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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December 30, 1992 Mr. Terry D. Wagner Environmental Program Manager Virginia Water Control Board Office of Spill Response and Remediation P. o. Box 11143 Richmond, VA 23230
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5000 Dominion Bouler:ard Glen Allen. Virginia.13060 VIRGINIA POWER 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 12/30/92.... 9301050239 REC ID W/LTR IJID_
-NOTICE-THE A IT ACHED 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 WITHDRAW GROUND WATER TO A GROUND WATER WI~RAWAL PERMIT PURSUANT THE GROUND WATER MANAGEMENT ACT OF 1992 TO TO 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~tive 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 //
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Address :X-11.,,s brook. Tee,,..,'ca. I Cf!*,,,.'f-oer-,
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- 2. lo, o Phone {(o&f) 2. '71*J9f o Contact Perscn W, A. S procriL, :J,.,
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Location of Withdrawal Facility: (County/Cfty) __
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__ 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 !ii~ 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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No. of Col'\\Mctto"' t,11bltd ____ NI.U.,j/A..._ _______ _
Address P.O. Box 31S Surry, Va., 23883 PhoM
{804) 357-3184 Uptr at 1on h"f t ll.c>e r (,llb 11 c).a;N... /._,A,__ ______ _
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1 f aieaswreeents lf"f for I stngle..,ter ffe1d re1d1ft9, 11st wells f"Cluded 111 ftt14 SWCI llo.
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,op1.11uton Served r,wblfc' ___ Nu<<.,/AD.... _______ _
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Addreu P,O. Box 315
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Addl"tu P.O. Box 315 Surry. Va., 23883 Phone (804) 357-3184
. Surry 11,~ of Ooer1tor N/A Pos1t1on/Tlt1* --.N:./r.A;-------------~
Stcin,turt N/A O.te _N_l7'. _____ _
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Puh1tc !___ ll'ld11Strl1L_x_ OtNr (lpec1f1 ----------------------
1 f aeasurements art for 1 5fnt1t..-et1r fft1d re1dfft9. 11st wells fnc111ded 1a fft1*
SWCI llo.
Oiitner llo. ------
SWCI llo. ------ O.ntr lo. -------
$WCI lo.
Ol,tntr llo. ------
SWCI No. ------ Owner llo. -------
SWCI llo.
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S'IICI llo. ------ U-ntr ISO.-------
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~
Lu I ft:111 UI 1
2 l
4 5
1 I
9 10 11 12 13 14 lS
- luf.,.u, ** 11* Hell "' (f"1fcr1,1, tnl er 1111 Hlf ttlati, tNf II tM tf lloOll*"'°'l"I,e,1e,
- ,,..... '"' H '"'.,... Y,*pwllfl"I """
....., U\\tA ta w *11 1*
- f111f 0 1ttelf1 tlfllcll 11111 ----
1 an *,,heulr e, ~,wn,-ow* fl,611c nt.r '"" '"~
wtU. llttlUI Dl,ert1111u.,..,,.ft1.
Teti TtCA 11111 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.11*
.. ftD,111 1 0pe,u,..
U1 I I lloft UI 11111 Dvrl I lHt'llf
"' "°" lll
~.J/*ZJc..o 713oc;,
71 Ttu I C. IIOAS 3o<::>
D,,,1., Oi1r&er 3o
" c,p.,,u..
0.11 ~** 0v,,,1r
- Z 37 7
,,.n, a,,,...
D..rl"I Ovit\\-'
Wat.tr ltvtl 11 "
St.HI,.. "-1""***
7 / 50 c:>
3o "237,
X..__ "- II (I I
--~ \\trltot(II
--- ¥tll(IJ,,.. Wl"th)
GROUNO WATER PUMP.AGE A.NO USE REPORT S111t Dtpar11nc11l e( Hullh and Sute Wucr Contrvi loar41
,.11tc. Sf!lf ce,1 tf 'lf'O'I lt "1lt11, I Sue., v,c.,, C.*l"II to.... Offtc, l!!I le9to,,,I Sut.1 Neall.A Oc~rtw,,1 Offlct l"'llv11r11I. S~ cot, ef rtPOrt lt 1,,t1,.,.1 Sl4lt.. c.,, Co,,,trel kt*f Offtu 0~111,.
S*,,. coo,,,"" lt 1t11o"'I Sue., 11,c.,, c.,.,,.., lot" Offtct 17'l'Z-lb\\UI AP 1'i! IL
~ar\\.lr I (i) J *
(Cfrc:lt 0.-.)
~11t7/Cft1
. Surry
- 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 (,pe<1f1----------------------
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 lo.------
swca llo.
Owner lo.-------
SVCI llo, ------ O,,ntr IO,-------
~ter rudfngs,,. 11 --~ga;ji!a,ll.,.l~ons2.lllil ______________ (9111ons, 1000*, of 9111ons. cubic fHt, ttc.)
S~I lloJ5Z -
/fj't:> -7 I P °'"11tr IO.
G E).ta P',tttr Rudtng*
~11ons V*ltr Ltv11utt Ust<t If" r"' *'
t.,n lb\\t.A 31 I.Z.o '7'0.0 1
2 **.
l 4
5 1
I 9
10 11 12 13 14 lS
- ... NW I... lf.. NCI f,J (l"lflf't'1J ~ tf flJJ Hlf Ul.., tfff It 1n, ef IIOll*~l"I,CtlNI
"""ft "
- ,..,... rttf It '"'.,.,,,,-~1111,.,,o,
....., u,,. 11 1111 wll I*
- ff1t,,,,.cu,.-itcli wll ----
1 Ill,,1utal1 w !PIA11M11r-o,,"" i,\\Altc "'" '"" IJ'l..
wflA Keel UI Dt~rtllllc1~rwtt1.
lot.I: If IJlla fl vl'llltUrM, HllMtt ~91 11 ~lft 11 1o,,er rlthl*t.l"' Conllf'o Total lh,r fnt O.ta 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 c.n..
lblll 11pe,n111 t,ut o.,, 1111 I llonU.
DIii Dwrl I lwl"lfl flt lloAUI Ktltr Rudt 119*
C.11ons Used F353,/300 2.. z/3 fed z 'Z.13 cfoo
,,u1 C.tto,11 0..rl.. ~UIM
.3 c:;,
rout Operatliit 0.11 1111, Ovtrler 73 7ao A ilJ l,1r1t1 O.,t1"9 Ov*rtlf v,ttr Level""
Sutic" r~,.....
- z. 2.,. / 3 {o o 3o 7378"0 -.
1*1111*
f,,,. -** lJ*~*
V1ter '°""U:
_..... x_wll(IJ
~-- ~,.. 1,,
--- lltllhl *"' S,.l"f(I) e
<I I I *...., 1111" GROUND WATER PUMPAGE ANO USE REPORT
$111* ~p,r1mc11r e( Huhh 1114 Sutt Ware, Co111ra,I loar4
,.allc. s<<flf co, ef rt90rl ll..,,t,11,11 St.,t, Wei.Ir Ct*tf'tl loe-. OUiu ~
lttl-1 SU\\I Nul\\11 Dl~r~& Office l"'lllvHrlll,
,,.... UfJ 1f rtPOrl It..,,,11.11 !UU lltl.l* C611V.i lot** Off1u o,....,. s,.... cot,., "" l.e 1t1to11.1I SUt,...... c...,.... loirf Ofttu t-j'"f 2--
"°"' ~ 4P~ / L l>Jarttr I r J *
(Cfrt1t h)
Covftl7/(ft7
. Surry
- et of Water.or*,
lluw of Ooerttor
~l/A Va. Electric ' Po,..,er CO. - Surry Poslt1on/Tlt1t -~Ni7/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. 1000' s of 9111 °"'. cub tc f Ht, ttc. )
SWCI Ro.
Owntr llo.
F=-
Iott: If 111ta h ~l'lllllttl'1f, t1t1Ntt ~It fa '°'" fa IMt rf9llt*.. ~ COMllf'.
~u Kettr Rtldfng*
~110/II v,ur Level.. "
Dnt Ket.tr Rud1r"9*
&. 11ons Vdtr Leveltt" St1t1,"
,IIIC)f~ "
tlld.,
i LHt lb!UI 37 ro Io 1
2..
l 4
5 1
8 9
10 11 12 13 14 lS 16 17 18 19 20 21 22 23 24
~5 26 27 28 29 30 31 c,n..,
Toti I
~,,.. ~ta
,,u1 o.,, ep.,,u,..
.. II lb!UI Da11 Durt 1 lwer111
.., flofttll Used St.A ti,".,._,l'IQ ***
3744'30 3..f "2..-G) 34-z-e;,
Teul C.IIOM 34zo Durl8t O,ut.er Teul Clperat111t
'5o Dt11 VIII Ol,arltr 3o I I 4-
.Ail1 ***,.
°"""' Ovuttl' II 4
__ x_ "'11(11
--- s.,,,..,.,
--- "'""'.... ~l"thl
.. '.. '"~
GAOUNO WATER PUMPAGE A.NO USE REPORT S111t Ofpu1rn,111 e( Huhh an4 Sult W11,r Co".. loar,
,.allc. S.111 COi af rt90rl ** lft!...., I St.u, Vet.er C..11lrtl 1o,,... Offlu l!!f
- ,, °"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..... Offlc, THr
/ t'fZ-1\\,ftt) AJ>~ /L
~tr\\fr I (f) J *
(Clrc1t Ont) =
~nty/Clt1
. Surry
- 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 1 qn,t 11rt ____
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..__ ______ _
Uptn t Ion,. "It ll.c>tr,,lib 11 c).a.;N..,/.,.,A,_ ______ _
Ty" of U<t: rublfc~ JlldwHrl1I--L Ot.ller (s~1f1 _____________________ _
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.)
s~, 110.
°"'1lt,. lo.
G.
loll: If 111t.a Is w1111eUrtf, nttull ~91 f* ~an 11 1o,,e, rfthl*.. "' <OMlef',
l),i.
Meter Rudfng*
~ 110ftl V1t,r LtvcluH Oltf Met.tr Rudfr,g*
&. 11ons Used Sult,.. '~,'1
't/ll/1//)
I tflld.,
LHI fb\\UI io ooo
'f////lH///1,.
Used 16 1
- 2.
3 4
5 1
I 9
10 11 12 13 14 15
- IUf.. W.... tlat HCI C.r (1"tfff'1*1r tfll *f f11J
- If UlHI, rfff ti..... tf ICll*"""ffll,.,1e,
.....,.....,.., ** '"'., lltl*J*Pll'l!Pfllt ""
"-If UltA II ""wll la I fl11f, IPf(lfJ.. Mell 11111 ----
t All Jrht\\alJ W M1.. 11J*Or~ fl61IC w11tr ll!H1J IJ1U.
w1 U. Nell UI Dt~rt.ica~,.111.
17 18 19 20 21 22 23 24 lS 26 27 28 29 30 31 I C.11..,
Toti
~,,,. bl.II
- 1tt, o.,, I Optra\\f..
DIii Durt Ulh ~~
"t i.o,.111
~I loo I lo c0 fn1 I C.110ftt
//t!:>O
~
... ~.,&er 3o feul Clperat1"1 DIii IAII Ol,trltr
..3 7
.,..11, ***,...
°"""t Ov*rltt Vattr Level""
suu,..,,_,,.....
// c::>
0 3c:s:>
'37
... ** *'-'****~
...... 'lt"'WI....,,.....,
GAOUNOWATER PUMPAGE ANO USE REPORT t "f 92-lblUi Afll: /~ -
"',,, '°""'.:
_....,.l(......._ "'
--~ ~,...,,,
S111e £kp1r1mc111 et Huhh 1114 Stace W11tr C.01111.a loar4 P.111c. kllf co, tf 90 LI~'""' Slate w,i., C.*lrtl to.rt Offlct ~
- '°""' '""' IIUIUI 0.p,r~, Office Qua,~, I([) J * -
(Cfrt11 One)
--- Vtll(IJ *"" Wl"'tll) 1"4vll'111, h4'f CotJ tf '° tt lf.tlol'lt I U.1tt vu,, CoA&nl to.,1 Office 0~111,.
Se... coo, 1f rtPOrt LI ltt11iwl 11.11.f 11,t,r (e,1trtl lotrt Offtu Cov11t7/C u,
. Surry
~... of V1ten,,ork1
-Va. Electric, Pl:wer Co. - Surry
~14,.
Va. Electric ard Pc,..ie.r Co.
Addrtn P.O. Box 315 sun:y, va., 23883 Pt1oiw (804) 357-3184 lr*Df or Ooer* tor --.:MiJ/-.A ____________ _
Pos It toft/1 It 1, __
"iiN7/A.-------..------
S1Qn1t11rt N/A o.i. __
N_/7'. _____ _
Poe,uhtfon Served (P11bltc'---Huu/A...._ _______ _
No. of CoMfct1on, f P11bl tel __
....,N.._./A..,.__ _______
Uper1 tfon Pe ~u 11..c,t r (Pllb 11 c)... N,..,)~A!...-______ _
Ty,,. of U<e: Puhttc~ lnd 11st.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 *o.
0-ntr *o. -------
SWCI lo.
Oi,ntr llo. ------
SWCI No. ------ o.,n,, llo. -------
$WCI lo.
().mer llo. -------
Ml lo.------ ~ntr IIO. -------
Meter rudin9s 1r1 11 ---!:ga~l~l!,,!onsl.Jil.--------------C~11ons, 1000's of g*11ons. cvbfc fHt, etc.:
SWl:I 110.
C).fler IO, O.ta Meter Rt1dl119*
~11ons 1-1 11,t.,r ltve 1 utt Iott: If 111la h WNIIIUrM, t1t1Nt.t ~II 11 '°an 11 loo,tt rftht*'611d COMlff',
O.ta Mtt.er Rud1119*
&. 110tlS Used z773oo-St..tt,"
Py11pf"' "
Used
[l'ld.,
- 1 LUI~"'
16 1
2-3 4
s 6
7 I
9 10 11 12 13 14 15
- ... NW I... tlN HCI,., ll'tflf'l~IJ tftl tf f*JI
..., tilttl, '"' It '"'., IIOll*fljllflflt,.,,..
- If t1ltt1 0 ralf II,,_. tf.,,,,.i,wae1111,er,..
1*1f UltA la 1111 11111 la I llt1f, ltt<lfJ -" 11111 ----
t an"'" w Mtwn,-o,,.. '1,611c.,,,.,,.,,,,, '"ie.
w1UI Ditti Ill Dt,ert.. u.,.,.111, Tott C..,rl Teu o.,,
17 18 19 20 21 22 23 24
~5 26 27 28 29 30 31 1 c.11-
.... Ill I Opernl1t
.,... ~..
Dtll Dwrl J lrttltl
"""°"'p Z7'f 3oo :z c::, C> ~
Tile I C.110ftl Z.eoe.
Dwrl91 Ovarlef'
,3a.
Ttt.11 Clpcret1111 D111 11111 Ov1rter b7.,..,,...,...
°"".., °"" \\tf Vet.er ltvtl**tt u.. t1," 1,-IM***
-:z_ C:, 0 CD
.3c:,
~7
-*-*,,,,....,,-~.
v,,,, '°"":
__ x_'"""'
--- ""'"11(11
--- '"""'.... s.,,,..,,,
GAOUNO WATER PUMPAGE A.NO USE REPORT
$1111 O<pir1mol e( Huhh u4 St.ca W11cr<:G111roa lou4
, ** lie. Sf"" c.,,,, rtfOrl le t.tt~I St,t, Vtt,r C.*l-.1 k,tr;i Offlu l!!f
- '°""' '"'" 11ol1A Dt~r~t Ofttce
,...,vllrt1I, h'II co,, tf r1p0,t ti ~10--.1,u,,.. t,, CoAl.rtl to.** Off1u 0~111,. St,.. cot,,, report l.e 1,,10,wl h.11.t -...,, CtAtrtl lot,.. o,r,0
/~ 9 z__
lb\\UI A~~/L
~art.tr I (jJ J *
(Clrtlt Cne)
~11t7/Clt1
. SUrry
- 11t of wuerwor* 1 If*~ of Ooera tor -.Hr:/iiA,-------------
Ya. Electric'~ Co. - Surry Po11t1on/THl1 _ __,~N7i/A~------------
Ow1'r Va. Electric and Po,,.ie.r Co.
SfQnHvrt N/A O.t.t N/1(
Add rt U P.O. Box 315
,opv1.i1on Ser,t4 r,vbllc' __ _.Nu.fuA~--------
Surry, Va., 23883 Phoiw (804)357-3184 No. of COMfCt10M r,vb11d _ __..NJl.,S./...taA.._ ______ _
t Up tn t Ion,,,..ft ILc>I r ('vb I 1 c),a;.N..... /...,A.___ ______ _
Type of u..,: Puta11c __ Jftd 11strfl L.J-Ot.htr hPK 1f1 -----------------------
1 f ae1swrenents lrt for I s1ng1e...,t1r f1eld read1nt, 11st wells Included 11,1,1, SWCI llo.
Owner llo, -------
S\\ICI lo.
Owntr No. -------
SWCI llo, ------ Olffltr llo. -------
$WCI llo.
Owner No. -------
SWCI lo.
Owner No.-------
SWCI lo.------ ~ner IO,-------
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 fa !loan la lo,,et,1,~t-~~ COC"Mf',
s~, 110.
