I/ 3 Z 7 7oc:;,
111 rttd *t tnd of llto7-pq,ap1119 ptrtod 0 Toll I 0pcrlt1ftt t.en 1n one IOll1 tn I ft114, specify lifltcll wit - - - - Day S Ult I llontll rh1ttl1 or pwHullr-owlltd p\bltc **ttr supply s1ste111
- 31 rout Opcr1t1nt Ol,s UIIS Qu*rter 6+
wiUI ttultll Oe1>1rtiaent pe!"ll1U. Oat ly Awft'I~ JtilJ lwtr19t
- Our 1119 Mofltll 277, 58'/ 0uri"1 Qv1rttr 17 ~ '??S-
Sc.ale CHpanmfflt or Hralch and State W11er Concrol loari, . Qu1rter 1 2 &_ 4
~~X.....__ ~ll(s) P ..1111c. ~ncl copy ,r ~ r t to b,giONI Stitt ll'1tt,. C.011trot IOI~ Offtc, '"'
(Circle Orie) a,91<11111 St.au KHIUI ~ , . ~ t Offtce - County/City
~~~ S~r1119(sl lnd .. str11l. SMC! cooy of rtPOrt to lle910f\ll Sutt W.tt,. Control ao.,.. orrtc,
- Surry Othe,.. Str.d coo, of rt9QP't to lt-910,wl Stitt W.ttr Control 9ol~ Offtct
_ _ _ lltll(s) *I'd Spri1>9(s) ll!,, Name of WH!l"'l:'01"!:S Name of Ootrator -,?-:;-V;;A.--------------
va. Electric & PcMer Co. - Surry Posftion/Title _ _z,N.,/A..--------,N~,M*A.------
C>wlrer Va. Electric arrl po.,.,er Co. S1Qniturt N/A 0.te - - - - - - - -
Addrus P O. Box 315 Popul1tton Served (Public' _ __..,NIL/.&JA.__ _ _ _ _ _ __
Surry, Va. , 23883 Phone (804)357-3184 No. of Connection~ CPubltcl _ ___.N~l,.,.A_ _ _ _ _ _ __
+ Uperatton Perait Nualber (Publ1c) ... l!....1.:..:A,___ _ _ _ _ _ __
Type of u~e: Puhl ic _ _ 1ndustri.11 _x_ Other ( specf fy - - - - - - - - - - - - - - - - - - - - - - -
1f ineasurenents are for I stngle-eeter field rudtng, 11st wells included in field SWCB No. Own.er N o . - - - - - - - swca No. - - - - - - Ovner lo. - - - - - - -
S~B No. Owner No. - - - - - - - SWCB llo. Owner llo. - - - - - - -
swca N o . - - - - - - - Owner N o . - - - - - - - SWCB llo. - - - - - - - Uwntr IIO. - - - - - - - -
. Meter re1dings *re 111 _ __;g;;,a...l._l..,ons,a.,:,,._______________ (g*llons, 1000 1 1 of gillons, cubtc feet, etc.)
Nott: If 1,Stla ts UMeUt"ld, tst1Mtt pulilC)l9I S\i\:8 No. Owner No. flt boxes 111 1owr rt 91tt-11&M COC'1llr.
DAte Keter Reading* ~te Meter RHdfng* &lllons vuer level .. _
Used Static" l'-tna* ..
16 1 l7 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 $k, 7 00 2 32-0 Tot.a 1 &.i l10ftf Tout &.111**
3 .3 70 "41""'*
- lt1d atteP' Staf U
- flCII -., (prtftr1bl7 tnd Of d11)
- rud It 111, rHd endof It tlld of --~11111 pertod 11e1,y-pu111p11111 period 111.,r 1119 lbltll Toti 1 Oper1tl119 Z 3"z.£' Clurf 119 Qwtrett' rou1 OperntAt
- lt11 tn one "'" tn I fltl4, ,pec1f7 ~tell wll - - - - Dl7 I Ulh NollUI 3/ Dl,s Utll o,,&rter 6~
t ,rh.-tel7 or Mllc:1111-owllld plA,ltc w1ttr 1u1>11l1 sy,ttal Oil 17 A,er191 wtUI Hu1UI 0ti,tP'1-llt ptrwfU.
Ing Montll 7 ,s;- ..llilJ lwtP'I~
1Nri"9 Ovtrtlf ~3
°""
- '.ns ""*t lH,;i GROUND WATER PUMPAGE AND USE REPORT l\:>nUI---A~,__,"'""~:.~u;::c:c):s:=-7..:...---_-_-
S1a1e CHpartmenl of Hcahh and Staie W11er Control loarlll Quirter 1 2 l 4
_ __._X.__ Wt 11 1s > Public. ~ftd cop, of r~r-t to le9fon.il Sutt V1ttr Co11trol ao,,.. Offtc, 1,..
(Cfrcle One)
- ,9f0ftll Sui. HHIUI ~Ptrtafllt Off1ct - County/City
_ _ _ Spr1119(s) lndustr11l. Sffld copy of rtport to leilonal St.Ht W.ttr Control So,1"11 Office Other. Strod cooy of rtf)Ort to ltg1 orw I SU tt W. ttr C011trol llolr-41 Offtc1
- Surry
_ _ _ lltll(s) *nd Sprf119{s)
C me of Waten,,orts Name of Ooerltor -,?-..-l/7A ; . - - - - - - - - - - - - - - -
- Va. Electric & Po.ver Co. - Surry Posftfon/Title _ _-.:N.':/r.iA_ _ _ _ _ _ _,r-+-,..-.-----
lM14r- -va:-Electric am Pc,.,.,er Co. SfQnlturt N/A O.te _N_7_'A _ _ _ _ __
Address P O. Box 315 Populufon Served (Public' _ __..,Nl,L/_...A.___ _ _ _ _ _ __
_ __,Sur==-=ry~,-'-V=a-'-.__._,.....2--'3_8_8~3- Phone ( 804) 35 7-3184 No. of ConMc t 1on!l {Pub lie) _ _NU,L,j/A~--------
Uper1tfon Per111t Put>er (Public) .£.N""'IJ.:.A.__ _ _ _ _ _ __
Type of U<.e: Puhlfc+_ _ !ndustriil_lL_ Other (specffy _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf 11e1surenents ire for I single-eeter field re1dtng. 11st wells included fn field SWC8 No. Owner Ho, _ _ _ _ _ __
SWCB No. - - - - - - Owner No.-------
SWCB No. _ _ _ _ _ __
Oimer No. - - - - - - - SWCB No. Or.mer llo. - - - - - - -
SWCB N o . - - - - - - - Oitner N o . - - - - - - - SWCB llo. - - - - - - - Ditner IIO. - - - - - - - -
Heter readings ire fn _ _~g!.i!a.a.l.i...l~ons,l.!.!jii1---------------(g11lons. 1ooo*s of 9111ons. cubfc feet, etc.)
llote: If 11st. ts 11ratterld. tstfMte pul!Cllge S~B No, Owner No. 6 fn bous fn 1owr rfpt-llltld corner.
Date Cftd of Lu t lton t11 1
Heter Readtng*
7 8' /oc:>
,,,,,,,,"'.~--
Gallons
'//////,
fllll W.ter level* .... O.te 16 17 Heter Readfng* &illons Used Ill ter lewe 1**-
St1t1c- "-it1111*-
2 18 3 19 4 20 5 21 6 22 1 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 78 :z._c:::>c:::> /e,O Tota 1 C.llOM Tot.ti lil110AI meter 11111 tfae 11c11 d1y (pr,f.,-lb1y 1nd of d*y J /oo Dur I 119 ~lr\ef' z~oe,c, Dur 1119 btll 1ltt1, rtU ,t Ind of IIOll-~1119 period Ulen, l'Ud It end of IIHYJ*~1fl9 per1ocJ Tou I Operuf119 Tot.ti Os>erUfllf
'" *If Ul111 1n Ont " ' " In I f11ld, specify ""'tell wll - - - - Dly I tll ts llon UI 3/ DI ,s tll ls Ou1r ttr ~.,t t All prh1ttl1 or pwlful 11-owntd public w1ter supply sys~
w1 UI Ku I UI Dtp1rtiae11t Ptral ts, Dlf 17 Awtt191 .11il1 lytr1~
0..r 1ng Nontll ? O..r i "9 Q,,,rt1r 375
GROUND WATER PUMPAGE AND USE REPORT
.***~****~
S1l11r lxpu1mrnl or Hulth and St.re W11rr Control Board Qu1rttr 1 Z/3) 4
_ _.J.X:....__Wtll(1) Pwbl le, SfllCI copy of ~ r t to ~IOM I Stilt 1111.tr Cofttrol to.l"CI 0,ftce llld
( C11-c t<'One) ltgt0111l Stilt Hr1lU1 ~P'rtaconl Office - County/Cf ty
- - - Sprt119(1J llldustrt1l. S~ COQy of rtp0rt to ~fOllil Stilt !Ill.tr Co11trol '°4rel Offtct
- Surry Other. Stnd coe, of rtp0rt to Regto~I Sut: ~~r C0ntroi &o.l"CI OHtct
!fame of Waterworks Name of Ooer.tor _ 1 r;.,J/ 7A ; ; ; - - - - - - - - - - - - - - -
Va.- Electric
-- ---- & Power __ ,.,CO, - Surry CO Posftfon/Tith __---.:N:."'./r.A.---------.....+1------
N/A N11A ewller Va, Electric d..111..1 PO,o,'e.1"
- S1Qnaturf--------- Dlte - - - - - - - ' - - -
Address P 0. Box 315 Population Served (Publfc' _ _-4lNIL/s:.AL-_ _ _ _ _ _ __
_ __,S""ur=...::rv~,.__.:.V.-=a~._..._,...;2::..:3:..;:8'-"8=3- Phone (804) 357-3184 No. of Connection!li (Public) _ _N .........