Owntr No..c:::o.Js..,-~if'-r10N SI-,-
°"~
l'otttr Rud1nt*
&, 11ons V*Ur lev11°-
O.t.t
, 111C> I fte"
[Ill.,
Z-Cfof74oo Lul lb\\UI 1
2 l
4 5
1 9
10 11 12 13 14 15
- ltlf -~ I... tfllf HCl,., (ytfff'l.1J W ef flJI Hlf Ul.., rNf II en, ef IIOll*""°'f"t,Ct1t,
- If,...... ru, u,n,,, titn,-~,,.,cr1t,
.... If U\\ftl ta lftl 11111 fat rtetf, 1,<<tfJ llfllcli 11111 ----
f 111 ~htUlf If' Ml~IIJ*OrllH Jl,611c **\\Ir sw,,IJ IJ1l*
lf1Ul llft1 UI Dltert11ut,t1Wfll, 16 17 18 19 20 21 22 23 24
- s 26 27 28 29 30 31 1 c.11..,
Tei.
c..,1111 lbllli 1,u1 Clper1U..
°
DIii Owrf
"' " "911111 I lrt'l'lft
.., "°"~
!Cf Ur lud11"9*
C.llOftl Used zc:r;-07.,{-oo ~o c,c:.o
./~t>OC>
let.al C.110ftt
..,,,.. ~ar&er
..3o
,,u1 Clpf,au..
D111 llill Ovarltr IS-3~3
.,.n, a.,,.,.
°"""' o.,.,,~
V*t.tr leveltt" St.Ufc" "-111,Q***
_.f6oo~
Jo
/S..333
~_.lC...__lftll(al
~---- s.,,..,,,
--- lftlllll *~ Wl"thl
............. ~
GROUNDWATER PUMPAGE ANO USE REPORT
$1111 ~p1rtmCfll *' Huhh ln4 Sue. Water CofttrGI lou4
, ** lie. ""' ""., '"'°, *..,,...., sue. 111\\tr C.Alrtl lotrf Offlc, ~
1t910,,.,I Stitt Null.A Ot~r\\Nolt Off1ct llldw1lr111.
Sf'II C0'1J tf rtPOrl II ~10,,. I 1lltl lltt,r Co,,tnl lot*t Of flu 0~11e,.
St.. c~, tf report._ 1tt1o,,.( Sutt lltt,r C111trtl lotrf Offtct
'"' lf'f--z-
~::., ~.
(C rcle Or.I)
~11t7/Clt1
. Surry
- ~ 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.
S1qn1t11rt 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.
Owner IIO, -------
SWCI llo.
().oner lo.-------
SWCI lo.
1).-n,r lo. ------
SWCI llo. ------ Oa-Nr llo. -------
$WCI llo.
Owner llo. ------
Ml llo. ------ O,,ntr IO.-------
Mtur rudfogs 1r1 11 __ 4ga,1Sl..1]...
1.!.lon.,l.llit ______________ (91l1ons, 1000'1 of g11l0111, cubfc fNt, etc.)
S'-'=1 llo. :Z.9-/90 - 5"o C.. Owntr lo, A O,t, Mettr Rud1119*
~llons 11,ur ltv11.. "
su,,,..
P'\\lllll?IA41" fl 'IJIIIJ t.111 "°""' /Cjz.PDZoo 1
2 3
4 5
6 7
9 10 11 12 13 14 15
- ._, attar ** Uat Helli.., (,..1ftf'1~1J lftf tf IIJJ
..,,......,.., U,,.,., IIOll*Nlflftl,.,1..
- , u,... rttf u '"'., ltlYJ*Nlfllll,.,,..
....., ut11 ta w.. 11 1*, rt,1,, 1,-c1f1 "" 11111 ----
1 All Jrhnalr., M1t;.,11,..,llt4 Mlle.. 11, '"" 17'\\tla wUA IIU1UI Dlptrt111of"'k,-111.
lot.I: Jr IJllall 11 11.-t.ertf, Hltalt.1 ~91 11 lo.an fa 1oioer rlthl*lll"' <onwt".
Tell
~rt o.,,
DAU 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
, ean..,
Ill IIIIAUI I llpcraU1t UI 11 "9ftUI Dlt1 Dl,rl
, l,tf'lfl
"' "°" u, Ket.fr ltud1t19*
"llons Used
/oz.S-ozoo ~o=o Ttul Cal10A1
~OoC
~,1., ~er~
~/
Tn11 Optret1111 D,71 tall O.,arter
/~/~
AilJ l*1r11t1 Dvt1"9 Ov,rt1r v,ur Leval.. "
Hut,'" '"-l11a***
I/'? J"oc G-/
1?6~
e
- l'-'1111"'
GROUND WATER PUMPAGE ANO USE REPORT
/f/7/z--
~
tJi
('1A:o/
_ _.J-. lit 11 (I J
--~ s.,,,.,.,,,
S111t Dtp,anmcl\\C ef Huhh *"' Sue. Wutr Co111rol loar4111
,.111c. Soll co, 1f '"'° II t.,1..... 1 S~t, Wtt,r c,,.,,,, to.... Offlu ~
lttlOflf I Slit, llft 11.A Difp,rta,,111 ~flu l).i1rte,,cv, *
(Circle Orie)
~11t7/Clt1
--- lftll(IJ.~ S,,1"9(1) 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
. Surry
- ~ of W1te~r*s Va. Electric, Po,,.,er Co. - Surry
().rl.r Va. Electric a.rd Po,,.ler Co.
Add,..u P.O. Box 315 Surry, Va., 23883
. Phoiw (804) 357-3184 KaDf of Ooerator t-l/A
,o,ltlol\\/11t1t -,N.i'/'riA~------~-----
SlqnH11rt N/A OU.t NIA
,091,1 ht Ion Ser-.td ("'b 11 c' --~H~tA1i-_______ _
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.
Oimtr lo. ------
SWCI lo. ------ Oltner llo. -------
$WCI lo.
Owner llo. ------
SWCI llo.
O,,ntr lo.------
SVCI lo.------ 0-ntr IIO. -------
~ttr rudings lrt 11 --~ga~lull!.C!)S!.ii-------------- (g111ons. 1000'1 of gallons. c11bfc fttt, ttc.)
s~, 110 *..3" - 19o -,;;; 1 c Owner "°* :5 Iott: If *11'-- la 11,-ctt,_, nttaete ~91 h boan ta 1o,,,er rl1ht*....., <OMll'I'.
Dau Ktter Roding*
&, 11o.is v, Ur ltvel....
Oilt Mtltr ltud1r,g*
s.. non, Used Sutt,** '"""'" "'
Used JI
["'.,
UJ un 11ot1ui.3 3 'l~</-5o-~ -
1 2*
3 4
5 7
10 11 12 13 14 15
- lclf IICW laa,e lfat HCI,., (y1flf'tt.1J tftl tf ftJI
.... tllftl, '"' It '"'., 11(111*""""',.,1.i
- If tel,., tHC It ctnC tf lt1YJ*""'1111,trlof
...... u,..,. 1111t....,. I 11,11, 1,<<lfJ.....,...... ----
- AU frhl\\111 tr ~1'1,IIJ*O,IIH J\\,tlCc ~,er 1""11 ll't..
wiUI 111t1IU1 Dlt4rt1*,o~,.c11.
16 17 18 19 20 21 22 23 24
- s 26 27 28 29 30 31 I C.llllf 1,u L\\i,1,. lblUI t,u o.,, I Opt,uc..
D,C1 Dur!
Ulla li!DnUI 111 lloftUI
~t47Z~o 75'.-/-Te>o 0 foul C.111111 7>"-li'DOO 111,,1.. ~trW
...3/
r,u, Opt,,u..
Dt11 u,, °""
'iz,~,; '8"~
A IIJ l,trf11 0..rt"t Ov1rttt V1t.tr level.. "
Sta ti,",,,_,...,...
IS-/ot loo kl ZS'"Z "/71 - -
___ x __ "'11(1,
~-~
~.....,,,
--- Wtllltl 1"'1 S,.l"fh)
I I I IV I I' 11'11 GROUND WATER PUMPAG£ ANO USE REPORT S11tt ~putmc111 *' Hultll 1n4 Su&c Water Co111r~ loar4
,.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 to.** Offlu 0~11e,. s,,., coe, ef roort lt lt91o"fl SI.It, 11,1.1, COflt,..1 lo&rf Off*ct
- ..., 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 s I 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.)
SWCI rto *.3/- !"lo -S-2--c.. Owtltr No, ~
lot.I: If 111t* h wl'llll!ttl"M, 11tia.t.1 ~"
11 bun ta 1 o,,er r 1 thl * \\I "' c Dnllf',
D.tt.t
""tcr Rud1119*
~\\10i\\S V1~r ltv1luH Oltt ICet.tr Retd1 ng*
C.11ons su,,,..
~
,~111o"'
lktd
[!Id.,
x-bu.,4c,
.,,,,,u, Lut 1',or.lJI 1
2 3
4 5
6 1
I 9
10 11 12 13 14 15
- lftf NW I... It.. NCI"' (l"tftf'I.IJ ~ tf flJI
..., tel111.,... It '"'., loCll-...-.1111,c,10,
- If 1111",.rtlf It 1111 tf..,.,,.,..,..1119,cr10,
.. **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 '"'*
tr1UI IIU1UI Dt~r~u~,.ttl.
Tota 111,rt
,,u o.,,
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.11*
Ill "°""
I Opernt..
Ill ta "°""'
Dt11 Dwrl
, lttf'lfl 3~?/C,/oo 113?70<=>
'" C.111111
//817°-<=>
111,,1., ~,,w
.3 I Ttta1 OpfrUllf 0.,s VIII Ov1rttr o ~ 3 77
... i,, l,1,111
°"".., °"" \\ff Vet.tr level""
SIAtt,",.,_,.....
IS~~s-c:>-
6/
ZS-..336
.,.... I,,........,,.aw, X.__. w 11 h I
--~ ~....,.,
--- '"""'.... w,,..,,,
o I I
11oia11 I I I I,...
GROUND WATER PUMPAG£ ANO USE REPORT
$1111 Do(p1r1mtnl er Huhh an, Sula Wutr Con1rul loar4
,.. 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 1 ct
'""'""* 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
- 11t of Wlttl"wOr,s
- Va. Electric, Pc,...,er C.O, - Surry o., 14 r Va
- Electric ard Pc,.,.ie.r Co*
A.dd~u P.O. Box 31S lluw of Ooer1tor
~I/A
,o, It fofl/ T It 11 ---;;:N;-:/;-;;A:--------------
S f o~ twrt N/A O.tt _N_J_'A _____ _
'°""' 1 It f 011 Served ("1b 11 c' --~HuulA<i... _______ _
No. of CoMtc l f OM ffwb 11cl __
N....._.{A.,._ _______ _
Surry, Va., 23883 Phont (804) 357-3184 Uptu t 1011,el"llt 11..C>c r (,lib 11 c)... JJ'""L~A.._ ______ _
Ty~ of Uc.e:
,...,He~ Jrd 11strfi1__.X._ Olhtr (sp.cff1 _____________________ _
If eeuwrenents art for I sfngle-wttr f1t1d rudfng, 11st welts 1r.c1udfd hi SWCI IO.
~r IO.-------
SWCI llo.
t\\fner lo.-------
SWCI lo. ------ ~r 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.)
S~I No.
Oltner llo, I)
D.Ai..
P'ie ttr Rudt119*
~11ons v,ur Ltvel....
Usfd Sutt,**
~~
tlld.,
-z4r.,,.-z.1 o o
~n ~"'
1 2-3 4
5 7
a 9
10 11 12 13 14 lS
- lo4 acw,.., tlac..,,,., (,,-1ftf'e,11.,..,, **11
- If Ulttlo rttf II 1111 If IIOll*"""111f,crlO, I
"~'""
rm.,,
- If t,l... ruf II tllf tf llc117*"""'t111 pcr10,
.... If U\\" 11 lftC *11 11 1 1111' 0 att<lfJ llfltc* wll ----
1 All frhn.11, er Mlwn,.o,,IIH,i.t11c.,11, '"",,,ua w1 ~ 11t11 UI Dt~ri.iu~nilll, Iota: If'- ta Wl'IICtfrH, ttllNtt pui,Q,191 11 flo&H ta '°" rt9lll-~,.. Conllf',
0.tt 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 c.11...
- Tee, lll,rl1111 lb!UI 1tl4 o.,, I tlper1tt..
o.n 0.,,1
"'" ~~
, ltlf'III
.... "°"lll Mtttr ludtng*
1., llon1 Used
-Z. S~o7 c::>o -1 ?= e, 0 l_,->8000 Tiu I C. lllftl 111,rl"I 0,,1,w
.31
,,u1 Opt,u,..
De11 ~** Qvarltr 31~/
.,ejfJ l,1r1tt
°"'""' 0.,1,t..
V1ttr level.. "
Sutt," "'-IM*..
/~ 7'..30~
~/
z_77S:-
1;lfZ-
~I)
~
OROUNO WATER PUMPAG£ ANO USE REPORT IIHtt \\owl'\\t:
X..__ lit II (I J S111t Dtp,r1mct1I er Hcahh u4 Sue., Water Cot11r9' loar4 Pwtllc. Scllf co1 tf tt90tt t* '-""' Slit, Vet.tr C."t"'I to.!"f Offlc, ~
- t*-1 II.Ill MultA Dtp,r~I Offlct t-1,1.er I /1l J4 (Ctrtit Or.)
--~ s.,,,..,,,
--- lltllhl.... s.,1,..11)
Jlldwttrlll. ltftl COfJ tf rei,ort le ~to11o1I \\lilt v.1.1, Co"trtl to.** Ofhc, Otiw,. s,,.. coo,,, report c. 1t1**l'lfi h.1t.t v.u, Co,1t,...1 to.rf Offtu Covtlt7/C tt1
. Surry
- 111 of 1oun,o,*1 N*~ of Oocrator -.~:.-1/11A,-------------
Va. Electric, Po,..,er Co. - Surry Posftfon/THl*--~Ni"J/A.-------------
ard Co NI*
Nt'Jl 0,,1',
Va. Electric Pc,,,.le.r Sfqn,t11rt-----"---- ou, -------
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 ------------------------
1 f -.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.;
S~I 110. /~ z -/-!o -7/pOttntr llo.
Iott: If,,,tta h 11,.t.trN, ntwtt ~91 11 t,ou, fa To,,er rlt~t-llllld COl"fttf'.
~lt Mtltr ltudlnt*
~11ons V1ltr ltvel.. "
Dile Ket.tr Rudfn9*
- c. non, Usf'd - mi
[~.,
un "°"'"' 3.!> 3 3..; 300 Used 16 1
2 3
4 s
1 I
10 11 12 13 14 15
- *.,.. w 11111e u.. Hca,.,,,,.,,,..,.., tftl *' **,I
..,, u,111, '"' n 1111,, __,_,..,,.,.,,.,
- If Ullfl, rtlf It I~ If flell'J*puatflll fJIOO,
.. "If Ultfl ti W wll 11 I ftt1f, tftctfJ llflldl wll ----
f Al.I trh1tel1 w M11Ji1117-o,1114 ~ltc n\\lr 1ve,l7 IJ'Ula w1Ul IIU1UI tlltptrt.ur,eiwfll.
Ttta
,,u 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.11*
'II ftof!UI I ~,nt1t Ill f I !loft UI Dlt1 Dvrt 1 ll'trllf
... "°""'
~SS--z f7.e:oo 2. lf'o /o6
'Z- /9o r'-=
Toul C.IIOAI
°""' ~.,tel' J/
r,u, Optrat1111 11111 UIII Ovartlt' 7o~~r.,.n, t,1,1tt
°"" "1 0..* tltf V1ttr level.. "
IIAtl,"....-h,ca...
~3J'>'oc, b/
7:z.193
GROUNO WATER PUMPAGE ANO USE REPORT
-~x-. "'""'
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 1t11~1 Sut.t Null.A Dilp,,r~t Office llldvttr11I.,..., cot, ef "'° tt "1**,,. I Sutt 11tt.t, COlltnl to.** Office o~iw,.,,.... CNJ., report ti ***'*" Slit., 11,14, (o,11... 1 to.l'f Office
--- \\tt'IAt(II
--- 11tllhl *"' Wl"11*1
- 11111 of waur-,,orls Va. Electric, Pc,.,.ier Co. - Surry
(),, Vt r Va
- Electric ard Po,,.1e.r Co*
ldd.-.u P.O. Box 31 S Surry, Va., 23883 Phone (804) 357-3184
-.~ of OoerHor
~1/A Po,ltlon/Tltlt
-,N:;-:/11A.----~---------
Sfqn1t11rt N/A OU.t Nii\\
'°""'ht Ion Sent<! t,11b1f c' ---.l:IN:.1..IA~--------
llo. of Connfc t 1 OM,,.,.11, l __
AJNu..f.cA..._ ______ _
Uptf'lt Ion Pt 1'1 t 'l.c,e r (Pllb 11 c)... N,..,/~A.__ ______ _
,,~ of u~,:
Puti11c !.__ ll'd11S v11 I __x_ Other ( spec1f1 ----------------------
1 f 11,tls11reinents lrt for* stngle...,ttr fft1d re,d1nt, 11st wells Included 11 fh14 SIICI llo.
~r llo. -------
SIICI lo.
0-ner lo.-------
SWCI lo.
Oi,ner lo. -------
SWCI lo. ------ Owner llo. -------
SWCI lo.
Oitner llo. ------
Ml llo, ------ u,,ner IIO, -------
Keter rodings 1rt 11 --~ga~l~l!lo!onslliiL--------------<9f11ons, 1000'1 of 9111ons, cubic fttt, ttc.)
S"'I 110.
()l.ner No.
J::
o.u Meter ludtng*
~ 110ftS w,ur levtl.. H
- USN Sutt,**
37'f+3o I.In l'o/lUI 1
2 l
4 s
7 I
10 11 12 13 14 15
- lftf.. tar s... tfN HCI 111 (f"tflf't.11 tftf tf ltll
- If Ul.., lttf It tftf tf IIClll*Pl,<IIIOlllf fttlef
'~" "'
~
t,c, Dl,r I
- If Ult41, Itel It tftf tf lit1Yl*Pl,IIIP111f Pl""
...... Ultll II tlle.. n I* *,,,,,,,,e,cu,.,._,,. wll ---- "
D111 1ou: If,,st.a ts 11,..u~. ntlMU ~91 11 kan 11 1c,,.er,1,11t... 114 c~.
Olte Meter ludtn9*
&.11on1 Used 16 17 18 19 20 21 22 23 24
- s 26 27 28 29 30 31 31 c.c./-, 0 z..o 3-o I C.IIOIII Ttu I C.111111
.. flg,i~
2..c:, 3 e, Dvr*at ~,,w I 0ptr1Uat 3/
r,u1 0p<<,11111t 1111, ~"'
D111 "'" °""'
- an.,,1nu1, er fl,61~111-owftt4 111111,.,.1,1, '"" lfltlla w1 UI llu 1 UI Dtpert111u~,wt11.
o.n Dl,c-1
, a,er111
... "°"'"
&:,~
AilJ l,1,...
°"' " °"" *~
Veter Leval**"
nut,",..,-,.....
~fls-o
~/
?9 - -
1.....
-~X..__*lll*I
--~ s,.,,..,,,
--- lltllhl.... S,,1"911)
... ***~****"'
GAOUNO WATER PUMPAGE ANO USE REPORT S111t Dcp1r1rnc11l e( Hulet. an4 Su!.e Waler Co111,., lou4
, ** lie. Sc/If "",, 'tfO If If.ti~ I """ V1t,, c.~,..., 1o.... Ofllu ~
lc9I0111I Sull Nul&A Otp,tr~& Offlct 1"4v1tr1al. St.., <OfJ tf rcpo,c ll "1101\\tl U.*tt.. u, ~~'"' lo.** Ofr1u O~iwr. s,,.. c~, 1f report t.t lt9to111i Sut.a "'"' Ccnlrel io.l"f o,11u
'"' ~
- ., ~ ~
4 (Ctrc1t One) =
Covft tJ / C tt1
. Surry
- 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 1 on, 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 lo,-------
S\\ICI llo.
O.Cner IO. -------
Meter rudfn9s 1r1 11 __...:,ga~l~l~onsu,,i:. ______________ (911lo,1s. 1000'1 of 9111ons, c11bfc fttt, etc.
SVCS 110.
Owntr llo.
6 Datt Ket tr Rud1119*
6.l 110"S v,ur ltve1°"
Usfd Sutt,..
[,wf.,
S' I loo -
- LI n l'<ollUI 1
2 l
4 s
6 7
8 9
10 11 12 13 14 15
- lc14 NW,... lfllf HCII CIJ (lrtftf'1*t1 tM tf flJI Hlf Ulftlo rttf II..... tf IIOll-..... lfll,erte, rll'IPIR "
~
- If u,...,.., n.,., et "****"""',.".,
-.. If Ull1' 1a tftl.. 11 ta I fltlf, lpt<lfJ llfltc, w11 ----
1 All frh1ttl1 tr M11Ji1ll1-o,ne4 J\\A)Uc u\\lr tvP911 IJ1\\lla w1 U. IIU 1 UI Dtptrt~iur,.,-111.
Iott: If 111t. h uNl!fttrtf, t1\\la,tf ~II 1a klan ta to,,,er r1tM*'6~ <Of'111f',
O..tt 16 17 18 19 20 21 22 23 24
- s 26 27 28 29 30 31 c.n.
Total 0.,,1,. lblll
,,u, o.,, Opt,au..
Ill I I !bl IA o.n Owrt I a,tf'III
"' lbtlll Met.tr Rudf r,g*
C.11ons lked
?/7'oc,
?<:>0 2o~
T1ul C.IIOAI
~,.. ~art.tr
...3 /
1,u1 Opt,au..
Da71 UIII Qv1rler z~...,,...,...
°"""' o.,.,t..
V1ttr level.. "
Stut,",,,_-IM..
/7'&l 0 6/
3/
......,,,....... lJ*lwl L:z'?' z__ -
~~, '~ -
GROUND WATER PUMPAGE ANO USE REPORT (Clrt1t One) v,1e, Sov*u:
___ x __ 11e 11 h I
-~- \\,,ta,(*>
$111, 0cP'r1fflCIII., Holch ln4 Sue. W1ltf Conlr9' lornlll P.tllc. so, u,, ef 'tfO tt a.,,....,, Suu v,u, c,,.,,.., ao.... omu ~
lt9to,,.,I suu llctllA O.~rtwolt Offtce llldvttrttl, 1tflf,.,, tf " Ct ~10,.,.1 Sutt 11,u, C..11v.1 lo.I** Otr1c, 0~11e,.
Stlloll cot,,, report ti 1,,,,,.,.1 St,tf lltUr (Olltl'tl 161,.. Offlct Cou11t7/Ctt1
. Surry
--- 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 11rt 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 11 kian 11 '°" rltht*hi"' COMllf'.
s~, No.
Owntr lo.
fl O.tt
"'eter Rud1119*
~ 1 lons v,ur Lev1l 11 "
o.i.
ICeur Rud1ng*
g,, 11 OC'II l'~IM"'
Used
[M ef t.ut "'°""' 279300 1
2 J
4 s
6 1
a 9
10 11 12 13 14 15
- ltt4 a,ew I.., lfllf Hc:I.., (lr1ftr1,IJ ~ tf flJI Hlf Ulttl, rttf It I"' et IOll*...-.1"1,crte,.
- u,... '"' It lllf.,.....,.~,... ""..
....., Ult11 11 tilt"'" t1 I flt1f 0 IPf(lfJ 111\\tc* 11111 ----
f All,,tuttlr er Ml1.s.e111-0rlll4,..,., wt\\lr '"" 1,u...
st~ 111t1I UI lllttrt~uP'kiwtll.
16 17 18 19 20 21 22 23 24
- s 26 27 28 29 30 31 I C.11*
"°"~
Tot.I t,u I Opcratl..
Da11 O,tl Owrt tltl I floft UII llt "°" \\II 2..-tJo~e>O
//c,c:,
//
e:,.e,,,u 1 C.110ftl 11,,,.. ~.,--
.3/
r,u, c,p.,u,,..
..,. " o,.,,,,.,
J~
.1111, l,,,...
Dli""t Ov*rt1r V1ur ltvel**w SU ti," l'\\acl 11111* **
3 / c::,c:::,
~/
S-/
., *.*.,,......,,.a;,,
X.__ "-III I J
--- s.,,,,..,,,
--- 11tll(1I,,,,, s,,1"1!1)
GAOUNO WATER PUMPAGE AAO USE REPORT Srut ~p,ar1mc"I ef Holch 1n4 Sue., Wuu Co"~ loar4
,,eltc. k,,. Ct'1 *' 90 lt ~lt11,I 1t.,t, Wei.fr c,,.,,,, lot..i Offlu l!!f 1t91°""'1 Hu, Nul\\A Ditp,er~t Offtu lodvn,111.
,,...., cot,,r " ll lf.t!t,...I 1u,, w.i.,, CoAtrwl Sot** Ofhu o~rw,. s.... coo,.,"" C. **,,oiwl 1t.,t, W.t,r (Ofllrtl ao.rf Offlu
"*lllf of WHt~r*s II ui, of Ootrltor M/'A Va. Electric ' Po,..ier C-Q. - Surry o-..1'r Va. Electric arrl Power Co.
s OS ft toll/T It lt N/A f Qnl t11rt N7A Addrtn P.O. Box 315 Surry, Va., 23883 Phoiw (804) 357-3184 No QP\\llllfOII Served c,11blfc'
, of Conntctfon, t,11bltc)
'"' /j'f'.Z-
~t) /J,,ft!(--
~., \\f, 1A'J
( C t;:r, t °'"4 )
~11t7/Clt1
. Surry O.te Nfll NI.A 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 1 llded 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.)
S~I 110.
l>,,1)t lfo..::::. e> N S TJ<:.CJ C. If O...._
r 5 I -r<iS""
o.iu Mtttr Rud1ng*
6411ons w,ur ltvt1 11 "
Us~
Hall,..
~
'l/1/J
[ltd.,
Zf~7foo
~n PlolltJI u,IN/1, 1
2 3
4 s
1 a
9 10 11 12 13 14 15
- lct4 -~ ** 11* ttcl,., (l'tflf'tllJ lftfl er,,,1
- If tlltt1. '"' n,,.,,, aoa-,u.pt,.,.,,.,
l'lllc;)lft"
"' f/1, 'H4o Tttl TtU
- If 111141. rttC It tftf If.. IYJ*p.iaipfftl lfrlof
-..,, ut111 ** 111t.. n,. * "* 1JtCtf1 -*c* wll ---- o.,,
Iott: If,,,.. ts Mr,actfrM, HllMtl ~91 fa kllft fl ICMr rftht-~,_. CDnltr.
o.u Ket,r h1dfng*
&.11ons Used 16 17 18 19 20 21 22 23 24
~5 26' 27 28 29 30 31
~~(,.~S-r:>c. /S-? /oc, I c,11..,
IS-7' /oc:;,
Ttul C.11CNII
.. !bill D1,,,.. ~.,~
I Oper,tf..
" Opt,u1111
"'" lb,~
-3/
Dl11 Ulfl Ouarltr 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 Dl,rf I Arlf'lfl flt "°"'"
S-/ 3 2-a.-
AilJ l,1r1te O.,r,"t 0..1rt~
Vat,r lev,1 11 -.
Slatt," '"-'""'"**
~/j? /o=
~/
/o/4~
I
..............,,.a,;.,
x.__ 1H II (I J
--~ s.,,,,..,,,
--- ¥tl1(11.... S.,t"9(I)
CROUNO WA. TEA PUMPAG£ ANO USE REPORT S111t Dfp&r1fflCIII.r Huhh '"' Sutt Waler C.0111,vt loar4
,,,lie. S...i co,*' 10 tea.ti....,, St,t, Vet,, ~"lrtl to.~ Offlu t!f 1,,,-1 Sut, Nul&A DfP'rtNo\\1 Offtce
'""'"""*'* 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,
'"' /f'7'Z-
~
t)
- re,I/Vc=
~mte, 111) > 4
,c~. On.t)
~nt7/Cft1
. Surry
- 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 "'°"'
(804) 357-3184 No. of Co,wctlon, fP11b1ld _
__...N.,../....,A _______
t 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.)
S'-"=1 110. z '7-19'0 - 5"'"°6 C. Oltntr llo,
~
D.tu
"'ettr Rudi~*
~11ons v, ttr levt 1.....
Sutt,..
,~.,
un lb\\UI /OZ-'>t!!J -z_.oo 1
2.
J 4
5 7
I 10 11 12 13 14 15
- lltt4 N\\.er laat tf* HO ~I (l,'1flf'1,IJ 8i'4 If flJI
..., Ulee, rH* It,,,.,, -*Plllf'"I 111,111 1'~1~"'
- If u,,., rue 11 tnf,, 11c1,,-pwap1111,-,,..
M**lf UltA 11 i11t 11111 11 I f1t1f, IPf(ffJ llfltc* 11111 ----
1 All.1rhn11,.,. MlfJ.1111-ow* ~He.,,., '"",,,i.
w1 ~ ICI t 1 UI OtP4 r i.iu f">t,.111, Iota: If 111ta h Yl'IIIICUrM, t1'1MU ~91 fa lioan la 1o,,er rt1H*~III <onwt',
Toti
~rt o.,,
O.tt 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I c.11..,
.. fblla 1 Opt,au..
Ulla !loft~
11111 Dwr1 1........
"' "°""'
Meter Rudi 1'9*
C.llons Used
/07'3/s;,o 13/300
/8' r/.300 Teul CIIIOAS
~I.. ~art.er
.3 is, ftt.11 Operltlllf DIii Ullt Ov1rllf'
&. /,:/'3
.,. n, a,1,.,e Dl,,i "1 0,.,r,~
Vet.tr levcltt" su,t,",,._,IIQ...
l;'o <<//-=-=
~/
33 ~
"l----
,......,,.,.....,,.e.;.1
_..,.x_ lie" h,
--- ~,..,,,,
--- 11tllhl 11111 Wl"tlll I I I..... I I' I,...
GAOUNO WA TEA PUMP.AGE A.NO USE REPORT S111t ~par1incn1 e( Hulcll 1n4 Sc..ee W,cu Co"crvl lou4
,.111,.
s.1111 U'1 *' '"° lt lfttt11,I Suu vn,, c,,.,,..1 to.rt Otttc, l!!f
- ,,OIi, 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 Ovwr. s,,.. coo, ef "" c. 1t111... I Sutt.,c.,, (o,11,..1 to.art Oft1u
- 1111 of WUtr"'WOr*1 va. Electric, ~
Co. - Surry
~lir Va. Electric a.rd Po,,.ier Co.
~d~n P.O. Box 31S N*~ of Oocr.tor
~l/A ro,ttton/Tttlt --.N"/r.A:---------------
5 f qnHwrt N/A
- 0. t.t _N_7_'1' _____ _
,~1uto11 Senl'd (Pwbllc'--~H
.... LuAL.A..-. _______
No. of CoMfcl1on, fPwblfc) __
Nu.,..,/A<.L... _______ _
I.IP tr It ton Pe rwtt lutit r ( 'lib 1 t c) -li-L... A'----------
,,~ of u,,: '"""' ~
llld11strt1I ___x_ Ot.Nr (s~tfy _____________________ _
Surry, Va., 23883
, Pho11t (804) 357-3184 If 11eu11renenu are for 1 1t~h-wt1r fft1d rud1nt, 11st we11s 1r.c111dtd 111 SKI llo.
Owner llo, ------
S\\ICI llo.
Owner lo. ------
SWCI llo.
Owner llo. ------
SWCI lo.------ Oilner llo. -------
SWCI lo.
~r llo. ------
5\\ICI lo,------ ~l'llr IIO, -------
Attar rud1ngs.are 11 __
..:;ga~l~l.!io!onsl.lil. ______________ (~11ons, 1000'1 of 91l1on1. cwb1c fHt, ttc.}
SWCI llo.3o -190 - S-/ G o.-ntr IIO.
3 O.t.t Ktttr Rudi~*
~ \\ 1ons w,ur Level.. "
suet,..
["4.,
r1..J7 2-soo
~n "°""'
1 2
J 4
s 7
a 9
10 11 12 13 14 IS
- letl.. w I-11* HCI,., l,rtfere,tr lftl tf IIJI Hlf UI.., tttl It IN If IIOll*,.,..1..,.,te, l'~f11e"' I T,ta Owrf
- If Ulftl, rtll II Inf tf ICIWJ*,.,..1..,cr1e,
...... UllA ta Ille *II I* I fltlf, lpt,elfJ illlcl1 11111 ----,,u lot.a: If 111t,a h 11N11eU,..., HllMU ~91 fa 1c... ta 10,.,.r rt1~t*M"' <Ol"ftlf'.
O.tt letter lud1ng*
&.11ons Used 16 17 18 19 20 21 22 23 24
- s 26 27 28 29 30
'-l'1,Y1z. 8'oCJ 8'~.yo3ao 31 1 c.11...,-J/ 3 T1ul C.111111
.. IIQoill IOT ~ O~
Dwrl9t 0,ar~
I Oper1U..
VI II lloll UI J=
r,u1 0Nr1t1..
0.71 Uifs Ov.,te, t All frhu.e1, w M11.ii111r-o.* '1,611c.. 11, '"" 11'\\lla wt~ IIH1UI Dl~r~ar,t,.111.
0.11 Dwr1 1 **.,....
flt "°""'
z3/34'-3
..,.11,, *.,...
°"""' 0..1,t" V1ur Levcl 11 "
Sutt,",.,.; ! /WI I...
- z. 3 (le/I,jo o
'//
zt, I 'I'? 3
_.... lC...... ""
s.,,,..,,,
VtllhJ.... s,,,.,,.,
......,.,.... ~
GAOUNO WATER PUMPAGE A.NO USE REPORT S**** O(p1r1111e111 e( Huhh 1114 Sutc W11~, Co111rol lou4
,....,. Sfftf,.,, *' 'tf'O It -.,,~ I St4t, Vet,, C.*Vtl lotrf Otrlu t!!!I 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
/~z_
lbldl 'J~ -
~*rte, 1 <1)J 4 (Cfrc1e Ont)
~11t7/Clt1
. Surry
- 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,-------
SKI llo. ------ O.ntr lo, -------
SWCI lo.
Owner lo.------
SWCI llo, ------ Oainer llo. -------
$WCI lo.
~, llo. ------
S'IICI llo, ------ O,,ntr IO,-------
fitter rudtngs art 11 --~ga~l~l~ons!.Jlii.--------------Cf'llons, 1000'1 of g111o,is, c11bfc fHt, etc.)
1ou: It 111t11 ts ~-u"", t1twu ~91 fa llolft II '°"" rl9llt,~III Conwf',
S'-'=1 Ro,.3 / - 1'70 - ~
z.. c. °"11er lo. C.
O.tt Keter llud1119*
"11ons v,t,r level....
Dltt Met.tr lud1 ng*
&. 11on1 Used su,1,"
,~111411"'
Used
["'.,
'1////////////// J,.".,,,.