IAI..L.._ _ _ _ _ _ __
+ Uper1 t ion Perai t Nud>e r (Pub 11 c) ~N:.L/~A.__________
Type of U<.e: Puh11c _ _ Jndustri1l---X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf measuresnents *re for I single~ter field reading, 11st wells included fn field swca No. Owner"°*------- SWCI No. - - - - - - Owner llo. - - - - - - -
SWCB N o . - - - - - - - Owner N o . - - - - - - - SWCI llo. Owner No.-------
SWCB No. Owner No. - - - - - - - SWCB llo. O.ner IIO, - - - . - - - - - -
Meter readings are fn _ _...,:ga~l1wl~o,l!ns~--------------<9*11ons, lOOO's of gallons, cubfc feet, etc.)
llote: If systa fl 11.-Urtd, tst1UU SUIPl91 SWCB No. Owner No. 14 fn boaes fn ll*tr rf9llt-lllnd corner, Date Heter Reading* Gallons Wat.tr level**.. Date Meter Read1 ng* &.llons V. tar Leve 1**-
Used Stllfc- ,111,-11111***
Cnd of Lut 11ontll z.~z 300 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 ~floe /~c:, 0 Tota I 'altOllf Tot, I C:. llOIII
- llttd attar seat tfat Hell day (prtftr1bl1 tnd of d11I ./ 'i?' t::> c::> D11rf119 Quarter 5'"700
- If Ult11, rHd It Ind of --puapf"t period Dur Int llollUI
- If Uk111, rud It tnd of lle1YJ-~1"t period
" .. If tlktn 111 Ont "'" 111 1 field, SPK1f1 wflfcll wll _ _ __
t All pr1,1tal1 or pvtillcallJ*Olllntd put>11c w1ter sul)CllJ 111t-t111 Tou I Clptntl119 Dll11 tll 1s !Ion tll . 3/
Total Opernf11t Dll)'I Ulfs Ou1rttr &,I' w1tll Huhll Otpartlllf11t pera1U. 0.1 11 A,er19t AilJ l,tr19t Dur f r,g !loft t II bB' During Qutrttr '?2-
YHr /f'?'/
GROUND WATER PUMPAGE AND USE REPORT lbnth AveicJST 51:11~ ~putmul of Hullh and State W11er Con1roJ Board Qu1rtu 1 26) 4 (Cfrc1e One)
~_.....){.__~11(1) Pwbllc. ~lld copy of rf'P()rt to ~lo,wl Sutt Vat.tr Co11trol Icard Offtu 1114 h9fDftAI Sutt Holt.II ~~rtNftt Office - County/City
_ _ _ s~1119(11 l"<fustrUI. Se<'ICI copy of rep0rt to lf-9101111 Sutt V.t.tr Co11trol Icard OH1c, Ott~r. Send coo:, of rtPQrt to lrij10nil Stitt V.t.tr Control Bo.rd OH1ct
- Surry
- - - llell(sJ alld Sprl119(1)
Name of Water.orks Na- of Ooeritor N/A Va. Electric & Pc:Mer Co. - Sun:y Posftfon/Title -.:NT/;;;A~-------------
Owlw!r Va. Electric arrl Pa.ve.r Co. SfQnitur* N/A Date __ N_IA Address P O. Pox 315 Popul*tfon Served (Pub1fc 1 _ _.....,NLL/...,AL_._ _ _ _ _ _ __
Suny, Va. , 23883 Phone (804) 357-3184 No. of ConnectfoM {Publfcl -~N ........
IA..__ _ _ _ _ _ __
t Uperatfon Pen1ft Nullber (Public) ....N:.,.1..:..A.__ _ _ _ _ _ __
Type of U<.e: P11hlfc _ _ lndustrt.1--X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 11euure11ents ire for I sfngle-11eter field rHding. 11st wells included fn field SWCB No. Owner N o , - - - - - - - SWCI No.-,------- Owner N o . - - - - - - - -
SWCB No. Owner No. - - - - - - - SWCI No. Owner No. - - - - - - -
SWCB No. Owner No.------- SWC8 lo. Oifner No. - - - - - - -
Meter rudings ire fn _ _...,g:;;,a ...l.,.l..,o""'ns""""_ _ _ _ _ _ _ _ _ _ _ _ _ _ (g1l1ons, lOOO's of 91l1ons, cubic feet, etc.)
llott: If systea ts 11niraeurect, tstf11&tt IUll)l91 SWl:8 No. fa bolft 111 lo..er rfgllt-lllnd COl"Mf'.
Date Heter Reading* Dde Meter Reading* Gallons Vlter Level**-
Used St.Ille" l"-iba*-
[ltd of ust lloftUI z..f75" ~t,oo 16 1 17 2 18
- 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 Z'5 IS Z. ~oo 3'? ~ 3oa Tou I Gt I ICNII
- lead aew 1eae tfae Hell **1 (pr1fe,-1bl7 end of day)
- 1f ut111, rNd It tnd of IIOll-~1119 Pfr1od Tou I 'a IIClllf Dl,rf "9 lblUI 3~6300 Dl,r I 119 Ql,1 rter 'iia '8, '8 c;) o
- If t1l111, rtad at tnd of 11t1,7-P1111111"9 p,r1od Tou I Oper1tl11t roul Oper1tt11t
.... If llllll In ont IOIII f11 I f1tlf, lpe<1fy wlllcll wll - - - -
t Al I ,rh1ttly or Mlfcal ly-owntd public wit.tr suppl7 1ysttaa Dlys tJI t 1 !loft U1 3/ Dl11 tJII I Ou1rt1r ~4' wlUI HuJUI Dep1r*11t ptrwCb. Dlf 17 AwtrllJI .11 i Ir l,rr1q1 Dllr Ing Montll 1z7114' Dllri"II Quarttr /3/o&:,
GROUND WATER PUMPAGE ANO USE REPORT ~Ui S~1>7e.-N1..9Ef'.
S1a1~ Cx-putm~nt or Hulch and State Wat~r Control loud Qu*rt.r 1 Zri) 4
_ _..cX.__ w<< II ( I ) Publlc. ~,., copy ef r~rt to ~tonal Sult ll1ltr Control loi...a Offtct 1 ..i (Cf re W'One)
- tg!ONI Stitt Ht1IUI ~Ptrtatllt Office - County/City
- - - ~prt119(1) lftdustrtal. Sfftd cop7 of rtP<>rt to Re9to,wl Sutt V.ttr Co11l1'1>l loil"f Office
- Surry Other. Stnd coo, of r'fl)Ort to l~ton,I Sutt lllttr Control ao....i Office
_ _ _ w.111,1111d so,1119(1) of Wa ter,;,orli:s Name of Ooer1 tor N/A
- a. Electric & Po.ver Co. - Surry Positfon/Tith_:=_=.:N~/:A::_-=_-=_-=_-=_:-=_::::=.:::::=.:=.-=_-=_-=_-:_-=:_=
Owlrer Va. Electric and p ~ Co. SfQn.turt N/A O.u __N_l_A_ _ _ _ __
Addrus P 0. Box 315 Population Served (Publfc'--~N..../.._A,..._________
Surry, Va. , 23883 Phone {804}357-3184 No. of Connection" CPublfc) __NUL./A~--------
+ Uper1tfon Per11ft Nunt>er (Put>lfc) *.N.... V...s.A:__________
Type of U,;e: Puhlfc _ _ lndustrfll--X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf 111easurements *re for I sfngle-.ieter ffeld reading, lfst wells included 1n field SWC8 No. Owner No. _ _ _ _ _ __
SWCB No. - - - - - - - Owner llo. - - - - - - - -
Sl<<:8 No. Oitner N o . - - - - - - - SWC8 llo. <>.mer No. - - - - - - -
SWCB No. Oitner N o . - - - - - - - SWCB No. - - - - - - - U-ner IIO. - - - - - - - -
Heter re1dings are 1n ___g~asa..l.l.:lol..:ns!.!:il._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (g11lons. lOOO's of 911lons. cubfc feet. etc.)
Nott: If 1,sta fs UIWlfUr'N, tSt1Mtt l)UIICll9t SWCB No. so -1 Gf o - Sl C. Owner No. '"B fn bous 1n la.er rtgllt-t.alld corMr.
Datt Heter Reading* D.lte Heter Read1 ng* 6111ons W1 ter Leve 1**-
Cttd of 16 Used St.ltfc..
"-t-***
1 17 2 18 19 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 o't:> f3o S-oo .,/303 7t,,7 15 31 ltr ,.., tfllt ,,ca d17 (pr1ftf'1bl1 ~ of d*1)
Toll I C, lion,
~rt "9 llollt.11 ~~3 7~i Tou 1 C.. llCNII
~rl119 l),artAr Z 1~7 Z. /o,::;J
- 11. rHf at tlld of IIOll*Pl'I01"9 per10d 111. rod It end of 11t1w7-~f119 periOd Tou I Oper1U119 roul Operattnt
.... 1, tel111 111 one .,11 t11
- fltlf. 1pec1f7 lllfl!cfl wl1 - - - -
t- All prhaltly or pvt>l!c.117*0,,ntd pllbltc water s111>91y ,,,u.
0.,1 tll 1s Non tll .3o 0.11 Ulls Qu1rt1r 7'~
wlU\ Hult/I D,ep1rt.ent penatu. r "1>1\,7'\ 0.1 17 Anr191 Mi IJ lwtr19t
¥-KE"A-"t>!NG °l,A-SE!> ON IZ MON-ntS Dvr 1119 ~lll /,¥ 3~5""'7 O..r1119 Qutrttr zz8',,/-z7 0/~o - 7/ttl ,
- GROUND WATER PUMPAGE AND USE REPORT ~ th S P 77:::7Vf B ~
S1.a1" ~putm"nc o( Hullh and Stace W11"r Concrol l!loar .. Quarter I zCi) 4
_....J.Jx.__ 11,11(,i P11blfc. ~IICI copy of rt90r-t l4 l~fon,I StHt W1ttr Co11t"11l to.iii Offfct 1 -,
(Cfrcle One) 119 t OtWI I St,t1 tiff 1UI Dti,,. rtlleft t Of ff Cl - County/Cfty
- - - S1>r1119(1J
- llldustrl1I. Send C09J of rtPOrl to ~fon,I St.ti lltttr Co11~l loil"CI Offfct
- Surry Ouwr. Stnd co0y of rtPOrt 14 l~lorwl St.tt lltttr Control &o.iil Offtc,
_ _ _ 11tll(1J 1nd Sort~{5) of Water..orks Na111e of Ooerltor :---;?-.,J/7 A;;----------------
ric & Po,,,,er Co. - Surry Posftfon/Tit1e __--;;N:t/r.A.--------------
n,..._.,..._ Co N/A N1'1v Va. Electric c:uu ~
_ _,.::i
- S f q n a t u r * - - - - - - - - - Olte ___ n _ _ _ _ __
Address P O. Box 315 Populatfon Served (Publ1c' _ _--4Nul.c.A~--------
-~s~ur=ryJJ..,_V-=.:a=-.:..._.,,__;:2=3__
8__8.a:.3_ Phone (804) 357-3184 No. of Con~ctfon" CPub1fc) _ _.uN.s...lAD..._ _ _ _ _ _ __
t Uper1t1on Pe~1t Nuniber (Publtc) ..N...,./.._A_ _ _ _ _ _ _ __
Type of U<.e: Puh 1 fc _ _ l ndustrfl 1 _x_ Other ( specf fy - - - - - - - - - - - - - - - - - - - - - - - - -
1f 11easurements are for I s1ng1e-Jll'ter ffeld re1dfng. 11st wells fncluded 1n ffeld SWCB No. Owner No.------- SWCB No. - - - - - - Owner llo. - - - - - - -
SWCB No. _ _ _ _ _ __ Owner No. - - - - - - -
SWCB llo. ~r No.-------
SWCB No. - - - - - - ,ner No. - - - - - - - SWCB No. ~ner IIO. - - - - - - -
Heter re1dfn9s ire fn ___g:.,.asa-.l-.lons~~--------------Cg11lons. lOOO's of g11lons. cubfc fett. etc.)
llote: If 171tea ts u!llfltrtd, tst1111lt ~ , .