3t,,'8' /t;. /oo,,,,,,,...
un "°""'
'H/H, 16 1
2 3
4 5
7 t
10 11 12 13 14 15
- ltaf Nier *- lf* ttCI ~f l,rtflf't'1J tfll ef flf)
..., u,...,... It,,.,., IIOlll*,._.1,.,.,...
.....,..... '"' It,,.,.,....,.~1,.,.,.,..
....,, u,.. 11.,.. wll ** 1 11,1t,,,.cu, 11111(111 wn ___ _
f an frhu,1, 11 Ml.. 11,-o,1114 "'611c w11o1r lwH1_J *f1'-
w1 IA 11t11 UI DtPfrtll,u~,-fll.
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.11*
,,ua o.,,
0.11
°"
!bill
°"""..
Ulh lion~
, Aun11 "I ~UI 13 7, z. 7..J.od 6?1/..3c:>a
'?// 3oe
,...., 1.1110M "1,1., 0-trW
...3o ret.11 0pt,1t111t D111 "'" Ov1tttf' 30377 AilJ l,trttf
°"""I Ov*rtlf V1ttr level.. "
St.ut," l"-IM***
- !. t/ ~
b.?oo
~/
2.~ '1'? 8'
.,.....,,......,,-~,
CiAOUNO WATER PUMPAGE ANO USE REPORT S111t ~par1mc11t el Hcahh an4 Sc..i. Wuu Co11u9' loer~
,.Hr /z..zz-
~~ -..,JPN?'
~.,...,
1 '
J *
(Circle ~)
x...._ - ""'
~-~\\f,'1..,1,1
,.. 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 lodwllrttl.
St<lil CotJ er r1,o,1 II ~IO"tl 11.,tt.. u, C411trtl lo.** Ofhct
~t1/Clt1 0,w,. S.111 coo, tf ""'° &e **1*1"'1 Su~ vu,, <ont"II 1o.tr1 Offtct
--- "'""' '"' s,,,... 11,
. Surry
- -.e of vuerwo,*,
Va. Electric, Pc,..ier Co. - Surry
().rlir Va. Electric a.rd Power Co.
Addl"<<u P.O. Box 315 Surry, Va., 23883 "'°"' (804) 357-3184 II*~ of Ootr1 tor
~I/A Pos1t1on/Tft1t -"i<N"/A.--------""-,-'11<------
S!QnHurt N/A O. t.t __.,_n ____ _
Popu ht Ion Servtd CP1111 ll c' ___
NUL.;IAo.._ _______ _
No. of Co/l/lfct1on1 fP11b11d --.uH1.L/.cA..._ _______ _
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.
Owner lo.-------
SWCI llo. ------ Olmer llo. -------
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.)
SWCI "o.
~, IIO. 'j::;,
loi.: If 11,ta II w,_Ur-M, t1l1Mtt ~91 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
,~lfte" Used r,..,,
LH t l'\\:M\\ UI 2S'"foo7oo 1
- 2.
3 4
5 1
a 9
10 11 12 13 14 15 Uf',... U* HCI,a, (f'lftrl'1J tflf If IIJI
- If tllttlo FNf U tftf If IIOR*..... lllf Jilrllf
,u,.
- ,..,...,.., u.,.,., lel'IJ*l'\\llfl.. ""
-**If Ul.. 11 lftt *II tat f1t1', lff(lfJ lllfltc* wll ----
t an,,1uu,, 11 M1t:.Ur-orllt4 "'611c.. 1.1,,.,,,,_ '".._
wt~- -.,1 UI llllput1111u~1,.111.
Teti
,.~
D171 16 17 18 19 20 21 22 23 24
~5 26 27 28 29 30 31 1 c,11..,
"' lloflll
' c,p.,.u..
Ull1 ll&>ftUI DIii Dwr1
, hlf'ltf
..,....-ui 2t:. '- 3 ~ e.o /..:=. 3 /.:;,c,
/03 /oc:,
f1ul C.IIOftl
.,,,.., ~.,w 30 f1t1I Optrut.,
D111 '"' °""'"'
.3c.,l,3 7.
AilJ l,1r1tt
°"""' o,.,.,,~
V1ter Leval.. "
Sult," l"->11111...
- 2. 7 2..4-eoc:,
9r
- z...'7 t',3
.,.....,,,.,. -**,,.a.;,1
-~X-lit II (I I
--~ St<'lllt(II
--- Wtllhl *"4 w*11tl1I GAOUNO WATER PUMPAG£ ANO USE REPORT S111t Dtp1r1mc11c e( Huhli 1114 Suec Wuu Co,urvl 10114
, ** 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
,..,.,"'"'* 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
- 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 ~ct f OM CP11b ltd ---.....Hu..f...
A _______ _
"'Ptrlt 1011 Pe r111t II.cit r ( Pllb 11 c) 4,N.._/.:.zA'--------
T1pe of u,,: P11t11lc~ 1nc, 11strt11_L Other (spe<tf1 _____________________ _
If me1s11rements art for 1 1tngle~t1r f1tld rt1dtng, 11st wells 11\\C 1 llded '" flt 141 SWCI llo.
Olmtr llo. ------
swca lo. ------ Ollner lo.-------
SliCI No. ------- Oi,ner No. -------
SWCI lo, Owner No.------
$WCI lo.
0,.,-.er llo. ------
SWCI llo. ------ Owntr NO.-------
Mtttr rudfngs art t1 --~ga~l... 2~0Cflu,r. ______________ (91l1on1, lOOO's of g11lon1, c11btc fNt, ttc.)
lote: If l7St.a h t1NICU1'1'1, t1tWtl ~91 11 '°an ta 1oiotr rlt~l-~,-, COMltf',
SWCI 110. /~2 -/9o - 7tro.Mr IIO. -
c::.
O.t.t f'.ettr Roding*
6'11ons v,ur ltvt1 11" Oltt Meter ltud1n9*
6.1 llo,11 Used HHt,**
P1111Pf~a" Used r"' *'
~,,,,,,.
- un l'ollUI,~~z./700 "
1 2
l 4
5 7
I 10 11 12 13 14 lS
- ... Ntar.... If* Hell,., (ytftrl'1J tfl4 tf 1111 Hlf tlltl, fffl It fr,f tf IIOll*"""lftl,.,,..
~
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
- n 1 c.11...
Ttt.a 1111,,.. lloolUII
- If ti\\.., rte, It lftl tf lclYI*"""'"' ftrl..
"**If tlltA II 1111.. 11 1,1 I flt1f 0 lf,KlfJ lllll(ll 11111 ----
TtUI DIJI Oper1U..
UI II Ron UI f 111,,1,n,11., M1.. 111*0r~ M11c ""' 111H1J 171t*
wtUI Ntt1UI Ol1Mrt1*urkralt1.
DIii Durl J lwtrlft
"' "°""'
kf~KZ3~o /Z..?,?8/eo
/2- "Tr <?c,c>
, *..,, C.111111
...,,... ~.,~
.3'c:,,,u, Opt,1t1111 o.,, tall Q111,1er 7"3Z7"3 Ai1J l,1r'1f o-,,..., Ow*rttr VU.tr lev11*u*
Hui,.. -'""'**
S-70 2..6oe>
~/
¢,Z~~
GROUNO WATER PUMPAOE ANO USE REPORT
.. '"'~~/~r~f'~z.::::_ __
lbft~ _.:rz.;;;,..~~/\\1...:;~;;,_--
~~lC'...__ 11tll(1J
~-- s.,,.,.,.,
___ "'""',,.,, s,,,,..111
$111, ~p,r1mc111 e( Hullh 1n4 Su&c Wtru CG""°' loar4
,.111c.
S.111 ce,1,, rt90rt le 1.tt1.,..1 Sutr V1t.,r C.At"tl So.'11 Otflct l!f
.,,,~, St.ttr 1101111 °'~'~' Office l"'4vUrttl. SW co,1 tf ttPOrl ti 1.tt10,..1 Sutt.. tr, CoAtrtl lotrf Off1c, Ot11tr. St,.. coe, tf rtPOrt lt lt910,..f St.tt., v.c.,, Co,1t,..1 to.l"f ou,u
~*-' 1 cI> J *
(Cfrc:1t ~)
'°""t1/Clt1
. SUrry 11,11e of Vtttr.o**1 ll'*me of Ootrltor
~I/A Va. Electric, ~
Co. - Surry
,osltfon/TIC1* -"iNi7/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....._ ______ _
_ __.Sur==-ry..__.,"--"V,-=a ___......,~23~8~8'"-'3_ PhoM (804) 357-3184 No. of Conntctfo"' r,11b1fcl _ __.N...,/""'AL-______ _
Uptratfon Ptrw1t JLc,cr ('vb lie)...
~
... L~A..._ ______ _
T1pe of u~,:,.. 1111c ~
Jnd 11s trta 1-.__x_ OV..r ( Spe< t f1 ----------------------
1 f ~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.-------
Meter rodfngs lrt f1 --~ga~lul~OOS!Uiil:...--------------C~llons, 1000*1 of 9111ont. c11bfc fett, etc.),
Iott: If 111ta fl w,-et.tf'ff. 11t1Nte ~91 la ~.&ff fa lo,,er rf9M-~.... CC>nllf',
SW\\:I lo.
~r llo. -
I-l).IU Ktttr iltAdlng*
&.110IIS V1tfr ltv11....
0.C..
Miler llud1t19*
g,, Ilona St.ul," '"""'Iii" Used r,_.,
~
lut "°""' 311:>c../-foo 16 1
2.
3 4
5 1
I t
10 11 12 13 14 15
- lul *w,... ti* HCI l,J (1"1ftr1'1J tfll ef ftJJ Hlf Ul... rttf ti 11'1111 tf IIOII*""""'"',.,,..
- .,......,,., tt lflf.,,.. **,.pw,ap1111 w,..
....., Ultt1 ta 1111 11111 I* 1 fltlf. 1~lf1 _..,,, wll ----
t 111 frhU.tlf II Ml~11J*<<-rllM Pl,611c..,., lvP,IJ IJ'i.
wt"' IIUIUI DtJtrt.ou~l'Wltll, 17 18 19 20 21 22 23 24
- s 26 27 28 29 30 31 I c.n..,
~,,,. "°""
ftU o.,, I Oper1U111 0.11 DI.rt Ill t I lb;\\ VI
, htrlll 37 7'T90
/~30
/'S""..3o foul C.UOAS Dw,,., 1),1,1.er
,3c:::,
rot.al 0pe,,u.,
Dt11 \\Alt 0w,,,...
~,
.1111,, **,...
Dwrt"t Ov*rt~
V1Ur levt1ttH Stulc",,.._,, 11Q***
&.??o 9/
77..
- *II.._. 11, I,....
i GROUND WATER PUMPAGE ANO USE REPORT
/ 'i' f 2-b~ ~-vc
-~X.,.__ "- II hJ S111t Dt~rtmcnt *f Huhh 1n4 Sue. Wuc, Co111rol loar4 P.tllc. Sf"',.,,*' 'tfO ll ~'""' Sue, vu.er c..~t,,1 to.~ OHlu l!!f
''°"' I St.HI Nu' UI Do.. rt.fol, Office 1...s.. ur11I. St<lf tofJ., "" ll ~""' Stitt... c,, eo~1.r1, to.,, Ofhc, Ot,w,. S."4 coo,,, report t.1 ltt""' Sutt"'"' Co,1trel to.,. Off*c,
~*rte, I Cf) J *
(Cfrc1t h)
Cov11t7/Clt1
--- Stt'lllf(II
--- 11111(1) IIICI S,,l"'t(IJ
- 111t of 1t1ttn,o**1 Ya. Electric, Po,.ie.r Co. - Surry Ow 1' r Va
- Electric arrl Po,.1e.r Co, Address P.O. Box 31 S Surry, Va., 23883 Phone (804) 357-3184
. Surry 11 *., of Ooeru.or
~I/A Po,ttton/Ttcl, -"iiNi7/A.------~~------
S1qnu11rt N/A Ott.t --------
P opJ ht f on Servtd (Pwb11c' ~-....1ff.i.luA~--------
llo. of CoMfctfonc lP11b1td _ __,H......,/A....._ _______ _
NIA Up trat 1011 Perwf l ILc>t r (Pub 11 c).._N,..,l.:..:A1..-______ _
Type of u~,:
Publtc ~
lnduUrtaL.... X-OU\\tr (specify----------------------
11 NU11renents art for a 11nglc-Nttr fft1d rudlftt, 11st welh Included Ill SIICI lo.
()tner llo, ------
SWCI llo. ------- Oimtr llo. -------
SWCI llo.
Owr,tr llo. ------
SWCI llo, ------ o-,ner lo. ______ _
SWCI llo.
Owner llo. -------
SVCI llo. ------ O,,ner N. -------
Mtttr rudings art 11 --~ga~l...alJ.COSUi1.--------------<11al1ons. lOOO's of gallons, cubic fHt, etc.)
SWl:S 110.
Owntr llo.
6:,
Dau Meter Rod1119*
~llons VHtr level.....
Us-tt,**
tlld.,
¥Hf/I, Lut l'MUI ~I 'Joe:,
1 2
3 4
5 7
a 9
10 11 12 13 14 15
- ltt4 NW,... ti* HCI l&J (,,.lftf'l~IJ ~ If flJI
..., u,... '"',, '"'., IIOll*N"IP*..,.,,..
- If 1,1,., rtlC It 1111 er.,,..,.p,.,aiplfll,en..
,\\111111)1~ "'
Tota Ttll i,.,,
lot.I: If 11sta fl w~tArN, nlta.Lt- ~II fa ~&al fl lo,,,er rl9~l*lw~ COMllf',
O.tt ICtltr ludf r,g*
C.1ton1 Used 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
'if.z. / C>-=-
zc::)~
31 I C.11111
'" ~,,...
.. lloolta Z-=o
.,,... ~trc.r I Clpernt..
&lll !loll~
3~
fetal Opfratt..
C,.,r1 11111 0111rllf'
....., Ultfl 11 1111 11111 ta I flt1f, 1PKlf1 !lfllcll 11111 ----
1 All,,1uu1, w MIIJ!lllr-o,"'4 fl,611c.. 11,,.,.,, IJ'lal9 wt u. !Itel"' Dt.., ** r,,,.111.
Dill Dwrl I A,tl"llf
.. "°""'
7*
.,.n, 1,,,.,.
Dwru't Ov*rl_.
Vittr level.. "
suu,..,-,.....
- 2. /
c:, c:,
~/
z.3
-*~*.,,......,,.._..
v.i,, '°""':
x.__wllhJ
~-- \\tt'lllf(II
--- lltllhl.... ~,...,,,
I *II,._ I 1 *I,...
GROUND WATER PUMPAQE ANO USE REPORT S111t Dtp,r1"'c111 *I Huhh 1114 ~cc Waler Co111,8' lou4 P.11tc. s.... ce,, *',t90,, le ifi 1...., 1 St.u, v11.e, C.11tr1I 1o,,.. ou,u ~
"°""' St.It.I Nul&A Ot~r~, Offtce 1"4vHritl. '"" rot, 1f r1p0,1 ll "1111111 SIAlt lltt,r C...trtl ~** Off1u O~iw,. St"' coo, 1f,epo,t te lt9t1"'i St.,&, 11.t&tr COlltrtl ktr1 Oft1u
/ff-z-lbl ~
- Tu,N' C
~.,...,
l 2:i) J *
(Circle Orlt)
~t7/CU1
. Surry
-- _1
- 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 lo.------
swca 11o.
~, 11o. ------
SWCI llo.
O.ner lo,------
Sliea 1o. ------ Oifner IIO. --------
~ur rudin9s lrt 11 gallons (p1tons. 1000*, of 9111on1. cubfc fttt. ttc. l s~, No.
Oltner No. rl
().a~
Meter Roding*
~ l1011S v,t.tr ltv11.....
1:,
r"'.,
I
.2?07'0D Lut,O,,Ui I
- 2.
3 4
5 7
10 11 12 13 14 15
- ltlf at\\at.... If* HCI l,J (1'lftr1*l1 tftl ti flJI
..,, u,... '"' ll.,,,., --""""',.,...
...., u,...,,.... '"'.,,...,,.f'YIIPtlll ""..
....,, u,,. 11 ll'C wll I* 1 ftt1f, 1ft(lfJ llfllcll wll ----
t 111 Jrh11.11, er,...11J,tl11-0r"'4 M1tc.,,., lvPtll II'.,_
"1~ Nul Ua lltr,ar~*t,t19fll.
1etl 0.,,1 Teu Dell
°"
Iota: If IJSlla fl 11i.UrM, 11ttau, ~
I* loan fa '°""' rl9ht-~lllf c~.
Dita Ket.tr au<11 r,g*
C.. 11ons VI tar Leve 1 u" Used S\\.ltl," '-'"'ll"""
16 17 18 19 20 21 22 23 24
- s 26 27 28 29 30 Z8Z4'=c, z..~oc=:,
31 I C.11*
Z-~OIO T1ul C.IIIM r.s-c::,, -c:,,
119 lbl&a o.,,,., O.uw I ilperl\\1..
r,u, Ope,1t1111
'?/
11111 illc!"Ul
'30
..,, "'" 0v,,,...
I A,trlfl
. ?c::>
.,.n, ***'ttt 4=,C>
"' "°"'"
°"".., o.,.,,~
v,,., \\ow*u:
__ x_ "'11 h,
--~ s.r,.. 1,1
--- Wtllhl.... ~,...,,,
t I I I""" I"
GAOUNO WATER PUMPAGE ANO USE REPORT S111t Ofpar1mc11c el Hult II an4 ~I.I Waltr Co111rol lou4 Pwallc.