SWl:B No. 3 / - 190 - ~2 C Owner No. C. 1n boan f II I o.r r1 gllt -1111111 COMllf'.
Date Heter Reading* 611lons Wiler level*.- ~te Meter RHdfng* GI 110III W1ter level .. _
Used St.tic" l'IIIC)111 -* Used Stltfc- .,_,tna***
Clld of ,,_ m Ult l'lanUI z.~7/ooc:> 16 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 z./ -z.../~ooa 173 ooo 15 31 Toul C.IIOfll ttr saat tfat ,,ca d*y (l)f'tftr,bly ~ of d*y)
Toti I G,11Dftt Durt "9 llonUI 1J3 c:>O~ Dvrl119 ~,rt.er z.t:;>~<-600 111. rHd ,c tnd of IIOll-~1"9 periocJ
- 1l111 0 r11d U tnd of llt1WJ*l)Ull'l)fll9 per10d Tou 1 Clperlt Illf Total Clper1ttnt
.... ,, t,t111 In Ont"" !11 1 fftlf, 1p~lf7 wtilc~ 11111 O.ys tJI Is "°" tll 3o ~i,..ij 0.71 Ulfl Ov*rt1r ;?~
t All prh1ul1 or pub1ful17-owntd public water supply 1ystt11a wl tJI Hu I UI Dep1rtsie11t Ptl'III ts. 0,1 17 Avtr19t .itily l,tr,9f Dur l1t9 Montll 5" 7(o 7 Our 1119 0111rur 3/ 34'--
7
GROUND WATER PUMPAGE AND USE REPORT ~UI S"E:P-rd,;11 B <'=~
S1&IC! ~putmenr of Hullh and Sule W11cr Conrrvl Board Quari.r 1 z(J) 4
_..-,;;.){.__ Well(5) Public. ~nc, cop, of rt?Qrt to ~fo,wl Sutt Wit.tr C411t1"11I to.l"d Offfct *~
(Cfrde Ont)
- ,9fonal Sutt HHIUI 0.PtrtMftt Office - County/Cf ty
_ _ _ Spr1119(s) lnduHrla1. Se-llCI cop7 of rtp0rt to ~!01111 Sult W.t.,r ~nt.r11I to.rd Offfct Ot~r. Stnd co01 of rtpOrt to Rt9fon,I Sutt W.lfr Control lo.I,.., Offlct
- Surry
_ _ _ 1/fll(s) 1nd Spr1f>9(5) of Waten<<>rks Name of Ooerator N/A
- a.
e>,.,ller Electric Va. Electric
& Po,-ler aooCo* - Surry po,.,er Co.
Pos flt on/Tit 1, -==~N;/;,A~==========================
SfQnaturt N/A O.te __ N_IA______
Address P O. Box 315 Population Served CPubltc' _ _--i.;Nul-6..A,._________
Surry, Va. , 23883 Phone (804) 357-3184 No. of ConMcttons (Publ tc> _ _N IA...._________
Uperatton Per11ft Nuirber (Public) ...N:..&./.s..A,___ _ _ _ _ _ __
Type of u~e: Puh ltc !.__ lndus trfl 1___x__ Other ( spec! fy - - - - - - - - - - - - - - - - - - - - - - - - -
1f measurements are for* sfngle--uter ffeld re1dtng, 11st ._ells fncluded 111 field swca No. Owner No. SWCB N o , - - - - - - - Owner llo. - - - - - - - -
Sl<<:B No. Owner No. Swea No, ().mer No. - - - - - - -
SWCB N o . - - - - - - - Owner No. - - - - - - - SWCB Wo, - - - - - - Owner IIO. - - - - - - - -
Meter readings are fn _ _-.:ga~..,.l.lo""ns,.,,..,_______________ (g1llons, 1000's of gallons. cubic ffft, etc.)
Nolf: If 1ysta Is urNttred, tst1Mtt ~91 SWCB No. Owner No. "}:> 1n bans 111 lower rl9Prt llllld CONlff.
0 Date Heter Reading* 6'11ons Wiler level**- O.te Heter lleadf ng* &illons WI ttr Leve 1**-
P'~ln ... Used di/IA St.a Uc.. '"-1ft0***
Clld of un 110nt11 / S--'1 s-fo.:9 I 16 1 17 2 18 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 18" 3S-7oo Z. rfo 3 oc;;;,
15 31 ter ,..,. tlae tacn d17 (pr1f~1bl7 ,net of d17J
'"* rHd at tnd of IIOfl-~1"9 period Toti 1 &a 1lont Dlirl "9 "°"UI z_e/o 3oD Tou I C. llllftl Dlir f 119 Ov* r ttr 77s- / o o 1l111, rtld It tnd of lltlYJ*P11-c>f"9 period
- If t,t111 fn one wll In a f1tlf, SP>Klfy _..fell _,.11 o.,. I Tota Qc>eratln9 UIII NonUI 3o roul l)pfrttl"I Di.rs this Ovarur 9'~
t All prfwattlJ or P\lt)lfCJIIJ-owne-d put,lfc water supplJ systetia wiUI HulUI Oep1ri.nt ptrwlU. 0.1 IJ Avtr191 .>1 i I 1 l,trlqf Our f ng Kontll ?"o /0 Dwri "9 Qui rttr F Z~0 - --
GROUND WATER PUMPAGE AND USE REPORT ~di 6~.P7E7J18§!_
S1a1~ CHpu1m~n1 or Hnhh and St.ale W11~r Control li!loar4 Quuw l 2 CJ2 4
_ . . .x....__ 11c 11 P11blfc, ~"'° copy 1f rtP()r-t to ~to,wl Sutt Vttar Co11trol lo.ll"d Offtc, ,,.,
(Cfrcle OM)
. b9f0Nl Sutt ~IIUI Dtp,rtafftt Office - County/Cf ty
- - - Spr1119(1) lnc:!11strl11. Stfld coo, of rtPQrt to ~1on,I Sutt V.tar Co11trol lo.I~ Offtct
- Surry Other. Send coo, of rtP()rt to ltg1o,wi I Sutt V. ttr Control lol~ Offtct
_ _ _ Vtll(sl *nd Spr1119(s) a Ow~r of Waten.iorks
- a. Electric & :E'cM'er Co. - Surry Va. Electric arrl Addr,ss P O. Box 315 Po,,Jer Co. Siqn.tur, N/A Nuse of Ooerator _ ~ , ; . - - - - - - - - - - - - - -
Posftfon/Title _ _,:N,:/r;;A.--------------
N/A Population Served (Pub1fc 1 _ _-.JoJNu.lA:JA~--------'--
O.te __ N_i_A______
Surry, Va. , 23883 Phone (804) 357-3184 No. of Connection" CPub11cl _ _N IA~--------
Uper1tfon Pe1"11it ftullber (Public) NIA Type of u~e: Puhl!/_ _ lndustri11-X_ Other (specify --=----------
If 11easurements ire for
- s1ng1e-<<ieter field reading, 11st wells fncluded tn field swca No. Owner No. swca N o . - - - - - - Owner 11o. - - - - - - -
swce No. Owner No. SWCB No. Owner No. - - - - - - -
swca No. Oitner No. SWCB llo. Omer NO.-------
Meter readings ire fn _ _....;g~ald.l...._l..:ons~---------------<9111ons, lOOO's of g,llons. cubic fNt, etc.)
SWCB No. /S-z. -1'10 - 7/ P, Owner No. C Date Heter Reading* &.llons
- W,ter Level* ...
lote: If 111tea ts Ulllftued, 11t1allte IUIPlta Dlte in bo11u fn Jo-er r1glrt*llllld corner.
Meter Reading* C.llons V.Ur Lev11**-
Clld of List ltontJI 1
2 5"'1 Z. 3 ~"°
- Used I Sut1c.. I
~ - 16 17 18 Used Sl1t1c- "-f11Q*-
3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 J, '3t.'?&' ?,u~ .t/.-,/~ 3 5'DD 15 31 Toll 1 C.llonr Tot.ti GlllOAI
-ter saait tfae ttCII ,., (pr1f~1bl1 lfld of d11) ket1, rHd 1t end of IIOll*pullC)1ft9 period
~r fng lb\UI 4'~t,3 8'o~ ~rf119 Qt.,1rur / s- 7'? I f;"o <=
Ullfl, r11d It end of lletYJ*l)ulllp1f19 period Toti 1 Oc,trl\1119
~~
roul Oper1tf119 If Ulen tn one 11111 111 1 fte1f, l1>tctf1 *Mell 11111 - - - - Day I UI h !bl tJI ..3o 0.1' Ull1 Ou1rttr t All prfnte17 or pvb1fc.ll1*0lfntd pielfc i,,ter suppl7 sysU.
- 1 UI Hu 1tJI Dep1rtiae11t penit u. 0.1 1, her19e 0,,,r 1119 "'>ft tll / 7'? 7f'3 JAilJ A,1r1ge O..r i "9 Qvarter l/b7 '19'~
GROUND WATER PUMPAGE AND USE REPORT lb\UI Sc?,A1 ~~
S1a1~ ~partmcnt or Health and Su&e Waccr Concrol loarlil . Qu&rt.r 1 2~ 4
_ _.....x.__ Wtll(s) Public. ~no copy of ~ r t to t.gfOMI Sutt Vattr Control to.rd Offfct allf (Cfrcl Ont)
. *,9to,wl Sutt KE1IUI ~rtNftt Offtc1 - County/Cfty
_ _ _ Spr1119(s) ln<Mtrlll, Stftd copy of rtpOrt to ~lon,I Sutt w.tttr Cont.1'111 lo.rd Offlct
- Surry
_ _ _ lltll(s) 1nd Sprfrt9(sl Other. Stl'ld cooy of re-port to ltgforwl Stilt llattr Control Board Off1c 1 ----=-------
me of Waterworks Name of Ooeritor --.?-:;'l/7,A.--------------
Va. Electric & Pl::Mer Co. - Surry Pos1tton/Title __-.:N~/r..A_ _ _ _ _ _ _,r+,.-------
-- Co N/A Nt'A o.~r Va. Electric arrl Pcwer
- S1 Q n i t u r * - - - - - - - - - 0a te - - - - - - - -
Add,...ss P O. Box 315 Population Served (Publlc' _ _-J,JN.._/.,....A..__ _ _ _ _ _ __
____Sur=:...:r:y:.J..-1,~V=a"'""._._,_2-"3'--8~8-'-3_ Phone (804) 35 7- 3184 No. of ConMc t ton~ (Pub ltd _ _NO,M. .j/A.. .__ _ _ _ _ _ __
Uperat1on Pel"llft Nult>er (Public) ...N 1/__A.___ _ _ _ _ _ __
Type of U<.e: Puhltc + __ !ndustrf1l_.X_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If 111easurenents are for I stngle-11eter ffeld re1dtng, 11st wells fncluded tn ffeld SWC! No. Owner Ho. _ _ _ _ _ __
swca No. - - - - - - Owner lo. - - - - - - -
SWCB No. Owner N o . - - - - - - - SWCB No. Oirmer No. - - - - - - -
SWCB llo. - - - - - - - Owner N o . - - - - - - - S\ICB llo. ~r RO.-------
Meter readings ire fn --~g~a:!.l1a..l~ons~;z_______________ (g*llons. lOOO's of g,llOM, cubic feet. etc.)
llote: If 11sta h ur.ettr-ed, est1-tt ~91 SWCB No. Owner No. 'F 111 bous 111 tor,,er rfght-llind comer.
Date Heter Read1 ng* O.te Meter Reading* S.llons V..ur lev11**-
Used SUt1c- '"-iffta*-
Cnd of LI st l'on t11 3',S- i "5 'i?"0 16 1 17 2 18 3 19 4 20 5 21 6 22 1 23 8 24 g 25 10 26 11 27 12 28 13 29 14 30 ..3'-+ (g'o 15 31 Tou I &.llonr Tot.II &.110III attar SMI tfat t1cll ,uy (prtf1f'1b1y tnd of day) alffl, retd at 1nd of IIOll-l)UIIC)flllJ pcr10d Durt IIIJ ftontll $"'8'00 Dur1119 ~arter 61/7° tel111, rod at Ind of 11t1,y-~f111J pcr10CI Toti I Operat1119 Tot.al Oper1tf119 f Ultn 111 one "'II tn I fl1ld, specffy -'llcll wll - - - - Days tll ls t Al 1 prhataly or pwltcal ly-owntd plAll1c *at.tr su1>9l7 sysU.
"°" tll 3c:::> o.,, UI Is Qua r ttr 9-/
- w1UI Htaltll Departiaent Ptl"IIIU. Oaf 11 Awlf'&~ .itlly A,tra~
O.,r Ing Molltll /'73 O.,ri119 Quarter 98'
- ... -* -- ... -* . ***""-"'~ T~r~~l~f~?~(~~~-
GROUND WATER PUMPAGE AND USE REPORT ~ tJI :SEP "'Ti!::/11 e ~
~ tc r Sovr-c r: 1 2 l 4 S1a1e ~pu1ment of Huhh and Su~ Water Conrrof Boar_,
_ _..LX._ ~ 11 ( s I P11bltc. ~ncr copy tf ,-.port to l,,glOMI St,tt ll1ttr Co11trol loir,11 Offtc, llld (Cf~le One)
- lt9to,wJ St,tt Ht1IUI ~rt:Mftt OHlct - County/Cf ty
_ _ _ Spr1119(s) llldvstr11l. Send coo, of rtPOrt to l,,gfOtlll St.tt W.ltr Cotltr111 loir,11 Office Ot~r. ~nd coo, of rmrt to lttg1orwl St.le luter Control to.r,11 Offlct
- Surry me of Water.,orks Nuie of OoerHor --;?-~T/ 7 A;----------------
Va. Electric & Pc:Mer Co. - Surry Posftion/Title _ _~N;'i/r;A_ _ _ _ _ _ _ _ _ _ _ __
Owlrer Va. Electric aro Pc,.,Jer Co. si Qna ture _ _ _ _N_,_/A_ _ _ _ Dile __N_/_A_ _ _ _ __
Address P O. Box 315 Population Served (Public' _ __.N..._{... A....__ _ _ _ _ _ __
_ ___.Sur='-"ry'-"-"1--'-V""'a.c...~*_2_3_8_8_3_ Phone (804) 357-3184 No. of Connection!> CPublicl _ _.uH.s...fA.....__ _ _ _ _ _ __
Upent1on Peraft Mullber (Public) ,.N;:;.,:l.:..A=----------
Tyi,<< of U'-e: Puh 1i c +__ 1ndustr111 __x_ Other ( s p e c i f y - - - - - - - - - - - - - - - - - - - - - - - -
1f 111easurements 1re for* s1ngle-11eter field re1dfng, 11st wells fncluded 1n field SWC8 No. Oimer No. SWCB No.------ Owner lo.-------
Sl<<:B No. C>.mer No. SWCB N o . - - - - - - Oimer llo. - - - - - - -
SWCB No. o.mtr No. SWCB llo. ~ner IIO. - - - - - - - -
Meter rudings ire tn _ __:g~a.3.l.i...l.l!ons"2..!iil---------------<v111ons. lOOO's of gallons. cubtc feet. etc.)
Nota: If systa ts ur.eterld, tst1Mte puilC)l9I SWCB No. Owner No. Q fn boaa fl ICMr r1pt-lllnd corner.
Date Meter Reading* Gillons W.ter Level* .... Dlte Meter Re!d1 ng* &lllons W. ter leve 1**-
Used Stutc** P'IIIIIC'1IICI-' Used Stit1c- "->1na* ..
1 Clld of 7&" runn,uur, 16 ust 11ont11 Zoo ,,,// ,. ....
1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 '
29 14 30 7F "'2-C> o - c::::> -
15 31 Toul litllOAS aeter uae tfae 11c11 d11 (l)f'tftr1bl1 tnd of d11l 1ltt1, rttd 1t tncl or IIOft-~hlCJ perloel Toti 1 Ca lion,
°"r 1119 "°" tJI - o- 111,,1119 Quarur z r/ ===
- UU11, reld It tnd of lltlYJ*l)Ulllll1ng jltl"IOCI
.... If Ultn In one ... 11 1n I fftlll, SPt<ffy WIICII -ell - - - -
- All prhately or put,lfully-cwned publ1c .. ia, supply s,su.
Tou I Oper1tfn9 n.,, Ults lb!UI ..30 Tout 0perlt1"1 Dt,s Ulls Quuter 9'+
wiUI Ktaltll Deparant ptralts. Dt1 ly AvtrAC)e ..,.11, lwrr19t Dur 1119 lbltll ~
o- Dwr i"9 0.,1rttr 2 s-5""
.....,._. I iC, '1111** \J-~J GROUND WATER PUMPAGE ANO USE REPORT
.... ,..,, ... ~ '"'
~UI tf't/
S:-§°PW-11dB"
. l1.
11, ur So.,ru:
S1a1~ IHputmcnl of Hullh ind State Water Control Board Quuter , 2 ti>c I
-~}{.___Wtll(1) P11bllc. ~M cop, of r~rt to ~1oiwl Sutt ll1ter Co11trol to.l"fl Offlct 1..s (Cfrcle One) lt9lonal Sutt HultJi ~~rtlltftt Office - County/City
- - - SP<'l"9(II lllduHr111. Send CDP1 of rtport to ~lo,wi Sutt 11.iltr Co11trol to.rd Off1ct
- Surry Ott~r. Stnd co01 of rtport to lt9lon,I Sutt W.ltr Contr-ol Bo.l"fl Off1ct
_ _ _ 11,ll(1J Al'ld Sp,1119(1)
Name of Water-.orks Name of Ooerltor _ 1?-.,J/T:A;;;---------------
Va. Electric & Po,,Jer Co. - Surry Posftfon/Title __-.:N;";/r,;A:--------,-.------
_...,:i Co N/A Nt'A Ow'IW!r Va. Electric cuu Pc:1Ner
- SfqnHur*--------- Date--------
-- -Addrns - -P O. Box 315 Popc.,l1tfon Served (Publfc' _ _........,N<L./._.A.__________
_ __.S=ur=-=cy~,--'-Va"----._.,"-"2=3--'-8___
83~- Phone (804) 357-3184 No. of Connectfonio (Pub If cl _____N ..........
/A....__ _ _ _ _ _ __
Uperlt fon Perai t lut>er ( Pub 11 c) ....N,../~A=----------
Type of U<.e: Puhlfct_ _ !ndustr11l__x_ Other (specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Jf eeasurenents ire for I sfngle~ter field re1dfng, 11st wells included fn field SIICB No. Owner No.------- SWCI No. - - - - - - Owner No. - - - - - - -
SlitB No. 0.mer N o . - - - - - - - SWCI llo. Owner No. - - - - - - -
SWCB N o . - - - - - - Oitner No. - - - - - - - SWC8 No. Uifner IIO. - - - - - - -
Meter readings ire in _ _..,:ga~l...,l..,o.::.ns,...,__ _ _ _ _ _ _ _ _ _ _ _ _ _ (~11ons, lOOO's of gallons. cubic feet, etc.)
llott: If 1y1ta ts uNDettred. tst1Mtt pu11p191 SWCB Ho. Owner No. rf fn bollH 111 Jo-er r1gllt-~nd corner, Date Meter Reading* Gallons Water ltvelu'" Date Meter Reading* Gallons Va ter Leve 1**'"
Clld of Lut l'iontll z.(p '-f / 0 e:,
WI/ID."'
"'W/ilj 16 Used Static- IPiaa1 .......
1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 z.~~ 700 2.-8'e, c:::>
15 31 Tot, 1 C.1111111 Toul C..IIOftl
- ltlf aettr sMit t i
- 11c11 4117 (pr,f.,-1bl7 tftd of d*JI Durt "9 llonU 2-?e:, t::, Duri 119 ()itrter ?700
.. ,, tOt11 0 rHd 1t tnd of IIOll-~1119 perlOd
- If Ultn. rtMI It tnd of lltaw7-p,.-p1119 period rou I Opern 1nt
.... ,, Ultn In one""" 111
- flt1f, spec:1'7 lllfllcll wll - - - - o.,,
Tott I (lperaUnt tllh Monti! - 3t:::> Dl,i Ulh Qu1rttr 9.../
. t
- At I prh1ttl7 or ,wl1all7-oirned public Wlttr supr,17 11stta1 OIi 17 Awer1ge .,. il1 l,1ra9t wit.II kulVI Dtp*rtiaent pera1ts.