S.111 u,1 tf rt90r\\ lt t.t1....,1 St,1.t lf1\\4r C.11tr*I to,,.. Ofrlct t!!f lt9IOO'lfl St,tl Null.' 0tPtrtNOII Offlct llldv1lrt1I. h"' <Ofl tf re,or\\ lt 1tt1,,..1 St,te.,t,, to"'"' to.** Offlct Ot11tr.
Stlll coo, et rtPOrt t. 1t11,,.. J Sut,.,t,, c.,.,,..., ao..... Off tu
/ q'9 z_
~,
~~
.::T"() d'~
l).i1rt.tr 1 (l) J 4 (Clrth One)
~11t7/C1t7
. Sur!)'
- 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.)
SWCI llo.
~r IO c.o~s.-.R-t.)c:...,rooJ
- 51~
~~ Hettr Rud1ng0
~110111 11,~r Ltve1°tt Used Sut1,** '"""'11411"
[1114., z,~~t.soo~ -
~
t..11 1\\)11 UI 1
2*-
3 4
s 7
I 9
10 11 12 13 14 15
- *., NW I-lfar HCI Iii (Jf'lf~1*l1 tftl ef 1111
- .,..,... '"' 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 -----
t All -frhtttlr tt ~IWll,-o,1'114 tl,61tc N\\lt SVPf11 11'\\cla "1111 "ulUI DIP1riiaur)t,wt11.
I.rt o.,,
DIii Dvrl Iott: U s,si. h 11,-urM. nUut, ~91 11 '°'" ** lo,,et,1,11t... "' (Ot'1\\lf',
~ti Met.tr lludfnv*
c.nons v,ur Lo11eew Used SU\\1c",,_,/IQ...
16 17 18 19 20 21 H
23 24
- s 26 27 28 29 30
'rz..'i'f'3 ~70.:::. 3~2--Zec>
31 I c,n..,
Ttul C.llllftl 9.//sot:!:>
- '-Iii 3~:z.. z_oco ev,1., C),1rt.tr I °"'ttt11 Teul Optr1t1119
~/
Ill I I llol\\Ui
,3o
- 11 IAh Ouarter
, l,tt'III /07~.,.11,, **,...
/o 3<-1-~
... !bit!*
"'",., °"" \\If
~HUUND WATER PUMPAGE~AND use REPORT
~*th 7,4/,/i/Jk;;
Si.ate ~partmfflt of Health and State Water Concrul Board
. Quuter ~
2 ;7 Public.
~lid copy of ~r-t to Rag10NI Sutt Weter Cofttrol Soard Office llld frcle One) llt9fDn1I Sutt HHIUI Dep,rtaent Office County/Cfty 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
~-.
14>ttr Sovr,:-2:
-~:X:.__Well(s)
Sprt119(SJ
___ Wtll(s) *lld Sprtftg(s)
=
!fame of Waterworks Name of Ooerator --;?-;-;'l/,.,A;.--------------
ric & Pc:,..ler Co. - Surry Posftfon/Title __ ~N.:,/r;A _____________ _
N/A Nt'A Va. Electric and Pc:Mer Co.
Sfqnature _________ Date --------
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 No.------ Owner llo. -------
SWCB No.
Owner No.
SWCB No.
Owner No. -------
swce No.------- Owner No. -------
SWCB No.------- U..ner NO.--------
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 List llontll 7g, 7,([)c,0 16 I
1 17 2
3 18
\\ ~t ~l~J\\~l\\ iqqd")
19 I
4 20 i
I 5
6 21 I
i 22 I
I 7
23
~
8 24 9
25 10 26 11 27 12 28 13 29 14 30 15 31
~ ?1t./ 1,cX) /8'7 /oo Tout GlllORS
- leed aeter Slllt t1ae Hell d1y (prtftr1bly tnd of day) 1 Gallonr Tota Dur f"!I llonUI
/87 /0>
Dur1119 Quarter
/J7//oo f taken, rtad 1t tnd of llt1wy-~1ng period t1ko, rttd it end of IIOll-poac,1ng period f Uktn tn one 11ell 1n I field, SPte1fy wti1clt veil ----
11 prh1tely or publfctlly-owned publtc water su1>9ly systeal 1111 UI Htl 1 UI Depari.ent perwf ts.
Toti Days I Oper1t1119 UI 1 s llon t11 Oat Our 1y Aw1r1119 1119 llontll I
3/
roul Oper1tt119 3/
DI.rs tllf s Quarter 6,03S-
...,. i I J A~tra9e d,/03*~
O.,r i 119 Qua rttr
\\ J.
_ __...:X:.__ Well(s)
--- Spr1119(1)
___ ~ll(s) 1nd Spr1119(s)
GROUND WATER PUMPAGE AND USE REPORT S1ace ~panment or Hcallh and St.ate Wacer Concrol loar<<I Public.
~nd cop7 of rtPOr1 to lt9fONI Sutt llattr Co11trol loa,.. Offfct alld R19f0111l Sut.t llfflUI o.p.r\\Mllt Off!ct 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 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 No.------ Owner llo. -------
S~B No.
Oimer No.
SWCB llo.
().mer No. -------
SWCB No.------- 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.)
SWCB No.:3o- / o-S" I G Owner No.
Date Meter Reading*
Clld of Lu t ttan tJI 2Zl71c.o 1
2 3
4 5
6 7
8 9
10 11 12 13 14
(
15
- lead *. ter,.,. tlae tacll day (prtftr*bl1 tncl of d11) f tit."* rNd 1l tnd of non-~1"9 period f Ul111, rtld It end of llt1v7-puapf"9 per1od If.tllt11 tn one -ell fn
- flt1f. specff7 wflfcll wll ----
All prf,1t111 or Pl,tl11cal11-owned public water suppl1 s1sltlli w1 tJI Ku ltll Depari.en l perwt ts.
Not.I:
If systa ts unaiettrtd, tst1Ntt puap&91 fn boan 111 1oi.er rf911t-llalld corner.
Dlte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 JO 31 1 Ci llClftf Tota Dur '"' llotltll Tou o.,s I C)peralfnt Ulfs NcntJI O.t Our 1y Awtra91 1119 Mofttll Meter Reading*
Gillons Used
!'1.S-~ J' Joo 73S'o~oo Toul CitllOIII 73S"o?oc.
Dur1119 ~arttr 3/
rot.al C)perltfllf 0.71 tllft Qu1rter 237/23 A ilJ Awtra91 Our i "9 Quart tr Va ttr Leve 1 **tt Static-1,-111a***
73S-o Yoo 3/
237 123
ftu L;t:.~2-I~ -
I GROUND WATER PUMPA GE AND use REPORT d Su&e Wa1tr Control Boartl S1alt lxpanmtnl of Hul1h 1n Public.
Stncr copy of rfPC)rt to b9lon,I Rt9lon,I SUta Kt1IU1 ~rtMfl lndustr11l. S~ copy of rtPOrt to Re9I0111 Othtr. Stnd co01 of l'fj)Ort to Rt91orw1 S bdl VA-It/ d~
Quarter~ Z l4 frcle One)
_.....,..:x.__ !!ell(1)
--- Spr1119(1J SUta ll1tar Contl"Ol loa1'11 Offlct 1~
t Off1ct 1 SUlt llltar Control IOl1'4 Office County/Cf ty Ult lllltr Contl"Ol loa1'11 Offtct
. Surry
___ lltll(sl ind S0rt119(1J of OoerHor N/A Po sf tfon/Tit 1 e N/A
- me of Waterworks Va. Electric & Pc:Mer Co. - Surry o.,'14r Va. Electric arrl Po.,.,er Co.
f qn*turt s
Popu N7A O.te N1~
Address P O. Box 315 latfon Served (Publfc'
___,,Sllr===c..:ry:.J.-L,~V.-=-a~. _.,'-----'2~3~8~83'---_ Phone (804)357-3184
- of Connection~ (Publfc)
+
No Up eratfon Peraft Nuiit,er (Publfc)
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.
SRCB No.
Olimer No. -------
SWCB No.
SWCB No. ______ _ Owner No.-------
SWCB No.
NlA NlA NLA Owner llo.
~r llo.
U-ner "°*
Heter readings ire fn ___ g~a-1.lo~os~----------
(gallons, lOOO's of gallons. cubfc feet, etc.)
swca No. a"i-t o - SZ C Owner No.
Date Heter Reading*
Clld of 3-i.. b IO foo Lut lbltll 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15
- ~*d aeter l&at t1ae HCII d17 (prtftr*bly tncl of d*Jl Ultfl, rNd 1t tnd of IIOll-~1119 period f Ul111. re,d It end of 11t1v7-pvaip1119 period If t,l111 111 one 11111 tn I field, 1pectf7 9'11cll wll ----
f All pr1ntaly.or publtc.117-owntd public wuar supply s,sce-il w1UI llteltll Oep1ri.ent pel'lliU.
Nott: If system ts uiaeltrtd, est1Nlt ~ge 1n bozes 111 lowr r1911t-llaftd COMllt'.
Tou Durt
- Tot, Dlys Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 Gi 110ftf 119 llontll I Operut119 tllt 1 11on tll 0,1 Our 17 Avtr191 1119 Monti!
Meter Readfng*
&lllons Used
- 32.,z, toe= //~ 4oe:,
//~.Jje10 Toul C..IIOAI Dur1119 Qu1rter
.3/
roul Oper1t1111 Dl,s tJlfs Ou1rttr 37.rr
.11il7 AYtr19t Ovr i "9 Ou1rttr II.I ter Leve 1 **..
St1t1c",._,;1-***
// t,,. ~
a,e;:,
3/
..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 ~rt to leglOMI Sutt Water Cont1'111 ao.r11 Office aM fn:le Ont)
Re9I0111I Sutt HttltJI ~rtNftt Offfc1 County/Cfty
--- Spr1"9(S) llld11str1al.
Send cor,7 of rtPOrt to legfOIIII Sult W.ttr Control lotnl Office
- Surry Other.
Send coo, of rt$)0rt to 1,910,wl Sult W.ttr CCflt1'111 ao.ni Off1ct
=-------
--- Wtll(s) ind Sprl"9(S)
- 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 No.------ 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 Owner No. 1:::>
1n bons 111 l~r r1911t-llllld conwr.
SWCB No.
Date Heter Reading*
Cnd of Z Io£/ /.t::> 'D LI st lton t11 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15
- Read aetar SUit t1ae tacri day (pr1ftr,l>l7 ttid of da7)
Uken, rHd,t tnd of IIOll*p,,II0111CJ per10d f t1k1t1, read u end of lleaw7-pu111p1119 per10d If Uk111 1n_one w,11 111 a field, specify wfllcll wll ----
t A11,rh*tely or pvl)lfc,117-owntd public **ltr suppl7 s,su.
wi UI Hee I tll Departlllent perw1 U.
Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I &.11onr Tota Dllr 1119 llontll 1 Operat1119 Tou D,y I tll 1s llon tll 0.1 Dur 17 Awtra91 1119 llontll Meter Reading*
Gillons Used Z Ff8' S-ac 9¢ "7"'oo r~*¥o~
Toul GIIIOIIS Dllr1119 ~,rtar 3/
roul Operat1111 D, 71 UI I I Ou, r ttr
,3o',f~
- .11117 A,tr191 O..r i 119 0,,1rt1r VI ttr Leve 1 **-
Static- "-1-***
7'-/. L/oo 3/
..30¥,*~
---"'X:...._ w<<ll(s)
--- Sprt119(1)
--- Vtll(I) illd SprtiwJ(I) uHUUNlTWA I ER PUMPAGE AND USE REPORT Scace !Hpartmfflt or Hulch ind State W11er Con1rol loarllll Pwbllc.
SetW copy of rt901"t to bgton.1 Sutt Veter Co11trol loird Offlct 1-,
Rtglo,yl Sutt Nt1IUI Otptrt;afflt Offtc1 ln<11,1str111.
Sefld c097 of rtpc,rt to le,g1onel Sutt W.ter Co11trol lot,.. Off1ct Other.
Stfld co01 of rtPOrt to *,9101W1I Sutt V.ttr COAtrol So.rel Ofttc, Mon th.:JA-!v t.) ~1-
. Qvuur 1 2 l 4
(Cfrcle One)
County/Cf ty
. Surry Na.ie of Ooerltor -,1'.;-J/7A~-------------
ric & Pc1,,ler Co. - Surry Pos ft ion/Tit 1 e __ ---;;N:,-/r,Ar------~...+1-----""-
--~
N/A Nt'A Va. Electric cuu P~
Sfqnature ___________ O.te --------
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 No.-------
SWCB No.
Owner llo. -------
SWCB No.------- 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.)
Date Cftd of 7:z.B#fao Lut flantJI 1
2 3
4 5
6 7
8 9
10 11 12 13 14
(
15
- lead aeter s1111 tlae Hell d1y (pr1fer1bly tncl of day)
Ultt1. rHd,t efld of fl0fl*INII01ng periOd Ulen, rt1d 1t end of lle1v7-i,u-s,1119 periOd f u1te11 1n one -ell 111 1 field, specify wti1cll well ----
11 prt,1ta1y or pytilte111y-owned pub11c wetar supply sy,ie..
w1 tll Hte 1 tJI Depa rant pel"ll1 ts.
Note: If systea fs u..etered, estwtt pgiip19I tn bo11es 1n 1owr r1911t-l'lllld corlllf'.
Toti Our1 Tou O.ys Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 &ellont 119 !loft tJI I Opera t1 llf Ul ts Noll tJI 0.1 Dvr 1y Average 1119 Noll tll Meter Reading*
&anons Used 7.¥.ofz_. ooo s-7f?2.oo
'5"7/7 2£JC.
Toul Gel10As Dur1ag ~erter
..51 roul Operet1111 0.ys Ulfs Quarter l?S-.39~
.Mi Ir Awtr191 O..,ri119 Querttr WI t.r Leve 1 **-
St1t1c- "-ihia***
- s-7¥7 *z.o 0 3/
/8S-37',Y
IHf t¥¥ ;:_
GROUND WATER PUMPAGE AND use REPORT S111~ ~putmml of H~allh and State Waler Concrol loa,4 Pwblfc. ~no copy of "l)Ort to t.g10IWII St.Ile ll1t1r Control lotl"f Offtct alld Jt>n di -:::J?t<<tJ Ir,~/
Qu1rterl"1) 2 l 4 /
'"t(trcle One)
_....,.,J{.__Well(s)
___ sp,-1119(sl
- ,9t01W1l Stitt llfflUI ~l'tNftt Off1ct 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 County/ C 1 ty
- 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.
Owner No.-------
SWCB No. ------ ~r llo. -------
SWCB No.
Owner No. -------
SWCB No.------- 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.)
swca No.
llote:
If systea ts uraettrld, est1Ntt P1,11Q191 Owner No. i::'
1n boxes 111 lowr r19ht-l\\llld corner.
Date Heter Reading*
Water Level*"'*
Cnd of LH t floft tll 3(,
Ou;)
1 2
3 4
5 6
7 8
9 10 11 12 13 14 r
15
- ~IO aeter,.., tfae Hell d*1 (pr1f1r1b1y Ind of d*1 l t1t<<11. rHd,t tnd of IIOll*Pl"IC'11MJ period t1l111. rHd *t tnd of lle1vy-puq,1119 pe,-1od f Ult11 tn 0111 i.,11 111 1 field, spectfy witcll w11 ----
11 pr1**talr or put,11cally-owntd public w*ttr supply sysltlll w1 tll Hu 1 tJI Dep*rtllent perat U.
0.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 Q,11on, Tota Dur 1119 llotl t11 Tou o.,s I Operul119 tll ts Non UI 0.1 Our ly Avtr191 1119 Monti!
Meter Reading*
Glllons Used 370 18'?:?
/ I '7,o
//~o Tou I Ga IIOIIS Durt99 ~arter
,3/
foul Operettnt Days tllts Quarter 37
- .,. i I J ber191 Ouring 0..,1r"ttr I
~ter Level**"
Sutic- '"-i111a***
//~o 3/
3J_
GE ANO USE REPORT uROUNO WATER PUMPA Scace ~panment of Hulch and P11bllc.
StllCI copy of ~rt to ~fOIIII Rt9I0111l Stitt Httltll ~rtN!lt lftd11strl1I.
Stftd copy of rtport to legfOIII Other. Stnd caoy of rtPOrt to *,910~1 S
..:;;. / ;===
!\\)(It)! _-"'tll[<L~&c/
0u1rter d' 2 l A
_ __..X:.__ Well(s)
____ Sprf119(s)
Stace Wa1er Con1ro, loartl Stitt Witt,. C411tr"11I loenll Offlct llld (Cfrcle One)
Off1c1 CoYnty/Cfty I Stitt llltl,. C411t.r11l loi....i Off1c1
- Surry tilt llltl,. Contr'111 loenll Offfct
____ Wtll(i) 1nd Sprl119(s) lf1me of Wate~rks Na me of Ooer* tor N/A sftfon/Title N/A Qnitur*
N7A Date N1~
latfon Served (Publfc' H/A
- of Connection~ CPublfc)
HlA Va. Electric & PcMer Co. - Surry Po Va. Electric arrl PCMer Co.
Sf Address P O. Box 315 Popu Surry, Va., 23883 Phone (804}357-3184 No 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 No.---------
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.)
SWi:B No.
Owner No.