Dvr 1119 Montll 93 Dvr i "9 0111 r ttr 93
'***'-1****~ YHr 1711 GROUND WATER PUMPAGE AND USE REPORT l4on th S"c:,P-T'E/11 2S~
Si.ale Cxputmcnl of Hcallh and SUte W11cr Conlrol Board Qvart.r 1 2 J 4
_-£.X..__ Wt 11 ( s) Pwt>llc. Sfnd copy of rt90rt to ~!ONl Suu V1ur Control to.rd Offtct 111d (Circle One) lt9lon,l Suu 11f1lt.11 Dci;i.rtllfllt Offfct - County/City
!f'l:d..:itri!l~ S~ c~y of rip,or-t le L~foM1 State V!t!r C.Ont.~1 !e:rd Off1ci
- Surry Other. Selld cooy of report to le,9torwl Suu V.ur Control So.rd Offlct
- - - Wtll(s) Ind Sprf119(s)
N.sme of Waterworks Nal!I@ of OoerHor --;t,.,J/ 7A;;----------------
Va. Electric & Po.oler Co. - Surry Posltlon/Title _____,N.i/,..A_ _ _ _ _ _ _ _ _ _ _ __
- - -- N/A t<lt'A o,...'Wer Va, Electric arrl Pa,..rer Co. Sf qn* ture - - - - - - - - - ~te - - - - - - - -
Address P O. Box. 315 Population Served (Publfc'--......:NLL/A.AL--_ _ _ _ _ _ __
_ __,S"'-'ur=-=cy=...u<<'--'V.;:;ac.:..-.L.'--'2:=..:3::..:8'""8"""3'--- Phone (804) 357-3184 No. of Connection" (Publ fc) _ _.... N.i.(AAA.._ _ _ _ _ _ __
Operation Pe,...lt Nuwt>tr (Pllblfc) ...N_.l.:..A=----------
Type of u~e: Puhltc + __ lndustrhl ___x_ Other (specify _ _ _ _ _ _ _ _ _ _.,....._ _ _ _ _ _ _ _ _ _ _ __
If 111easurenents are for I s1ngle~ter field reading, 11st wells Included in field SWCB No. Owner Ho. SWCB No. - - - - - - Owner llo. - - - - - - -
SWCB No. Owner No. SWCB No.------ Owner No.-------
SWCB No. _ _ _ _ _ __
Owner No. - - - - - - - SWCB No.------ Oifner N o . - - - - - - - -
Meter readings ire 1n _ _...:ga~l..,.1-:o""ns!=._______________ (gallons. lOOO's of gallons. cubic feet, etc.)
llot.: If systa Is u1V11tUrtd, tstl.. t<< JllaPl91 SWCB No. 111 bo.ws 111 l°""r right-hind COC"Mf',
Heter Reading* Dite Meter Reading* 6'11ons Viter level* ..**
Used Sutic.. '"-ifl'ICI***
16 1 17 2 18
- 3 4
s 19 20 21 6 22 7 23 8 24 g 25 10 26 11 27 12 28 13 29 14 30 2~57SS-oo ...,-zo G::, 0 0 15 31 Tot.I 1 ~110ftf Tou I C..110fts
- lte14 aetar s11ae tfllf ttca 111 (prtf~1bl1 tnd of d11J I z '5'J' 4'oc.
Dlirf 119 l'lo!IUI 42.oG,.oc:P Durt119 l),1rur
- If tlktn, rttd 1t tnd of IIOft-Pl,Olll)fllCJ p,rfod
- If t1lt11, rt1d It tnd of 11t1,7-~1119 p,trlod Tott 1 (lper1tf119 Toul Oper1t1111 09
- 1f t1lt11 111 ore wll 111 1 fltld, specify wtitcll wll - - - - o.,, th Is lion tll - 3o Dl1' Ulls Quarter ff~
t All prhlttlJ or PIA)lfully-owned public ~tu supply sysu.
w1UI Hultll Otp1rbltnt ptrwlts. 0.1 ly A,~1ge Dur !119 Monti! /io 'Z.O
.>Ii,, ,,,,.,,
D,,,ri"9 Ovtrttr /339-:;{
- - - - - - - .*Jiiiiiiiifii!!!-,,.e
...~-/----;,--~--rrn. L i:I.YGET1~ WEU DR1Ll.l.'iG CO~lPAN'f
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tJ,n,.d 1&__ llo_i; I:. bnd _____ ln __ _!iw:.:y. c 0 ...,r:y, :;1.ac. vL,:1nh
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PUMP DATAs
- 4.
I a.,Ne. - - - 'l')Jil 1-w *' /
l!J°";; ,i~-----~~-8=\.\--11-..-.--:.~--.----.. ,
t.. e. .J p.,~ If*~ ~~~-1.Q--~~~-*______,: . j.
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~fut Plevf\H' 3600
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R. L MAGETTE WELL DalLLl~G CO.iiPM, r
..J*
SlllTIO I r.l.i>, Vl!lfil:IIA vt*i L F Vlq; L'.,l::. F:tccc.r{: *!.-r~r Coap.any Well "a 1
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C011111,1 Stat*-Y!r:;1ni~
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ti~i-i...t c,,m.., ________________ ,19 _ _ Finished 1967 .J*
- ---:* --i O.-t.1C-
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- L
- ---l -'-***---i- *-**. --T,,.11-, -----------a___;.,.____
s-, Ne. ,.,,,. Lual,ew
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-*------------* ... * ~: l!'
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I * *
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- __°l)!"'Su=.~ar~*~~--~---O~pdw----*-M_*_.____.-_,: *}
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- -..._ ... -..-,.... - ......., STATE WATER CONTnOI. IJU/\HD
,~- ~* 1f.'o1011.:'-:---------
. 2n1 VERIFIED 0. Box 11143. 2111 North Hamilton Street fin-,* rr, .~\ r* ~,~ .* 1n--*
1*l *
- ru
- ev: * &-Yc4&}!jiv.J/b Richmond. Virginia 23230 Phone (804) 770-1411
-*
- I I I 61 o** - 7 /
,J* *r'"
oJ *al
- DATE
- b/2.(:;./s,D : WAiER WELL CCMrLETION REPORT o 20¥v 2 o ~
PEm1t'T"-tttff~~:i.:=;;:=..J. j (Certification of Completion) DATE REC' D8LJ0/1918 BWCH WELL NO. ::I l!ell Drill-- --- - TRUCK TAG NO. 2h]
~ ', .,
LOCATION OWNER I COUNTY: . airrz*- - .-* - . - . ~ --** ---- - - - - -* NAME-: - - -Vepco-- -we:c.i. ~*e/'-
STREET: P.O.* Bo,: 26666 WELL IS LOCATED APPROX. 16o feet/miles CI TY: --iH.c-:hJll-o-n-=-d--~--------
.>uth (di rec:tion) of intake cene.l and STATE: Va. ZfP: 23261 _ _
~ feet/mi Jes ~(direction) of i *western end ot canal
- WATER WELL USER
~-t.J.t'....c FIL .c...-7<:..- tt WELL IS NEWLY CONSTRUCTED ,f"' OR IS AN NAME: Slrry Pouer Plant
. ALTERAtlON, REHABILITATIOtf:0R EXTENSION STRF.ET: -Rt. 650 Off llwv. 10 _ _ _ __
CI TY : Surry-*-~;:_.;.;__..::_..;;;;.;;._
OF AH EXISTING WELL
- NUHBER OF CERTI Fl CATE OF GROIJNOWATEn RIGHT OF EXIST- STATE:-Va. ZIP: 23883 ING WELL, IF APPLICABLE -------
_CONTR/\CTO~ ,, \ . i l/,,..._1, .. ,
/'>
\ FOR OFFICE USE:' °?;;~--:~~~::~,~~{~};;:-'* . S IGUAl LJP.L: 7_?_~1?-/1:.""!_;1 . ~: ,1 f~ I'<:.~.,
NAME ( type) :'l'i.Ur.-,an rJe Service:{
~
0 VA. PLA.~E COORDINATES: ~ N s TRE f T: 1 6W~ "JoIIITI""Tld. 1 CI TY : CiiEwfiii~ af:e <
5TATE:.\1i\: ZIP: 2332\
TOPOGRAPHIC HAP NUMBER:
BASIC DATA 1ok1 D,fk. ~
DATE STA~TEo/lugust 8, 1978" DATE COMPLETED: Augiu;t 30, 1978 420 DEPTH DRILLED:
DEPTii OF COMPLETED WELL: b20,' STATIC WATER LEVEL: ,oo feet be1o,, land surface.
. - fu""'f' ;J lf..id. @:>. I YIELD TESTfW!lP Hethod; Drawdawn- 28 feet; Yield 220
-- gpm; Duration
-48 hours.
WAS ;HE WELL LOGGED?G/No, if Yes. BY WHOM? I.ayne Atlantic TYPE OF LOG(S) : ~ ;
WAS THE \IATER ANALYZED1@/No; If Yes, BY WHOH7 .* TYPE.OF RIG:Fa111Jlf WELL TO SUPPLY: Home/Farlll/Kunicipallty/School/lndu~tryisubdlvision/Other Vepco {jJ W~~r~~~t~~~~L~- SAVED7Q'isl~o (Well cut~i~:.d be c~llected at 10-foot Inter*
vals and shippe~ress col1~ct to this office in a shipping contain.er. Sample bags are furnished free of charge upon request).
PUMP DATA CONSTRUCTION DATA 12 o b2S BRAND NAME : Reda Pump Co. HOLE SIZE: in,hes from to feet TYPE: QN 63/8 -inc.hes from - t o -feet NODE L NUMBER: 7"'-S=f,_.n--as...___,.... - - - - - - -inches from to -feet RATED CAP AC I TY : 200 gpm at 310 feet of head. CASE SIZE: _6_i nchcs from _Q_tol.l2o_feet DEPTH OF INTAKE: 1uhu.7..i..{.1,1,ta..,- - - - - - inches from to feet
.RATED H_QRS EP O\lE R:* _.2...i.0'6.IH......P...,,..._._ _ _ __
R.ivc,,. B~ - t2 i 1:...-
Pre,\( - I 4 , .(Z"'\
e, ......- 1 ~ ., ,,
-inches from - t o -feet GROUTING7 Yes/Ho; from surface to n c_ - ..
Fo.--.:rho-; - k PTX-
. .:._. . _ =--
C {Cfo-71
' -~
- SC,J'EENS(..,Yes/Noi OR ..--
ES THE \/ELL HA f()TTED orCPERFORATED p I PE~~~/No
.. 'LOCATION Of SCREE- ...,,:..:':.._./ Give the diameter and depth of all scrce:ns or sec;;tic~s ,of slotted
- or perforated pipe.
- 6 inches from Inches f ro.11 400 to to
-420 feet feet i nchcs from i nchcs from.
to to
- -.,feet feet inches from QUALITY DATA to
- feet inches from to feet DID AAY STRATUM CONTAIN WATER WHI qi WAS UNUSUABLEr!~s TYPE OF WATER_
- DEPTH OF STRATUt1: from380
., to420 feet; from _ t o
\
feet. WATER TEMPERATURE:
\
- F
-~
- - - - - - - - - - - - - - -
- DRILLER'S LOG ~---------*-""'l___
DEPTH (feet) TYPE* OF ROCK OR SOIL PENETRATED
- REMARKS (gravel, clay, etc.i hardness, (water, caving, shot, From To color, etc.) screen~ sa~ples, etc.)
.....-----1--------------------11---------- -------*--
Sec attached sheets.
Drill wr,( .:-\1"7 i'~or Plw,*.. )
( \.'cl._11£)
c..*r Yc1.lot: fa1-d
-!elloi.~ ~.end Gn>y f.u1d Gro:, f,-.nd:£1n:,
- ,-Or.::,* fz.nd:£1~:,
3-Clcy Cl~y 11 O-f5.."'lc Grr1y f~n::J 12C-Fine ri"n ;J 1}J-Glly 1.!::>-Fina Gr4'y !"t:nd:~lt:;r 1$0-Clr.y 1f.O-Cl.ny 170-Cl.r.:,
180-Finc Gn.y f s.nd:!:lc;t 190-Fino Gra:,. f-£nd~hy 200-F:iJ'lc Gray f~"lo:.4::lt.y
,10-Fino Gray faij!..Chy 220-Cl.riy 230-ClL;r 240-Cl.l:y
\
\ \ \
250-Clr.:, << Yeller~ f211d 26c-Cl..::;r l.:. !'cllcr.1 !°Ole!
270-Clay &-_YellC"..* ~~d 280-Cl.ey & YellCi: :c.nJ A?o-Cle:y i,:. I:li:clc !-"'Md 9Jo-BlL.ck :and 31 o-m.:1ck .;"rnd 320-Bl.eck ~d 0 330-u.ack :and 340-m.4ack fc:.nd 3$0-1!::ld & lil.:;ck fMd 360-Blr:c k !°E.nd 370-Cle.:.r ~ck ~d 3eO-Glear Bl11.CK flmd 3~J-Clear F:5.ne frnd
.i:::0- ~".s.nd Is !-:e di tr:: & Couri:o
,i10-ft:!ld le !-~diUJ"', ~ Coarse J.2~:l:..."ld ls l:ediu-:i t, C_c,urse_*
- /t;C_-7/
6"\t:ell 1 t
(
-~~*'.'.
I I
._._ SO,Cement l
.l 12"Bole I l
.i
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w
~
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- ,- ~ .: 20 .3()4 St.ain.leaa St.eel Well S:reen
,. . . . 1
VJ~! C-. r -
. j,W*2 COMMONWEAL TH OF VIRGINIA
.1-10,000 WATER WELL COMPLETION REPORT *BWCM No.
(Certification of Completion/County Permit)
Stat* Wauu Cunirul lc:rd P. 0. Bo* 1110 2111 North Hamilton St. SWCB 11erm*t Richmond, V*. 23230 County Perm, t Certification of ,nspecting official County/City _ _ _ _*,-*..:._...,..:._ _ ____.:5=--.::a:;.:..~::-~---1.'"?~--:-:~-::------- This-II does meet code/low reQuirernenu.
does not
£ounty/City StMnp s. ____
- V org,n,, Pl*ne Coordin*tes
_________ e N *owner vt/iLM,..,,
- well Design*tton 1>r Number P()wt:X-Date _ _ _ _
F or Offic. Uu Address_ "1.lv1.a~er- ~~ Qa&,a\,~ ,a "P,c;,. "'h6 2..,-c.. _____
Latitude & Lon<<Jitude
_ _ _ _ _ _ _ _ _N ___.._~~o~, J4, %-Sf1:wl Taa Map 1.0. No.
w (!5 * "';) i77,.- - '"1
Phone '5 Subdivision
- Top o. Map No. _ _ __
- Elevation _ _ _ _ _ _fl. *DrillinQ Contractor Address ~ a,
~~:1-jf:,,,.,.,
~~~~ G:.
~, Section Block
- Formation _ _ _ _ __
- L1thOIOCJ'I _ _ _ _ __ ;,, ) 5,!,)0 Lot _ _ __
Cl. . Well I
- - - . IIA
- River Basin _ _ _ _ __ Phone~ai) ,l,S 2-~/i()(} 118 me __ _1110 --
IIIA . 1118
- Province _ _ _ _ _ __
- Type Logs _ _ _ _ __
- Cuttings _ _ _ _ _ __
- water Analysis_ _ _ __
WUL LOCATION:
and Bo 1'fi @miltt 3QC?* direcliont of Se'
(!Si)miies~ldirectionl of# H1Nf!t I If possible pie. . include map showing loc11ion ~kedl WP M'-' 'F4Cnn!M .,
CA*,.u._locat.. ~--'i=KJ
~~-1L.~*
Ill[_
- AQuifer Test _ _ _ __
Date started Jo 1' t:'. Type rig h:.L, .,.. --*
I. WELL DATA: Newd,_Reworlted
- Total dept.ti 3 , ,
Oeepensd _ _ __
ft.
- 2. WATIR DATA
- Water temperature_
eSiliiie ...ca, !;,:c! lun:Nmaed i..,ei-menu -~.--=~--~
- 1..a t.
- Depth to bedrock ft. *Stlbil:zed meaa.ted pump1NJ water !eveI
- Hole size IAlso include reamed zonnl *St1biliZed yietcl KO gpm a,,,r - ~ - - t , .
- ' j'r,r inches from 0 to .3&C ft. NMural Flaw: Yn ___ No _,/_. flow rate Q
- i,lj: 1ncnn trom :i'SQ to:3f . . tt. COfflffllllt OIi QUality - -
- _ _ _ _ 1ncnn trom - - - - - to
_ _ _ _ _ _ ft.
- 3. WATIR ZONII: F r o m ~ T o ~~ -
- Casing size 11.0.1 and mate,ial From---- To . From To
- 't" inches from _ __.,Q,.__ to _)..IC--...,..--.!'* From To From To _ _ __
Material
~
_J ... AC y Y/
I~ A L.V: '* USI DATA:
- I Wt. per t o o t - - - - or wan tnican111 _ _..,..,,.-_ _ in. Type of ua: Orinkiftt V . Ln,estoclt Watering :
- t?, inches from is><< to i W:I, h. lrr_ion _ F ~ e s 1 1 n g ___ . Household _ _ _ I
~terial S C I-/ Y<2 LJ <<' ~ e. 1.4ttfl'-dt Manufac1Urlfll _ _ , Fire safety . Cleaning Wt. per toot o'rw;.(tnic*,l,;. _ _ _ _ _ _ in. AecrNlioll_. Antheuc _ _ ~Cooling or ne;.1nca_ i
- _ _ _ _ inchn trom _ _ _ _ _ to _ _ _ _ _ _ ft.
llliection _ , Ottlat _ _ - * - - - - -
Material _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
- TVDe of fa:il1ty* Oomesuc , Pubhc water supc,ly _ _..-
Wt. per toot or -.II ttlickNIII ___ 111. flulalic iflltitulion --;;,m __ -* . Industrv _ _L_ '
e:icreen sia and mnh f~.-91_. IOIII twlllfe IPPlicmle
- ;1 '" inc"-\~ -
- Mmsi11 ~ Type 'MIi<<*
1 J,tr..2 10 ..32.-~----ft. -
ace e-ecrl~.S..
Commerc..
I. fl\W DATA: T.,,,.
- 1n1atl16-tttl ti, f
. Omer 11/F --;-;;,;;-;:; P. ___f_,,___.
,c.--;,v _!-~~ ;,-
{,d/'S lt..e
- i n c~.j:
~**~ __so n _ h. ' I. WILLHaAD: Type. MIi . ., ~ :~ 4rOUt dM '
- Mesl'I si11 - - - - - - Type - - - - - * - - - - - , , _ , . lank / 2" gal., Loe._, Nrrl-:fC _:___
- _ _ _ _ inches lrom - - - - - to _ _ _ _ _ _ _ ft. SlfflDlt tap .--:::: . Mwurement pcwt * * - - - - - -
- Mesh size ______T y p e - - - - - * - - - - - Well '1111111.L::_.. Preaure rehJf valve __________
- _ _ _ _ inches trom - - - - - to It. G* velwe ~ . U..C11. vlllWe llllohefl requirldl _/""'
- Mesh sin _ _ _ _ _ _ Type Electrical dileone** Mitct'I on power supply_
- J~-,
- Gravel pack 7. DIIINPICTION: wi.1 dili11fec1ed ._d. __ yn
- From------- to - - - - - - - - - ft. o... 0111nfect:int used_ y 6(T b'
- From to ft. Afff0Uft7~ . tt,>u,s u*------~
NT lwllere _..icablll *yee ___ no ( ~
- Grout I. AMNOO
- From __..(J__ to _.s_O__ ft., Type jle,a4<<1 ree::r -~ .Califttpuled Yft _ _ "°*--- not apglcat>le _ _
- From to _ _ _ _ h., Type 'lutlifll pout Fl'Offl _ _ _10 - - - --"'*ter,al_
OVER
8WCM PIia. --
- 9. S1e11 , _ req 11 ,,n .,bn111t1nt 10 lhe Virginia Staie Wate, Control 8oa,,t ,nformt1tl0fl about aroundwa1er lflCI -11, tor -rv _., .,... ,n Ille Siu,
,ntendld for -ter. °' any other non-eaemot -* This information must bt 111bmittad """-ttler lhe - " is compl11ad. en nanclby. or ~ -
lnfo,mahon r1Q111r<<I incllldft: Ill accurately and CQfflCIIIIIIY p,apared water -11 c~tion report. 11111 data from any ~,,., pump,,. '" droll cun,111111 takan at 11ft loot interval* h11II- tQffllltion it -uradl. the r1111l11 of any chefflical analv1e1. Ind COOtfl ol .iv ~tlys!QI loCII. ~ .., ..
1 1 pumpege and 11* repor11 ar1 requiracl from owners of public IUPPIY 111d industrial -11,. County or Statt 111rm,n 10 droll may bt required ,n IOffle i:Nr,; of 1111 11111. Some countllS ~uira .,bmiu,on ol 1 _ , . , -11 completion report. The Virginia S1e1a Htallll Deoartmen1 requor* 1 " ' " " -11 comp1 11 ,on
,,tp0rt fer public ~ Y witll1.
- 10. DRILLERS LOG hneadd11,on.i Slltets ,I necessaryl 11. 1Z. DIAGIIIAM OF WELL CONSTRUCTION Iwith dimtn110nsl DEPTH 11"11 TYPE Of ROCK OR SOIL REMARKS ~illi"I From 0 I To
!J
"--~
(color. mataroal. la.ii,. llardllfta.
etc.I 1-tw. cni111. cavitift.
lllrollen. car,. shot. lttc.l Ti-IMin.l
.~
IJ .)S ~
,~o M.Pr~
.3S I '"/"
/'f 1 1 '1 0 I '1 I
,,o
~
,,,,,,.._J rta.,.J .
r'I"
,,o do,'" ~~_µ......-.4 ~*-J
~~o :).. I ~
~
- J.'/ ':)15 ,-,- ~~
31.§ J6d ~~
3,~ IJ7C ~ .,
310 11 1 ~ k.,.