O.te Heter Reading*
Cnd of Ult l'onUI
?-u9b 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15
- lead attar u111 tlae HCII d11 (prtftrlbly tnd of 411)
Ultt1, retd at end of 11011*P1111C>f119 per10d f Ult11, rod at tnd of l1uv1-P1111C>1111J periOd If Ultn In one -e11 111 1 fftld, specify wflicll wll -----
All *P,.h1tel1 or putilfcally-owned public w1ter suP9l7 systta wfUI Hultll Dep1rwe11t Ptl'IIIU.
Note:
If systa fs unaettred, tst1111tt ~91 1n bous 111 lowr r1911t-llllld coner.
Tot.a Our1
- Tot, 11111 Dlte 16 17 18 19 20 21 22 23 24
- ?5 26 27 28 29 30 31 1 ""ont 119 llot! UI I Ope rt t1119 tll Is Non tll 0.1 Our ly Avenge 1119 llontll Meter Reading*
&lllons Used 7YS-oo 300 Tout C:.110fts
,3e:,.o Dur1ag Qu1rter
..31 roul Oper1tt11t 111,s Ulfs Qu1,.ter
/e;,
.11IIJ Awtr1ge O..ri"9 Ou1rt1r WI ter Leve 1 **-
St1t1c-
',U.,1...,***
Joo 3/
/0
_ __...X,__ Wt 11 (I)
--- Spr1119(1)
___ lltll(s) 111d Sprf119(s)
ATER PUMPAGE AND use REPORT lbldi...::.:..~~~:::;l..-
S1a1e ~partmenl or Health and Stale Water Control Boar~
. Qu.art.r ~
Z l 4
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 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 (specify-----------------------
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 No.-------
SWCB No.
Owner llo. -------
SWCB No.------- Owner No.-------
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 Owner No. If tn bolfl h 1owr rtgllt*hllld cOl'lllf'.
SWCB No.
Date Heter Reading*
Cncl of 273100 Lut llonUI 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15 Gallons Used
- Reid aeter s._ tfae Hell day (preferably tncl of day)
Uktt1. rHd u tncl of 11()11-~IIICJ per-fod f t1l111, read at end of he1vy-puapf119 per1od f Ulen 111 one 11111 1n I ff1ld, specify lllfltcll wll ----
1 prt,,te1y or pub11ctlly-owntcl public water supply systeal w1 UI Hu I UI Dtpart11e11t perwtts.
Toti
°""'
Tota O.ys Dlte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 ;anon, 119 llontll I Oper-1tt119 UI ts !Ion UI Dlf Our-1y Aver191 t 119 1'o11 t II Meter Reading*
&lllons Used Z7c/z.oo //oo
//e,e;,
Total c;.110AS DurlllCJ ~arter
....3/
rou1 Oper1tt"9 0.ys UI Is QIN r tar
....3S-
- JI i 1 J Awtr191 Ouri"9 Qv1rttr II.I ter Leve 1 **-
Sutic-,,_,!IQ...
//oo
~=s/
ss-
_-J.}{.__ ~ll(s)
--- Spr't119(s)
GROUND WATER PUMPAGE ANO USE REPORT S1ate ~partmenl of Health and Suu Water Control loartl P11111tc.
Stnd copy of "f'Or-t to ~fcuwl Stu, ll1tt,. Co11tr"OI lot1"11 Offfct allf lb!U-J;.,,-11/u,4,er Qu1rt.r 1 2 l 4 (Cfrtle One)
___ lftll(s) 1nd Sprl119(s)
Rt9f0111I Suu HtaltJI Oeputaeftt Offfc1 llld11strt1I.
Send copy of,.,p0,.t to ~fcuwl Sutt lllltr Control lot1"11 Office Other. Stnd coc,y of rtC>Qrt to ltt91onal Sutt llltt,. COlltrol lol1"11 Offlct County/Cfty
. Surry 11,me of Water-.o,.ks Name of Ooer,tor _
1f~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,.... _______ _
Uperltion Perai t Mullt>er (Publtc) NJA t
,&_;,£,:, ________
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 No.-------
SWCB No. ------ <Mner lo. -------
SWCB No.
Owner No.-------
SWCB No.
Owner No. -------
SWCB No.------- 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.)
SWCB No.
n..
N ~otJ s*TRuc.-no~
!Iott: If systa fs,uaettred, esttllltt pu11p191 uwner o.
Sl"Tc tn boats 111 lowr rt1111t*llalld coner.
Date Heter Reading*
Cnd of ult flantll 27 i"('f;; Z.c:;O 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15 Gallons Used
- lead aeur saae tfae HCII day (preftrably 111d of day) f tO.ffl, rHd.i tnd of IIOft*,...,1119 period
.f Ula11, rHd It tnd of llt1wy-,...,1119 Pfr'iod If Ula11 In one wll In I field, spec1f7 llflfclt i,ell. ----
" All prtwaitlJ or put,lle1lly-owned public w1ttr supply sys~
wt UI Hu I tll Oepar1Jlent perwt ts.
Toti Dur!
Tou 0.ys Date 16 17 18 19 20 21 22 23 24
- ?5 26 27 28 29 30 31 I C.llon, 119 llolltll I ()per, t1119 tJI 1s llon tll 0.1 Our 17 Awtrl91 1119 llontll Meter Reading*
Gallons Used Z78b$qoc,p70 ]oe>
~70 700 Toul GallOfts Dl,rf119 Quarter 3'/
roul Operattnt O.,s tllf s Outrtar Z/~3r-
..11117 lwtrl91 During Ou*rttr W. ur Leve 1 **...
suuc-
"-it1111***
67e> 700 31 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 Positfon/Title-==~N~/~A~============:N:,:..A:==========
ewl4r Va. Electric arrl PONer Co.
Sfqnature N/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 No. -------
SWCB No.
Owner No. -------
SWCB No, ------ Owner lo. -------
SWCB No.
Owner llo. -------
SWCB llo.
Uimer No.-------
Heter re1dings 1re fn __ _;g~a1a.l.i..la!ollJns!.s.-------------- (gallons, lOOO's of gallOM, cubic feet, etc.)
o~Owner No.
Heter Reading*
Clld of 997~/oo Lu t flon UI 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15 d *tcr u* tlae Hell d1y (prtftr1bl1 tncl of d11) tlktt1. rNd It tncl of non-~1119 period Ul111. rt1d It encl of IIHV)'*pu,llp111g period f taken 1n one 11111 1n
- f1t1d, spectf1 wfllclt wit ----
All prh1ul1 or put,11c,lly-owned public wit.tr 1uppl1 17st.ea1 w1 UI He, 1 UI Dep1rtl)fnt pen1t U.
Nott:
If 1y1ta fs u,-ettrtd, tst1Ntt Pl'IPl91 1n boaes 111 lowr rl911t-llalld corner.
Tot.I Our1 Toti D1y1 Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.110llf 119 llonUI I ()perat I 119 UIII Nontll D,t Our 11 Avtr191 Ing Montll Meter Reading*
&lllons Used
/e> 03' 7oeJ ~z/ 1;,:,00
/
d,z/6.c>O Tot.II G,llOIII Our1119 ~1rur zi Totll ()perattnt DI.rs t1111 0ulr'ter z J S-<t
- ..11117 l,tr19t Ourillg Ou*rttr Water Level**-
St.Ute-l"-1110*..
z.49, 700 t00 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
--- ~1119(1) lnd11str11l.
Sfftd copy of rtp0rt to ~IOflll St.It, Wlttr Co11tn1l lot1'11 Office
- Surry Ot11tr.
Stnd co01 of l'fPOl't to llt9fONl St.Ile W.ttr Control lo&NI Offfct
=-------
___ ~ll(s) 1nd Sprf119(s) 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-_______ _
---=SUr=:..:rv:..L-1.<<-V..=-a=.;;....
- ....,,c_..;::2=3=88=3---- Phone (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 No.-------
SWCB No.-------
Oi,mer No. -------
Owner No. -------
SWC8 llo.
Owner llo. -------
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.)
SWCB No.3o-/ CJ-51 ~ Owner No. B Date Heter Reading*
[lld of
'f S-t"8_ 7oD ust flollUI 1
2 3
4 5
6 7
8 9
10 11 12 13 14
(
15
- leed _tc,. Slat tfae Hell day (Pf'1ftr1bly end of d*1 I tllffl. rHd 1t tnd of IIOll*l)ulllClfng perfOd tel111. rt1d 1t tnd of MIWJ-P\\IIIIP1ng per,ocr f t1l111 tn on, -ell 111 1 field, spectfy llfllcll ~11 All,,.1,1taly or i,vbltcellJ-owntd publtc w1ter supply systttia wftll kulUI De~1rt11e11t perwfU.
Note:
If systa fs u..-tered, est1Mte p.apa91
- 1n boxn 111 lowr rt911t-llllld CCM"Mf'.
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I Ce 11Clflf Toti Our tng """tit I Optr1t1119 Toti Dly I Ul 1s llonUI Dl1
°"'"
ly Awtrl9t 1119 llolltll Meter Reading*
&illons Used 17 ?ooooc.
? Z3J 3.()0 fz3/ 3oo Total G.ll lOIII Dl,rt119 Qu1rter 29 Total Os>,r1t1111 0.11 Ults Ou1rttr 27383~
- .M i1 J Awtr191 Ovri"9 Ou1rt1r
/
W.ter Level**-
suuc-i"-fflOH*
/S-582./0D
~~
259, 70 2-
WHtr So..ro:
_....Jw}(.__Well(1)
--- Spr1ft9(1)
--- lltll(I) *nd Spr1119(s)
. '**I""'\\
GROUND WATER PUMPAGE ANO use REPORT S1a1e ~partmenl or Huhh ind Stale W11er Control loar4 P11bllc.
~nc, copy 1f,-.port to a.ttOIIII Stitt Water Control loird Office alld Re9t0111l St.alt KtalUI Dtf)lrtM!lt Offtc1 lnd11str111.
Stftd coo, of report to ~tonal Stitt W.ttr Cont.1'111 loi'11 Offtct Other. Send co01 or rtt,0rt to 1~10flll St.alt W.ttr Contl'Ol loi'11 Office lHr
- ~2-.
14onu. #:~~:
Qyuter Ii) 2 l 4 Tctrcle Ont)
County/Cfty
. Surry
- 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 No.-------
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.)
Clld of 3.Z.,::do ~ 00 u st ltontll 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15 ad aeur sue ttae eacll day (preferably tnd of d11) f Ukffl. rHd It end of IIOft-~1119 period If Ultll, rtld It tnd of IIHWJ*Pllaillf"9 period
- If *Ulen tn ont 11111 tn I fte1f, specify wlltcll well ----
+ All prh1t1l1 or Mlfctlly-owlltd p~ltc water supply sysU.
wttll Hultll Depert.ent perwtts.
Note:
If 11st. fs unaeterld, estillltt pul!C)lge fn bo-a 111 1owr rtgllt-llalld COMlff.
Toti Durt Tou o.,,
0.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 S.llont 119 flon tll 1 (lper1tt119 UI ts Non t11 0.1
!Nr ly Awtrl9f 1119 Nontll Meter Reading*
Clllons Used 3/ I 7 8 Joo /~S:-/300
/%/.Boo Toul C..llOIII Durt119 C),1rter z.9 foul Oper1t1111 0.11 Ulls Ou*rter 5"'o~S-
.11111 lwtr1~
!Nri~ 0.,1rur WI ter Leve 1 **-
St.ltfc- "-h..:1*** i
/5"°~7 7o=
~C) z!,.._/2-8'
-~~- ----------~
liHOOND WA TEH PUMPAGE ANO USE REPORT
~ter Sovn:.1:
_ __..,}{.__ ~ll(s)
--- Spr1119(s)
S1ace ~panm~nl of Hulch and St.aee Wacer Concrol loar4 P11bltc.
~lld copy of ~rt to llegfon,I Stu, llattr Control ao....-i Offfct,_.
~di F.::iaku;¥-
Quarter /ii) 2 l 4 "tffrcle One)
Rt91onal Sutt HffllJI ~rUottlt Offfct lnd11str111.
Sl'lld coc,y of rtport to le91DM1 Sutt Water Control to....-i Office Other.
Stnd co01 of rtl)Ort to 119101111 Sutt Water Control to....-i Off1ct County/Cfty
. Suny
___ ~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 (specify-----------------------
1 f 11111surenents are for I single~ter ffeld reading, 11st wells fncluded in ffeld SWC8 No.
Owner No. ______ _
SWCB No.
Owner No.-------
SWC8 No, ------ °""9r llo. -------
SWC8 No.
Owner llo. -------
SWCB No.------- Owner No. -------
SWCB llo. ------ Uifner NO.-------
Heter re1dings are fn __
_:;ig5,!a.... l,.lo~ns--------------- (g11lons, lOOO's of 911lons, cubic feet, etc.)
SWCB No.
Owner No.
Date Meter Reading*
[lld of Zlf8S-o ust l'OnUI 1
2 3
4 5
6 7
8
- 9.
10 11 12 13 14 r
15
- -,NI attar Slat t1at Hell day (pr1f1r1bl1 tnd of d1y) f tlklfl. rNd ll tncl of 11011*pu111pf119 period t1l1n. rt1d 1l end of lle1vy-pu111pf119 period f t1le11 111 one iotll 1n I fltld, SPK1fy ~lcll wll ----
l11 prh1Uly or putl11c,11y-o,,ned puoltc w1ter supply sysU.
wl UI HH 1 UI ~r-nt peni1 ts.
llote: If sysua ts u1111etered. tst1Mte pu111pt91 1n bous 111 lowr rl9llt*tlllld corntr, Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C. llcw Toti Dur 1119 lbltlt Toti 111,,
1 0perlt111f UI 1 s Non t11 1111 Dur 17 Aver191 1119 l'otltll Heter Reading*
Glllons Used 2300900 /02. ~o
/oz. c/-oo Toul C:.llCNII Durl119 (ll,1rtar 7-1' roul Operatlllf 111,s Ulls Ov1rttr 3:S-3 J
..11 I 1 y btr19t Dur i 119 Qv,rttr VI ter Leve 1 **-
St1t1c- "-111a***
/fd, ?'60 d:,o 3 z_J-"Cl
~~ uHuUNO WA l EH PUMPAGE AND USE REPORT
~Ui F$Bt;;;:~¥ =
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
--- ~1119(1) llldustr111.
Stnd coc,y of rtPOrt to Re9foiwl Suu W.ttr Co11trol 1o,a,.. Offfct
- Surry Ottier.
S1nd CDOy of rtPOrt to R,9101111 Sutt W.ttr Control 1o,a,.. Off1c1
=-------
--- lltll(IJ Ind Sprf119(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!___ J ncsus trf* 1 __x_ Other (specify-----------------------
1 f irie1surements ire for* sfngle-11eter fteld re1dfng, lfst wells included fn field SWC8 No.
Owner No. ______ _
SWCI No. ------- Owner llo. -------
SIICB No.
Owner No.-------
SWCB llo.
Owner llo. -------
SWC8 No.------- 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
[nd of Lut l'onUI 1
2 3
4 5
6 7
8 g
10 11 12 13 14
(
15 Gallons Used
- Reed 11tUr HIit tfae Hell day (pr1f1r1bly tnd of dey)
Ullft, rHd It tnd of IIOll*Pl.-ofllCJ period f t1l1n, r11d 1t tnd of lltlYy-~fnt period If tlllfl fn one "'" fn I f1tld, SPKffJ llfllctl wll ----
11 prh1Ul7 or Ml fetlly-owned plA,lfc we tar supply sys teal w1UI HellUI Depari.t11t perwfU.
Tot.I Dur1 Toll 0.71 Date 16 17 18 19 20 21 22 23 24
- ?5 26 27 28 29 30 31 1 C. IIOllf
"' Nofttll 1 Opernt111 UI I s Noll U1 Dal Our ly Anr*te 111CJ Nofttll Meter Reading*
&lllons Used
<Yo l'fj S-oc -Z lo 75"o~
z/c:,75bo Toul C..1111111 Durtag ~lrtM 2--9 roul Oper1t1111 0.71 tll1s Ovarter 72 ~72
.... 11, **,,.~
Ovri,ig Ou*rttr WI ter Leve 1 **-
Static" ~fft<>***
78'~f 700 60
/30911-
_ __._x.__ ~ 11 (, 1
--- Sprf119(1)
___ lltll(s) and Spr1119(1)
GROUND WATER PUMPAGE AND USE REPORT S1a1~ ~panmenl of H cahh and Sute Wa1~r Con1rul Boar_.
P11bllc.
~IICI copy 1f ~r-t to t.gfo,wl St.ata llatar Control lotrf Offtu 111111 R191o,wl St.ate IIHIUI ~~rtaeftt Off1c1 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
- me of Witen,orlts Name of Ooera tor -,?-.,T/7A;;---------------
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 No.------ Owner lo.-------
Si<<:B No.
Owner No.
SWCB No.
~r llo. -------
SWCB No.------- 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. )
SWCB No.
Owner No.
Date Heter Reading*
Clld of 370 1'8'°0 ust l'lonUI 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15
- le1d aeter Slat tfae HCl'I day (pr1ftr1bl1 tlld of day)
Ulfll, rHd It tncl of non-~1111J period t1l111. rt1d It tnd of IIHYJ*pullll)1 IIIJ period If Ultn 1n one well fn I ff11d, specff1..tilcll wll ----
Alt prfw1t1l1,, ~llcall1-owned p"'11c w1tar suppl1 systelll wftll Hultll Dep1rt.ent Pt"1ts.
!Iota: If system fs uraettrtd, est11111tl pu!IIC)l91 1n boau 111 lowr rfgllt*llllld corner.
Toti Dwrf Tou o.,s Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I ;. non, IIIJ llofttll I Oper, ti 119 tll II Non tll D,I Dur 1, btrlCJI 111CJ Monti!
Meter Reading*
&anons Used 3703~
/,/o
/~o Total Gtl11111s DwrllNJ C),1rter
~
rot.al Oper1t111t Dl,s t11f1 Quarter s--
- JI i 17 lwtrl~
Dur i "9 Ou1rt1r WI ter Leve 1.. _
suuc- "-'Ina***
/ 3<:b ~
c{;,C>
2--:z_
GROUND WATER PUMPAGE AND USE REPORT
- .'u. ;z::=~,e=~~
Sui*~ !Hpanmml or Hullh end State W11~r Con1rol loar4
. Quarter~ 2 l 4
/
IU ltr So..n:t:
_ __..X,__ Wt 11 (,)
___ Spr1119(s)
P11bllc.
Stnd copy of ~rt 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 lnd11str111.
SMCI copy of rtPOrt to le9ton,l St,te W.ter Contr11l to.1"111 Off1ct
- Surry Other.
Stnd cooy of ~rt to R191orw1 St,tt W.ttr Contl"Ol lo.ar11 Off1ct
=-------
--- Vtllh) *nd Spr1119(s)
- me of Waterworts Huie of Ooerator --;~~T/;;A.--------------
Va. Electric & Pc::Mer Co. - Surry Posftion/Title __ ~Ni"l/,;.A ____________ _
- ---~
N/A Nt~
Owlt'er Va. Electric arrl PONer Co.
SiQnature ____....;.. ____ O.te --------
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 No.------ Owner lo.-------
S.CB No.
Owner No.
SWCB llo.
Owner llo. -------
SWCB No.------- Owner No.-------
SWCB No. ------ Qi,ner IIO. --------
Heter rt1dings Ire fn __ _;g~a>d...._1.lo~ns~-------------- (911lons. lOOO's of gallons. cubfc feet. etc.)
SWCB No.
Nott:
If system ts ur.etertd, estlNlt ~91 Owner No. 6 111 bons 111 ICMr rtgllt-llllld conwr.
Date Heter Reading*
Clld of 7 5' S-oo Lut l'onUI 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15
- lead *etar u* t1ae ucll day (pr1ftr*bl1 lftCI of d*yl Ultt1, rNd n end of IIOll-p.-c,1119 period tel111, read at tlld of lle1vy-pulll)f"9 period f ul.111 tn one -ell 111 a f1tld, specify wtitcll w11 ----
11 pr1w1ttl1 or put,lfcally-owned public w1ttr supply syslelll w1UI HHIUI Dep,rt.ent pera1ts.
Dlte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 &I 110ftf Toti Dur t ng ll!Mltll Tota o.,s 1 Oper1tt119 tll f I Non UI O.t Our ly Awtn91 1119 l'lolltll Meter Reading*
&illons Used 7 8' 8'a,:::;,
3CJ<r:::>
Toti 1 GI IIOIII
.Bo<::::>
DurfllCJ ~1rtar
~
Tot,I Clpfratt"I D171 tllfs Qulrttr
/CJ
- .it I IJ btr1,,e Ouri,ig Q,,1rt1r WI ter Leve 1 **-
St.etic-Pua,f11<1***
~oO 60
/c:>
--- lltll(IJ *lld Wf"9(I)
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
"*lllf of W.tel"tl()rts Ila~ of Ooerltcr
't-1/A Va. Electric & Po,,,er Co. - Surry 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..2 3"-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. ------- Owner No. -------
SWCI lo, Owner No.-------
SWCI No. ------ !htner No,-------
SWCB llo, o-mtr llo. -------
SWCI llo. ------ Owner IIO. -------
Meter readings are f11 __ ~ga~l1...,l~onsai,;;z.._ ______________ (911lons, lOOO's of gallons. cubfc feet, etc. l SW\\:8 No.
(Nner NO, 1-1 loi.: If systa ts UMll!UrM, tst1MU ~!II 111 llolff 111 to,.er r19ht-hlnd CONltf',
I Dau Meter Rt1d1ng*
1>, lions w,ur Level.....
O.te Meter Rudtng*
S.llons Sutl,00 P'\\IIIP111G-
[Rd of 7-7 f ;v::, o
=,, *. I Lut lblUI
~~
Used 16 1
2 3
4 5
6 7
8 g
10 11 12 13 14 15
- lluf acter ** t1at ttca,., (prtftf'1bt1 tnd of dl1)
- If Ult11, rtt.i It tnd of -*PIIIIP1rig pcrlOf
- If Ult11, rtt4 It tnd of llt1v7-P1,-pf119 period
....,, t1l111 1* one wll 111
- fltlf, s~lf1 wfllcll wn ____ _
t All,rh1ttt1 or Ml1a117-owlltd pieltc w1ur 111P9ty s11t,-
wf U1 Nultll-Ot~rtllltnt Ptr.lU, Toti
~rl Toi.
o.,s 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.ltOllf 119 "°"~
1 Opt rat f"t CIiis NonUI 0.1
°"'
11 Artrl9f 1"9 llo,,tll z7r~.::, /~c::;,
/ 2--&J I!:;>
Tou I C. I IOftl D\\ir I 119 ~ar ter 2!-7' foul Op,frat1"t DI.rs Ulfs Ov1rttr
--=//
..,. i 11 l,trtqt Owrt"9 OsHttf Va~r Level.. "
Sutic" l"-fr,aUe
- z. 3 = c:::::>
4::> C>
33'
GROUND WATER PUMPAGE ANO USE REPORT INr to/<1;(
_ _.,,,.}{.__Well(s)
___ Spr1119(s)
Scace ~partm~nl of Hcalch and State Wacer Concrvl Boartl P11bltc.
~nc, copy of ~r-t to R.gtONI Sutt W1ttr Contf'111 loa~ Offlct llld
!bl di l=" ca~u4o/--
Qu1rttr tv 2 3 4 Tctrcle One)
Rt9I0111l Stitt Kt1IUI ~pu*tMtit Office 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 County/Cfty
' 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 No.-------
SWCB llo. ------- D.fner NO.--------
Heter readings Ire in ___ g::;i,a
...... 11.:o~ns~-------------- (gallons, lOOO's of ga11ons, cubic feet, etc.)
SWCB No.
Date Heter Reading*
Cnd of 27 8'C.5qc.,o LU t l1on tJI 1
2 3
4 s
6 7
8 9
10 11 12 13 14
(
15
- Read aet.r,.., t1ae 11c11 day (pr1f1r1bly tnd of day) tlkP, rHd at tnd of IIOll*l)l-c,1ng period f tal1n, read 1t tnd of llt1vy-~fng period If tlltn In one "'11 fn
- f1t1d, specify wlllcll w11 -----
t All prhately _or Plltllfc.lly-owned public water supply sys~
w1UI HultJI Depart.ent peni1ts.
Note:
If systaa ts urwettrtd, estfalltt puapa91 1n bons 111 lowr rlgllt*Mlld COMlff, 0.te 16
- 17.
18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C.110M Toll Dur f 119 lbltlt To~
Dlys 1 C)peratf119 tlli I !loft tJI Ott Dur 17 Avert91 1119 Nofttll Meter Reading*
Gallons Used Z'g4fo 7 '=,oo ?,e;I 7c:,o (pO/ 7o~
Tott 1 Cit 11 OIII Durl119 l),arur Z-7 roul C)perttfnt D111 tll11 Outrttr
- z. 0 7""' a"'
_,. i 1, A,era91 Duri119 O.,uttr Ill ter leve 1 **-
Sutt,- llluaifftll...
1z.7z ~o
~c, 2 I ZLJ7
-.... '"""'~
.,..... ',,, --* lJ*l,;;J GROUND WATER PUMPAGE ANO USE REPORT
'"'-..&....,~-==--,.--~
JbntJI """"-':!!,:-'--,~..!.----
11* ttr Sovrtt:
_....Ax..__ '"" ts,
-~~
~0,1119(11
--- Vell(1).,.., S,,1"9(1)
S1a1e lkputmue o( Huhh and St.ta Wa1u Con1ro, loar4
,~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 lftd!lttr!!I.
!t<ld ccp7 cf roort lii lrjlo,,.i Sutt w.u, Co11tr,il lot** Office O*.iwr.
Strwl c~, of rtport to ltgloiwl St,t, lut.er CCfttrol lo.ll"f Off1c1 Qvarttr Z-~ J 4
"~ 1,'*,an.,
Covnty/CH;
. Surry
"*me of Witel"'IIOrts Na~ of Ooeruor _ 1t-~l/7iA,-------------
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.------
SWCB No.------- Owner No.-------
SWCS No.
Owner No. -------
SWCI No. ------ o-.ner No.-------
SWCI llo.
Owner llo. -------
SVCI llo.
Oitner IIO. -------
Meter rudings are 11 ---.!<J<i:;jS!.la..11.!.ons4.!iiL---------------C9*11ons, lOOO's of gallons, cubfc feet, etc.)
SWCB No. Z6/-l'/o-5"'o ~ C>cnir No. 4 l)a~
Meter Re1dtng*
&.11ons Water level....
Sutt,**
[1'd of I.Ht llofttll /0 ~3C:, 700 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- lo4 attar llal Cfaf NCI ft7 (1"tftt'llll7 tftd of d17J ulf Uht1, rtd It tl'ld tf --"'°"1119 pcr1N
~ '""'"i
- ,, tilP. ru4 U tlld of IIHYJ*~'"' pcriO,
".. If Ultfl 111 Ofte *II 111 I fltlf,,pe<tf7 llfllcll 111el1 ----
t All,r1nul7.,.,...llall7-owned ~lfc w,,i., suppl7 IJl&Na wiUI HHIUI Dt~r\\Jlent perslts.
Iott: If 1ysta h 11,_ti,.M, ttt1Mti pui,ipa91 hi bollft t11 lo,,er rf gllt*htlld CDf'Mf',
- Tot, Dllrl Tote o.,,
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.IIOIII Ill lbl&ll I Operetl11t UI Is "en UI 0.1 Dur 17 Anr19t 1119 MonU1 Met.er Rudt n,g*
&. 11ons Used
/o I 30 -f{:>0
'f3 700
/
t!/3,70-=
fou I C:. llon1 1111,199 0,trt.er 3/
rot.I c,p.,u1111 Dlt1 UIII Ovlrttr
.3 C, z..3
.HI ilJ t,,,,,.
0..11119 Ov1rttr Vlter Leve,.....
St.elf,..,....,,...,...
3~5 yo=
'1 I 3 71~ -
.,.\\,. I,,.,..... tJ*~I 11,1,, S.O..rc:t:
_ _....X.___ lit II (I J
--- ~l"f(II
___ 11tll(1J lrcl S,rl"f(II t
It I"" I ***,....,
GAOUNO WATER PUMPAGE AND USE REPORT S1elt ixpartmtnl of Hul1h ind Sui. W11tr Co111ro, lou4
'**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 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 _ 1
?-:;-l/iiA 1 ____________ _
Va. Electric & PcJ,yer Co. - Surry Pos It 1on/T it I *--~N,i/r;.A ____________ _
-- --~
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 -----------------------
1 f aie*suresients.,.. for I sf119lt-11tttr fftld rtad1119, 11st _,lls fnc:luded hi fftld S\\ICI llo.
~r No.-------
SKI llo. ------- Own.er llo. -------
SWCI llo.
Owner llo. -------
swca No. ------ o.iner 11o. -------
swca 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.)
SWU No. 3() -l9'o- - S:--1 e, Owntr llo...ZS Dau P',fter Rtid1119 1
~llons WHtr ltve1°"
Sutt,..
tl'ld of
~
Lut l"c:MIUI I 1 j'c,o cJC>O 1
2 3
4 5
7 8
9 10 11 12 13 14 15
- ~H litW s* tfat HCI f,7 (,reftr,blJ 111d If dlJJ "If tOtt1, rHf n '"',, --P\\II01ft9 pe,10, P~IIIG"'
- If tlllfl, rtM It Ind If l\\tlYJ-~lllf Pft10f
""'If Ultfl 11 Ofte i,ell I* t fttlf, IP<<1f7 ljfilCII *II ----
t All Jrh1t.1l7., Mlfult7-owlltd Pl,fillc ut,r suP9IJ IJlttlll wf UI Nu1 UI tltP'rtllut p1rwft1.
lot,: U s,sta fl 11NlflfrH, t1t1Ntt ~91 111 llo.lft 111 loo,er r19M-hud COMlff'.
- Tot, Dwrf Tott O.tt 16 17 18 19 20 21 22 23 24
~5 26 27 28 29 30 31 I C.11oar 119 lblUI I Operuf111 l"11 lblUI 0.1 Dur
,, l,tf'l9' I 119 "°" tll Meter Rudfng*
6' 11ons Used
~o7/~o ?ZJ/~o 8Z.7/~
rou I c:. I Ions Dur1119 0.,1rw 3/
roul Operut111 DIJ1 Ulh Ol,1rtlf' zt.~/ Y/7
.,. i17 ***,.,.
°"""' o..,,,,~
Va tar Leve J tt" Sutt," 1,;.;1ftG*H z3e53S-=o
'!I 1!.6L1 /Z..b
_ __.X._ Wt II (I J
--- S~t119(1I
___ Wtlll1I,,.., w-1119(1)
-....,~****"
GROUND WATER PUMPAGE ANO USE REPORT S111c ~put,:ncnl of Hulrh ind Sutt Wirer Conrrv' loaul
,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
,,.,.,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 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 No.-------
swca llo. ------ Oltner llo. -------
SWC9 llo. _______ Owner No.-------
S'ilel lie.
Uitner AO. -------
Mettr rudings ire f* __ _.,:ga~l~l~ons.a..!!il---------------C911lons, lOOO's of g1llons, cubfc feet, etc.)
SW\\:8 No. 3!-lfo-£2.. c Owntr No. ~
I Date Htter Rudi~*
~llons llattr Lev11**H Used S~tl,..
[lld of 3fl7% /oo WI/////I//////;
Lut lb!UI
'lff////1//1/ I 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- lctf aettr,... tfae Hell.,, (prtftf'1bl1 ~
of d11)
- If UlP, rNf It tnf tf --""'°1"9 per10il
- If Ultti, rttf It tnd of lltn7-p,.,-pl119 ""OIi
~
,i,i,plft..
".. If Ultt1 ta one 11ett t*
- flt14,,~1f1 lfflfcll wit ----
t A11,,1uttl7 tr ~llult7-owllltd ~tic wn.1r s11P9l7 111ttta wfUI MHIUI Dlp,rt-,ut Ptrwfta.
llot.t: If 111i. h y,-ttrld, 11tfutt ~91 fa bo.lft t11 1°"'r rl9ht-hlftd Corntf',
Tott
~rt Tou o.,,
Dile 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C. ltOllt 111 lloftUI I 0perU111f tllf ' "°""'
0.1
°"'
17 Awtf'191 l"9 llontll Meter Read f ng*
&.1lon1 Used l3~z7,9t,o,= /ofz.~
/o~Z-~ei Tou I C. 1 IORI
~rf99 l)i,rter 3/
foul Optr1tt111 D,71 Ulfl Ovtrttr 3/ 2-c./ 2-A ily lwt**9t Dwrt"9 o...,u, Water Level.. "
St.nf," ~,.......
z,t.~<:J z.oo
?/
- z. tz33
.,.~., '" *** lJ*a.;;J
~___..}(.__ W.11(1)
~~- S~1"9(1!
--- w.111,1111d S9rf119(1)
I I I I "3:111 I I 1.,-q, GROUND WATER PUMPAGE ANO USE REPORT Sr ate ~~r1mcnc or Huhh and Sutt Water Control loar4
'**lie. Sfnd cop, tf rt90rt to ~1-1 Sutt Veter C6fttr"tl loerf Otf1ct,.,.
ltgf-1 Sutt KctlUI Otp.ertMftt Off1CI 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
- ~~
Quarierl"f) Z J 4
<Cfrdt One)
County/Cft1
- Surry
=
"*"" of IIUer-.orts Na~ of OoerHor _ 11':;-l/iiA.:--------------
Va, Electric & Po,.1er Co. - Surry Pos1t1on/Titlt __
~Nn/'"i:A ____________ _
o,.14r Va. Electric ard Pa,oJer C.O.
s 1 qnHurt ____
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::.;*,.__._<<--=-2 3=8"-'8c..;:3"--- Phone
( 804} 35 7-3184 No. of Connection~ r Pub 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 (specify-----------------------
1 f 111e1surements 1rt for I single-llfltr field re1df119, list wells included in fteld SWCI No.
Oitner No. -------
SWCB No. ------- ~ntr No. -------
SWCB No.
~ntr llo. -------
SWCS No, ------ Owner llo. -------
SWCI No.
Owner 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.)
SWCB 110.
()o.ntr No. J>
Da~
Meter Rt1d1119*
~lions 11,t.tr level**...
Used Sutt,**
,i,ic,1~ -
[IWI of
~
U st "°1\\ UI 2 3o~ 9'00 1
2 3
4 5
6 7
8 9
10 11 12 13 14 l5
- ~14 aei.r Uat lf* NCI.,, (,reftr*bl7 tfld of cr11)
..., lllt11 0 rt.el *t ttif tf IIOft*"""°1119 pcr10, 71,
- If t,l111. rod It 1nd of 11t1v7-puaip1119 pcr10f
....,, Ulen 1* Ont,oell 1* I '1tl41, SPKlfJ iot1t,11 *II ------
- All,rh1Ul7 tr Mlfc.1U7*0lflltd ploflllc wit.er 1uppl7 111tt111 w1UI tcul UI Ot1>4rtlat11t perw1U.