3-71 JI,'() ~~ ! <,,
i..rl:..,G, ~ ~/\
j ffd J'~
v1111y A... Off. PIICl-ftl ..... Off.
116 Nortfi ""'-'" Strllt *010 WIii . . . . s,,...
P.O. llo* 261 P. O. llo* 6111 llrl~ter. v1. 22112 Airllm~. Ve. 2J2JO 70l*121*25H ICM*257*1006 Soutll-t A... Off. Todlwater ""* Oft. 15. I cen,ly rflM ,,. '"'-°" COfttAlned " ' " ' " ,, " " ' 11111 correct Ind 11\81 111,, .. _.,
and/or IVlteft'I 1111 .._. installed 11111 con11ruc11d ,n accorCS..- "" tllt raquorlffltnn 601 E .. t Maon Str11t 217 PefflllfO ... Office ~II P.O. 9o* 676 S11111 llO lllleffl9'0lla No. I for MIi c:onstruct,on
- 1111Krhed ,n CClfflDI- willl lDPfOO,*at* county or *l'Clte>>ndt"'
VI. llelcll,VI. 23'62 c,iy ord1Nfteft llld lfle ' - 11111 rula of die cornmo._.,11 of v,,g,n,1 ADi,...SOft, VI. 2*uo 70l*621*511l ICM-699*17"2 WIii c,n1,11 A... OH.
Eaec:111, .. P1r11 Nortnern Vir*" .....
5515 CllflOIIN A-UI OH.
5512 119tars CrNII ROH Su111 *CM Aa.no11e. V1. 2*011 A11unar11, v,. 21lll 10a-11a-1oz 70l*7S0*911I
-oMMONWEALrH OF VIRGIN"" :.v~,1 eSc- l..J, DEPARTMEh. CF CONSERVATION ANO ECONO ... ,C DEVELOPMENT /f0-ZS.
MAILING ADDRESS:
DIVISION OF MINERAL RESOURCES OFFtCE*A.DOREs.!
P. 3667 JAMES L. CALVER, COMMISSICiNER McCormick Roac
~- ..... lottesville, VA. 22903 WATER WELL COMPLETION REPORT Charlottesville, '
>WNER: Tidewater Construction corporation MoilinQ Addr111: - - - - - - - - - - - - - -
r EN ANT: _____..;;:.-- - - - - - - - - - - - - - - MoilinQ Addrtu. - - - - - - - - - - - - - -
)RILLER: R. L. Magette* ..::C;.::cm=p;.;:a=.:n:.y_ _ _ _ _ _ _ _ MailinQ Addnu."
Slrlthfield, Va.
YELL
. . a~o,Qg,.__,.I LOCATION: C ounry _...,Su..,r.._ry
...s;a..l....a~o~d......:,VEu;,..P;__,;;Su,t,a,AJ,t..1,i~owni.___ _ _ _ _ _ ond _ _ _ _ _
Approa. - - - - " ' ' ' ' '
1111 ltl d If *c I I on) of - - - - - -
dUtCI GIVE OIRECTrON ANO DISTANCE IN FEET OR Mil.ES FROM TWO REFERENCE POINTS* ROADS, TOWNS, RIVERS, ETC COUNTY HIGHWAY OR OTHER MAP )
)ATE START E o: ____3-...:3;.::0..-..;.70:...-_ _ _ _ _ _ _ _ OATE COM PL ET E O: __4.;..-...:4:....-~70:......._ _ _ __
TYPE OF DRILL RIG USED: Hydraulic Rotuy TO T A l. 0 EP T H_ _;4:a.11111$r___
NATER LEVEL: Stondt ___ 6 _7 __ ,,,, bt 10 w 111rfoc:1 Q!.
1101 NATURAL flow ot _ _ _ _ Qollon1 per m1n11t1.
flELO TEST: Mttllad _.....;P:.um=,p~--------- HOLE SIZE: 10 ,ncn.1 lrom .....;aQ.,;_to --2Q.
- j
__.,l___ f11t __ 6_, ft C IU!I fr O Ill set to _fil I
~ _., .
_ __.21.liiiO:..-_ i;al. OH ffllA. ncllii h o i i i _ t o Duration 48 lln. ,__Q_m,11. SCREEN SIZE: 4 nrlle 1 "o"' 40s ro _ill NATER ZONES: lrom from 405 ta to 415 nClltl lrom
,,c "
lrom _ _ ,o _ _
10 _ _
CASE SIZ E: _ _,4...__ ,nc1111 from to
!"""' 1r*om 0 ro~
,'/ATER: Color Te11te ,ncl'ltl from 10_
Odor T1111p. ,ncll11 fr_o"' 10--
NELL TO SUPPLY: ( c:tlec:k on, a Ho111e GROU Tl NG: Metllod Pressure Farm _____ To**--- School _ _ _ __ Mo11rio1 Cement 0111111 SC X ru, Peminq 60 cyc;lo Suh.
lnd1,11try *** Other*~------------------ PUMP:
1 1,lT(R ANALYSIS AVAILABLE:~11-~112_ l l/4- HP
- nlLL CUTTINGS SAVED: v11.LN0 Depttl o , ,nto** 105 DAILL CUTTINGS SHOULD BE COLLECTED AT 10 FOOT INTERVALS.* THESE SAYP LES MAY BE SHIPPED ro OFFICE EXPRESS COLLECT. SAMPLE BAGS AR[ FURNISHED FREE OF ClfARGE UPON REQUEST I
, __ ,ARK s: ________________________________
Tidewater construction co. Wit: 2799 MA9ette Cl: 132 Surry (HOCJ Island) TOTAL DEPTH: 415'
- Depth
(!!!!)
GEOLOGIC~
0-20 Clay - grayish orange, moderate sandz mediUl!l grained; sub&ngular to subrounded; moderately well *orted, quartZJ feldspar; fer.ra-crate, few grains of glauconite; fev opaques, black phosphatic material.
20-40 Clay - light. olive gray, dlt.y, *andy, fin* grained, fcv pehblu, sw:,anqu.tar to subrowmed1 well sorted, quartz, few *hell frac;menta, black pbcsphatic 111&terial.1 few opaqg**, muacovit.e, for... (inc.
Bulimin&, Nonion, and Tut.ul&ria), bone fraCJ111111ta1 o*t.racode, spine* rar*.
40-60 Clay - liqht olive gray, IJ:Nndant. aand, fine to mecliua grained, fw granule*, sub&nqular to nbrounded, moderately *ortedr quartz, black phoaphatic mat.eri.al, scm vivunite (bladed and b&U.), few opaques, Bh*ll fraCJINDUJ fw graina of 9lauc:onite. i e 60-80 Clay - yellowish gray, sandy, fiaa to ..U.ua grd.Bed, tw pet61.e*1
~gulm: to s ~ , ~ - ~ l y sorbld, qu&rtS1 blade phoa-ph.at.ic material, saa viviaite (bladecl an4 balla), forau (inc *
- 80-100 Nonion,and Sulimina), glauccaite.
Clay - yelloviah gray, aandy1 fine to madiua 9rained, pebbles, subangular to subl'Olmded1 poorly sorted, q1artz, blaclc phosphatic material, vivianite, fonaa (inc:. Nonion, Textularia, and Bulimin&);
glauc:onite.
100-120 Clay - yelloviah gray, audy, fine to medium grained, subanc;ular to subroundad, moderately sorted, qurta, black phoapbatic material;
.form Una. BaU*iM, Bonicn, Tatularia, Siphigenuina, uvigerina,
.and Buccall&), sbaU frapau, 91&w:onite, spinea, nviuita.
120-140 Clay - yelloviah CJftYJ Andy, fine t.o aadiua grai.ned, pebbles, nbaD;,alar to wbraandech moderately *orted; quuu, black phosphatic aauri&l, ahell fraCJ!Mftu, --f~ree U,MQ BuUm1M, Te2!t.ularia, and Non1on>, ap.:t.nu, glauc:onit.e, oauacodu, vivianite.
140-160-
- Clay - yellowish gray, minor pinlcish cl&"!: sandv: fine ~"' _.,_.,; .....
- -*.-=.:::!, ;:,:=.. ... _.;.,,, :..:~"'**1 s~anqular co sucrounded, moderately sorted, quartz, shell fr&911enu, 9lauc:onite, for... (inc. Nonion, BaUmin.a~ BuccellA~ Quingueloc:ulina, Tnt.ularia, and R.obulus);
ost.racodes, shuJc'* tooth
- OWdlh Tidewater Const.ruction co. WI: 2799 Clay - yellowish gray; sandy; medium grained, few granules, few pebbles; subangular to subrounded; moderately well sorted; quartz, shell fragments inc. gastropod; blacf phosphatic material, muscovite, forams (inc. Nonion, Bulimina, Siphigenerina and Textularia); ostracodes, teeth; glauconite; spines.
180-200 Clay - yellowish gray; sand>> fine to medium grained, granules, pebbles, subangular to subrouncled; moderately sorted; quartz; bl&ck phoaphatic material, muac:ovite1 shell fragments, forama (inc. Nonion, Bulimina, and Textularia) bone fragments; glau-conite.
200-220 No aaple.
220-240 Clay - yellowiah gray, sandy, medium grained, pebbles, sub-angul&r to aub=anded, moderately sorted., quartz, shell fraq-manu, black pboaphaeic material, for... Cine. Nonion, Bulimina, and 'l'utularia) r *Pina*.
240-320 No aaapla.
r_. *andy*
- 320-340 Clay - yellowiah gray, fine to mecliua grained, few granul.u, pebble*, nbanc)ulu to ~ ' moderately sorted, quart:r shell fragaanu, black phoaph&Uc: material; scme mus-covite, for... (inc:. Nonion, Buliaina, and Textularia); glau-conit.er oauacodas vivianit.a.
340-360 Clay - yellowish gray with pale yellowi*h orange blaebs: sandy; medium grained, granules, pebble, subangular to subrounded:
moderately well sorted, qgarU1 glauc:onite, shell fragments; for... (inc. Nonion, B11limina, Textularia, Buccella, a.nd Siphoqenerina), black pho*phatic: material.
360-380 Sand - li9ht gray, slightly clayey, medium to very coarse grainad, nbanrJU1ar to aubroundech moderately well sorted; quart:, teldapar, scme glauconite, fw graina of garnet; Alldf U.Utcne fragment *
. 3S0-4Git. Sand - light gray, moderate clay, mecil.Ulll to very coarse
,f~:::; 9Z'&iDN, *ubanCJUl&r to subrowmed, moderately sorted, qua.rez:
'*f~ feldapar, glauconite, garnet, muac:ovit.e.
.,;_...;, - -*-J*~c. gra.y, ::icaarace cl~y, medi:wa to coarse grained; s ~ to subrcNJMSadr moderately aortec!r quartz, feldspar, glauconite, gunet, sandy limestone traCJMDt.
LogCJe4 by: Michael T. currie
- ONIIBll~:. 'l'idawaur Conatructicn eo. W#r 2799 t;. ,*
viYianit* verified by X-ray diffraction occurs as bladed
~- matrix and finer grained bluish balls *
. e:~F
~ -I}-
. GEOLOGIC
SUMMARY
~ Depth ~fe*t) 'nlicJcness (feet) Rocle Un!.t Time Rocle Unit o-2of 20 alluvium, Norfolk For. Recent-Pleistocene
- 20-2~+ 220+ Calvert Foxmation Miocene-Eocane
'.240-320i
- # 80 No Sampl*
- 20+-4~ 95+ Patwcent Fonsation Cr*taceoua
.* ).*
I VUGD1U DIVISIOII OF MIDJW. RESOUJCES
. , D~vid. Ae Hulm~, Jr., GQolo,ut:
Jilly 7, 1978
~.
,. .. ~*
I
-'\11
~
L. r,'IA\.Ji::.11 t LUidl" AU -
l~iC I ; .._,
Wo.rw- Supply Co1unctor - Smithfield. \'irp. .1.1 LOG OF WELL For :Jr:r.:::SWC:, CC::,
!."~l
!Ac:ntt:d at--B.qs:laJSPd in _ _J.iaaat~)l------- Cou~t~, StateUtqSnSe Date Drilling Sla~:. r::cb SD , 19..JO,.. Date Started ___ .*-*_'_.' _ _....:.__ _ _ 15 Finished Drilling ----t...*~;:,1,1d~lL--..::14 _____ ,19.JO_ Ymilhed _ _ _ _ _ _ _ _ _ _ _ _ _ u FonmiLion And Depth or Well Demenaiona Or Caainc And Sc:nen
-**----------------------------.------:~---=---------
Tolnl Dcr,th \ 011pLh or :
Of All SLral11 Each ' Formation Found At Each Stratum To'-! Len1th I Lenith or ! Speciry I Size or Of All ScreeM Each Sec. or: Scre.n Or \ Scnen Stratum l And Cuin11 ScrNn Or \ c
- Or Cuinr UIDI CuinK Ft. In. , Ft. In.
*----'-....:...._--:----------------+---+--+-~-+---4---
Ft. I In. Ft. I In. \
1 I
__a_ ____*~-21ii,10..__~_;___,*it*1,e1:.-a..l.t**u*m:111a*..J&..11.J.. 111'-*~.o.1-*11a,-L--+---+' --+--4-~1____j___
2'1..-~--~Ml.M'l~'*___;i~..G-lz:~-.,-C,,_:J,1~-:,_.&.U-ba:..__*~l]*WL-._--,.-~--~'-~-~-!,_1,- - - l -
.\0--** - : ..... ;
- * * '1 t,o * ~-:. 1
--o11Bai1JW1i*-...1i1*w;*.,_-~-------+--+--l~~--.:..*iI - - - - l - - -
1 i'~o f- ~l..PO :
i
..ll.w_o~M. LJ-rJJ**111-~~~,_ _..:.__4-_~~--L_JL __L_
. ltl._~9 i- ;lZO .--r---
'. : __..____*----*------+-----l---+---4--41---'---
~ 20 * -~ 140: -i- ----~- __ ;;;;;*----*---------1-----+--+--+--+---::...4---
!,~ ~n
. 1~--*.
-!!"- t - - - -.. *- ------------t-----+---+----4----4------4---
i * * *.
~:-::__~=---i--:_ *__:____:__*_*____
too __
- ___ 210* __
- _11.a'd aaa__l*=-=---*=-~1a=-->----+---:,__~-~1-~---4--
--+-----ll--+--:i...-_,--___...,.__
,~Q i I
--~_>>o ___ ._!. *ltlila-L..IA,l,l'ly-llJ.~---~-----+----+--+--~'----!.----1--
-U.. I
- ~--~----*~~~---**-L_--*~-bla* . . . *'ll!*!!!J--5!!~-:._J__J_j!_ _:_ I
_ _l_
1 , ! I DdU.Ua 111111 so ...., (m ;: :;la) I
- - - - - - - , - - - - - .i I l
.,-2~0 ___~ .. __:i zao* ***- . ****----*- -----*---------.. . 1 - - - - . . 1 . , - ~ .. - - - - * -I
= * * * *
- Ii'l_'!Q **--'*... ____ 1t'Ln I I !
' . . . :1Q j
I.,.... -~
1
'll!1&t~ *
- W
-.--*~1*-*~i***-.'I
- L I
I
- --=;.....~.-ci+eie I
....._~~~-----------~~~--;....,~---.... - -.....~ - - - J . - - '
I WELL Dr\T)
-+-r---h--uJWid .... ca'--~ -*-
I ' I
-~Q __ ~;..,':*-_.
- I ;. *
~:';,Q .. l~ ! * *
- Prcliminarv Tc r-cactim ..... Date Tested
- ~$(.) _____* __3l0~.1..i----llt.a~IIIIIIL*-----------'-------------1-9__,_
I
[Jacl __ -~ __._4_~_.:;_'_...;...---------------+------------G_P_~1 " Production r - . . . ---- ___________________
I 1~ou I*
- 4u* CwcNead Permanent Te I
____ I
--- 19
. Date Tested
- E- r--:-;-..--- i i
i i
Produc:uon Draw Down Ramaru:
GP~
Date Drilling Started _ _...;M=mr;;::-.:&..:h:-.::JO:.:..._ _ _ _ _ ,
in~~*-------
u1G Date Started
!I*. *
- Finished Drillin{_~""-*-'___apru-=--~-*----
Totnl OC?pth Jo'umsatiun And Depth Or Well D*pth Of F.11ch I
,19 10 Fnrmnlion Found At E,u:h Stratum Finished
- Dem;"naiona Or Caainc And Screen Toul lAnrth ! -
Len1th or I Spec:iry : Siu r;:
Or All Screena iEacb Sec. or Screen Or! ScrN:
0( All Str11t11 Stratum And Caain11 l Scre,,n Or Caains
! C
- aa&DI
\ Or Ca.in Ft. In. : Ft. In. Ft. I In. Ft. i In. II
--- ------*--*------. -- L..._ I
\
,~1*-:1_,!!.'J -*****------*--- --- . i ---
~
I
! r I I I'
__ ::4PEll ,r., +912 *--**--* A1Js£a_ I ! -i--
I I '! I I T tir4--~-- -------- s~*'J*----WAJ':Q;.J.-:;;;L
- .91 9,48-A.L----------* 3Z!-----
su,1
-iilr-------**-- I ;
- l&t-2il--*--:------* ---- '. .. - *-34'9--* --***-- --
- - -3r--3Y' -- ... - --**
61 1 --
I l
I 'r I
t--+/-I I
I 10:~0 . *-- *-*****: . - u- *-* .. ------- I i 11,2~ - -u- I i
i i1,sa ------ *-* ... *-511*- -------- - l I
-**--~ . . ___ Jr __
i
_1%.1.ZI> ___.,;JJi. : - I 12,~ ' w . *-* - I I
. -*1TtAJ""-* *------------- ----- --,.r--*-*---* ' I I ;
1111 550 Gal.lea um ac 40 i l l i '
i I
I
--Vtat~--1.,-u:J" l'~l(. Sfi9-Inl11.II *.
I
- .N 1 I
I I
I i I
. dJ;Ptl1 .11, 19 79 -* -- I I I I
I
,_ 1a:CQ
- mll-r-** ..
luaJa I
.ti.ta. - _______ .i_ ____
- "WI w.
311' Sl~f'-
20*
-J.ffll.ik-- ---*r-- ~---- ~-- ...
i **--t-*
WELL. DATA
_1
- t"ITJQ I
I
-- .I
- - -l---"'l(JP"-
..3Q!_
Preliminary T l~OO ,.:1.
. *1, i L ' -.- . - . .
D11te Tested I9
-- ...... ---*- i
- I
- -* -* ...... -- . -Lo---
Production GPM
- I }.G *t**1*1
""~;., ..... ~,-"tt:l1z:;:------*----------ii----
P~rmanent Tes Stade ac**1:wct:=Li& - -,.,~-- --------'---D-.ta-T_eat_ed ______,_ _ 19-
- ---------- .*-* * **--------*----1------* ---------GPM Dr*.4otm ac ud oi 41 t.. ca& W Producuon Vacu Len1 a&* ..S oi -..-i:-:-caac-10' Dnw Down Pu
- -*-*r***.---**--*---~---- --------'"--R-ema--rka_:_ _ _ _ _ _ __
-. '* . - .J *----- **-**-*. **----*-* ----*
i - ~-
~
l r I
f .. '
I.
I
- .:!i..... ~
t I
L I
t I
t WFI.L IL\ I,\
l'reh11111u1r, *1 ,.* :
b; I
... J.
I * *14111,'lllllt : l!U (;J *'.t 1:*111111,in( l...evel l',,r111 .. rM*111 f,.,..,*;
l .
~,I'
- I 111* l'r.,,,rl"f! .* - l 7 l~Q ~llllac fAi..-el 67'
'.. 1*,..,,, .* :,.,.
~ l) (il'M ,\,*t,ve St. I-",**I 70 1
.U I 1uru1,in1 I ~vel 7 0' I
1,n!y ~,* .~:*awd,,wn c1t 20 GPM I
L I
I
- L. . -----..--,-*-- .. ~
I I I \II' f '.-\TA*
.....\
1
..;.. '""I' ="u TyJ>f' l.uml~r I '*I'.. Jli--1J ~i1.e Su,*ti,,n r ..I. 1 I >*1*rh ~uans: 10) HI' to MlJ*
l,,
~~
-~
I S11* Culumn rn,.. Huwl
~u St.Apa I t" I.... nict h ~uc:uc,n Lc*ni:lh .\,r , .me D~hnrJe*
- .J 17 .! \ *---*-
- --r-I' I* I
,, *. I . I t *:,p'y and HNd 1260 Pr..,.ure 40
~I t i I I !
- I I I I I MOTOR DAT A
...*I: ...... l,
'* . ; I I I I *
- I !
I I I'
~~
I
- 1: *t
~ ,:,,,.. Pow*r l\ Volt..1* ~JO 1
I *.., '
- I H l':\I 3450 Ph11N l 1 h~' t ; ;*; :
- *r,~ S,,h<<n,-.-c:' ~- ' .-. , .... *'
Mah Ueming 6AHF4 Fume No.