Iott: If srsta h 11N11CttrM, t1t1Nte ~91 111 bozn tR Jo,,er rig~t-llud corMf'.
Toti DI.rt Tott o.,,
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.ll-,
111J lloftUI I Optr1t1111 Ults lblUI 11,1 Dlir 17 Avtr191 1119 "°" tll Meter Reading*
S.llons Used 2 3~! /oc ;?o S-o=-
~o/~~-o Toul C.llon1 Dl,r1119 ~lrlet' 3/
roul Or>trtUnt 0.71 Ulh Ou1rt1r 2.7/7
.11i17 l,1,191
°"""9 Overt,,
v, ttr Leve 1.....
Sutt,",,._,1........
z.? 7,300 671 3/ I £°'7
11,t,r Sovru:
~__...)(.__ 11tll(1J
___ v.ll(sJ 1111t wt11tll)
-.............. ~
GROUND WATER PUMP.AGE ANO USE REPORT S111t ~par1mtnl of Hullh and St.t.t Wuu Conlrvl loar4
'**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 1"4uilflil.
St..i co,7 oi rtPOrl lo ~10,,.1 St.llt W.ltr Co111.r91 to.,, Off1u Oti.r.
StllCI coo, tf rtPOrl to lt9to111l St,lt lltltr Control ao.,.,. Offtct Ccvnt;/C1ty
- Surry If*~ of w.ierworts N*~ of Ooerltor _ 11'~l/7iAr--------------
Va. Electric & ~
Co. - Surry Posftfon/Tit1*--~Nf7/A;.--------.<t"-N...-----
N/A N1'A Owlir Va. Electric arrl Pc,.,Jer CO.
Sfqn*tur, ____..;._ ____ O.t.e --------
Address P,O. Box 315 Popu11tfon Served (Publfc' __ _...N~/A...._ _______ _
_ __.S=ur=ryJ.-&-, _V--'a=.___._<<--=2 3::..;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. -------
Meter re1dings ire 11 --.::ga;tSUl...il.!.<ons~--------------C9fllons, lOOO's of g*llons, cub1c feet, etc.)
lot.I: If 11n* h u,..ttrtd,,sttutt ~91 111 bean fa 1o,,er rlght-llud COl"Mf',
SWl:8 No. l!>z. -/Cjt) - 71? Owner llo. -
c::
Date Meter Rudtng*
6'11ons Water Level....
0.tt ICettr Re.,dfng*
&.llons
- -Jil'""'MM
[ltd of wd un 1wiu. ~ 0 19 r s--oe:>
Used 16 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- lcN -ttr I... ti* HCI C,7 (1"tftr1IIIJ tftd tf f11J 11lf Ultt1, rHf U tnf tf -*Pl-.1'1 per1of
...., Ultt1 0 rtl4 It end of llttYJ-Pll'l!P1'1 per1of
....., Ultfl 11 one 11111 111 *,1,1,. sPt<tfJ wtitcll wll -----
A11,,h1t.1l1 ",v&lfCAIIJ-Orntd Pl,61tc wH.er Iv~,, 111t...
w1"' Ntt1UI Dtp,rt.rout Ptl'l1b.
Toll
~rf To~
o.,,
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C..llOIII
"' floftta I Dptr1 l111t UI 1s !Ion UI Dl1 0..r
,, btr191 1119 "c>ftlll "fr/ IZ.o ?o= 'f' z_ I '-fa, o
'fZ/4hO foul C.IIOIII Dl,r t "9 ~Ir ter 3/
To~I Optratf"I Dl,r1 Ulla Ou1rt1r zf7z3
.11 il7 l,cr19e Dun "9 Ovtrttr V*ter Level....
St.Uc" l"--1""***
377~ Joo 9/
. 9~_'-1</ I
GROUND WATER PUMPAGE AND USE REPORT
.,..... '1r11 *** lJ*~I
-.. ** *"'****~
THr_47~~:;._--,---
~UI ~/.U-'~-::r..,t.. __
_ __,._X.__ Wt II (I I
--- SP,-lftt(I)
--- V.11(1) lftd Wlftt(I)
S1a1t ~.,_r1mcn1 o( Hul1h and Sui. Waler Concrol loar4111
,.,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 I...Svstrul.
SMO <691 of '!POrt tc !.."110,,.1 Sl4ti lwt,r C011V11I lotrf Qffict Otlltr. Stnd coo, ef rtl>Ort t4 lt9lon,I Sul.I W.t.tr COlltrol ac,.,.. Offtct
~1rt.r Co\\inty/C!t1
- Surry lf*me of lilterworts Ha!!W! of Ooerltor -,t-:;-J/7iA.--------------
Va. Electric & Po,..,er Co. - Surry Posft1on/Tit1t __ -;:N,;/r,;A~-------,c,,+,..--------
Co N/A Nt'A Owlir Va. Electric a.rd Pc,.,.,er SfqnHur*--------- O.te --------
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 1 on, (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.-------
swca 11o. ------
().ner No.-------
Owner No. -------
swca No.
Owner 11o. -------
Ml No.
Owner IIO. -------
Meter rudings *re fl --~ga~l1w1l.i,ons{i.!,iit----------------Ciil10t1S, lOOO's of gallons, cubic feet, etc.)
SWCB No.
Owner No.
C Dau Keter Rudfng*
&.11ons Water ltvel'"'"H Used Sut1,""
[lld of ff/~
~
WI/II ///I/I/ b,11 List l'lollUI 3703~
1 2
3 4
5 6
7 8
9 10 11 12 13 14 15
- ~If *.tar u.. tfat HCI.,, (Pf'tftf'abl1 tftd of d11)
..., Ult11, rNf ll tlld tf --~f"t pcriO,
,IIIC)1~"'
- If Ult11, rtM ll tnO of llt1v7-~f"t pc,,ocr
-.. If Ultt1 ta one 11ell 111 1 fltld, 11>t<ff1 wfllcll wl1 ------
f A11,,hu.117 tr Mlfcall7-oi,lltd Mlle water suppl7 111te.
wfUI Heal UI Ot~rt11ut Ptrwtts, llot.t: Jf systa h u,..ttrtd, tll1Mtt ~91 111 !,ozn 111 l°""r r1ght,lllllld COMllf',
Tot.I 111,rt Tot.a o.,,
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C.110llt
"' "°"~
I Optr1tt"'
tll 11 lion U1 7 Anr191 0.11 Dur 1119 No,, u, Met.er Roding'"
&. 1lon1 Used 37/o/O
~~o
~fo Tou I C. lions Dl,rl119 f),1rtar 3/
Total C)ptrUlllf D111 Ulls Ouarter 2 A il1 l,1r1q1 Dur1"9 0.,trttr V*ur level....
St.at1," l"-it11<1*..
11'90 91 z2-
., *._. *** ~..... tJ*a;,
_ _....x_ lit II ts,
--- Sprt119(1I
--- 11tll(1I,,., wt119(1J
........... ~
GROUND WATER PUMPAGE ANO USE REPORT S111t lxpar1mcnl o( Hc1hh and Su&e W11cr ConcrGI 10114
,v.ltc. Sf"' COPJ., rtpOr\\ lo a.,to-wl St,U Veur CoAll"OI lo.rf Offlct....
lt9fOt11l SUlt HctlUI DifPHtiwftl Offtct llldu1trul, SIM <091 ef rtpOrt to l.-"'t10ft41 S~tf v.;., Co11trol So.** Ottict 0~11tr.
Stlld coo, ef rtport to lt9ton,I St,i. 11,Ur COfttrol lo.rf Offlct
- ~ ;{/a Quarter~ I J 4 (Cfrtle Ont)
Count7/CH1
- Surry
=
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=*~*-=2 3:.;;8;..;:8;..;:;3_ Phone
( 804) 35 7-3184 No. of Connect 1 OM (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 -----------------------
1 f 11t1surenents art for I s1ngle...,..ter field re1d1ng. 11st wells Included 111 fftld SWCI llo.
Owner No. -------
S~I No. ------- (),,ner No. -------
SWCI No,
(),,ner No.-------
SWCI No. ------ Olffler llo. -------
SWCI No.
Owner llo. -------
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 ta !loan 111 1CMr r19llt 0 hud cDr'Mf'.
SWCB No.
Owner llo.
1~0 I z_.L::)O Toti I 1.t llOftl Durt119 ~arter 3/
ToUI l)ptrUlllf Di1' UIII Ou1rt1r 39 AilJ l,trltt Dwt1"9 Ov.,ttr v,ttr level**..
St1t1,.. -tM***
/8"'=0 9/
2.-£)
.,."' **,,,.... l J-1,;;J II* ter Sowrtt:
_ _.....)(.__11tll(1)
--- \\pr1119(1I
--- ~11(11 Incl S9rl"9(I)
GROUND WATER PUMPAGE ANO USE REPORT Suit lxpu1mtnt or Huhh and Sui. W,1,r Con1rO, loarlll
,.&lie.
Sfncl cop, tf rt90rt to R.tt~l Sutt V1ttr Cofttrol lot~ Offtct ~
lt910ftl I Sutt Kol UI tltp.,rtllltftt Office lnclwHrlll. S~ <091 of rtPOrl lo *~lc,.,4! S~ti -..ur ~11t.rol to.rt Off1u O~~r.
5tlld co01 of rtport to lt9lon,I Suu ii.c,r C011trol lot~ Offlct Coa.:nt;/C1t1
- Surry llf*ine of WHer.orts Na111e of OoerHor -,?-:,-J/;;A,-------------
Va. Electric & Po,,Jer Co. - Surry Pos 1 t 1 on/Tit I '--~Nf-7/A..--------------
- --~
Co N/A N1'A o-.lir Va. Electric a.rd Power 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 No.-------
Ml llo.
Oitntr IIO. -------
Meter re,dings are 11 --...:gad!il-lul~onsll.!lit..---------------C9allons, 1000'1 of gallons, cubfc feet, etc.)
SWCB No.
Owner No. 1-1 Date P'ieter Re*d1ng*
~llons W*ttr Ltve1.....
Used Sutfc'"
l'i,i,c,1111 "
[lld of ZJ5"' roo Lin "°""'
l 2
3 4
5 6
7 8
9 10 11 12 13 14 IS
- Inf aettr *- Uat HCI.., (,r,,,..,.,, tftd of **,,
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
- 71.
t A11,rhU.tlJ tr ~11ca11r*owlltd p~llc w1\\.tr 1u1>91J 1,it,..
w1UI Kt11UI Otp,rt.ut PtnilU.
lou: Jf 111ta h ulWtU,.N, ttlta.t.1 ~91 1111 t,ozn 111 1o-oer r19~t-halld corner.
Tota
~r1 Tott o.,,
D.te 16 17 18 19 20 21 22 23 24 25 26 I
27 28 29 30 31 I C.110llf 119 lloflUI I Oper1t1111 UI ts !loft UI 0.1 Ovr 1, **,..,91 1 119 IIQc, t II ICeltr Rud1ng*
&. llon1 Used z77 300 /--It£) 0
/~tP-~
Tou I C:. IICNII
~r1111 0-.,arttr 3/
roul l)ptrU111f 11,,., "'" °""
~/
_.. ilJ lwtr19t 1Nr1"9 Ov1rttr V1ltr Level.....
St.Uc;",,._,-1.... ***
-f~e 9/
~?
_ _,X...__ Wt II (s J
~-- SP,..lft\\!(J!
--- Vtll(1J 61'1d Wl"f(I)
- **,. *'-ltl*t" GROUND WATER PUMPAGE ANO USE REPORT S111e ~par1mtnl er Huhh and Slat.t W11u Con1rvt loar4
,.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
!~~HrU!. S~ CGPi ;;f ri..O*i iO ~io,..i \\Utt !let.tr (6,.tr111 lo.Ir* Olflct 0~,,_,,
Stlld coo7 1f rtPoOrt to ltglo,..I Sue. W.t.tr Control lo.r,11 Offtu
~nty/Ctt;
- Surry
"*"" of wuer-worti Ma~ of OoerHor _ 11':;--l/'iiA~-------------
Va. Electric & Fewer Co. - Surry Pos1t1on/Title __.:Nf:/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 No,------ ~r No.-------
S1oC8 No.
Owner No. -------
SWCI llo.
Owner 11o. -------
swce No, _______ Owner No.-------
SVCI llo.
Oitner AO.-------
Meter rudings *re 11 ---lga~li...11,.!,ons~L----------------Cs*llons, lOOO's of g11lons, cubic fHt, etc.)
SWCB No.
l>wM N c.G>N~-no"'
r o.
- s1-r, Date Heter Rud.1ng*
~11ons 11, ter ltve 1.....
Used Sutt,** )PUlll)1! -
Clld of
- 2. Z"..J.t,. 7 l.,,oo ~
WIHAi Lut l'lcwlt.11 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- lu4 acttr 1* tf* uc* ~, (,reftf'llblJ tfld of d17) ulf Ultfl, rNd It tnd tf --~1119 perfof
- If Ultt1, rtMI It tnd of 11<<1v7-~f"9 period
....,, Ultll 1* Oftf 11<<11 1* 1 fftld, IPK1fJ 1,fllcll wll ----
All,,hettlJ tr ~lte1ll7-0rlltd p!Alllc **I.Ir luP91J,,,t,..
wltll kulUI OtP'rt.-tnl Ptnilts.
Iott: If 111f.a fs UNllftfrM, tst1Mtt ~91 111 l)ous 111 IOWtr rfghl*llllld COMltf',
Tote Dl.tr1 Tott o.,,
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C.lloar "9 floflUI I Operetlllf Ul11 llonUI OIi Dvr 1, AYtf'l9I I 119 No,, l 11 Meter Reading*
&.1lon1
~ed z~ o~7$0c 57'9yo0 Tou I c:. 1'0ftt s-79 ~00 Dl.,rl119 ~art.er fot,1 C)pfrUIAt
.3/
De71 Ulh Ov1rttr
/3 7o3 Ai 1, l,,,,,,
O.,r, "9 Ov1rttr V*ter level....
StU1c",-,.......
I ?.S--z_ Zoo "1'1
- z.o, 3s;-f
t-...
..... *** __,,;-o*.;,;,
_ __..x.._ Well(s)
--- 5PP'lft9(1)
--- ~ll(sl Ind Sprl"9(S)
GROUND WATER PUMPAGE AND USE REPORT S1a1e IHpartmenl of Heal ch and Sute Waler Concrol Boar~
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 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
'*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 No.------ 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.)
S~B No. 2&f-l'10-5oC. Owner No.
Note: r f sys ta fs uraetel"td, est 11111 te puilll)l91 fn bous fn 1owr rt911t-l'lllld corner.
O.te Heter Reading*
Date Meter Reading*
Cillons Wlter Level**-
Used suuc-......:1no***
Clld of 617729'00 ust 1tont11 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 Durt I Ca 11cw "9 !loft tll
/f /-=c:::>
I Durl119 ~arlar' Z.~ ~ ~=o Ule11, rtad II tncl of lle1w1*pu111pt119 peP'iod f Ukfll 1n on, 11111 tn a field, specify wfllcll wll ----
t All prhat1l1 or Mltc.lly*ownecl puttllc water suppl1 sysu.i wf tll Heal tll Departllent perwtts.
Toti Days 1 Operattn9 tll Is Non tll Oat Our' 1y Awer191 1119 Nontll 3z-Tot,I Operatlnt
'12..
Dl.ri Ullt Quarter
./ >/I
.11 i IJ A,tra~
Dwri"9 Qvaretr Z/7e>~
GROUND WATER PUMPAGE AND USE REPORT Te-tr l'r'ff (
!bl UI "D ~
.::;,.,e-M ~
1::, ~
S1ace IHpartmffll of Hcahh ind Sta&e Waler Con1rol Boarlil P11bllc.
~IICI copy of ~l"t to ~lon,I Suta Vet.er Co11trol lol,.. Offlct 111111 Qu*rtcr I 2 l ~
(Cfrtle Oni'}
~__._}{.__ llt11(sl
~-- Sprl"9(S)
Rt9t0111l Sutt Ht1IUI ~rtM!II Office lllduHrt11.
Stfld copy of rtPOrt to ietlDflll Suta Wltar Co11t.rol lol~ Office Ou~r.
Stnd coo, of rtPOrt to lt9torwl Stitt Wltar Control Bot~ Office County/City
. Surry
___ Vtll(s) 111d Spr1119(s)
IC*me of Waten<<>rks Name of Ooer*tor _ 1?-.,l/7A;.---------------
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 1 tel __
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 No.------- Owner llo. -------
S"1:8 No.
Owner No.
SWCB llo.
Oimer 11o. -------
SWCB No. ______ _
Owner No.-------
SWC8 llo. ------- Uitner "°* --------
Meter re1dings 1re in __ _..,_,g:l,da""l..,l~ons~:..,_..-------------- (g1llons, lOOO's of g11lons, cubic feet, etc.)
SWCB No. 3o-1 O - s I C. Owner No. "B Date Heter Reading*
[nd of df..../.t0z.(, 300 Lut PlonUI 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15
,tftd meter Slllt time tech dlJ (pr1f1r1bl1 end of dtyl Ultfl, rHd 1t tlld of IIOll*l""'ll1"!1 per10d f Ultn, rud It tnd of llt1YY*l""'ll111!1 per1od
- If-Ulen in°"' 11111 In* fitlf, sPtCHy wtiicll wll ----
All 11rhat1l1 or pwllu111-owned plAlllc wet.tr supply,,ntlia w1 UI Ht1 I UI Depari.tnt Ptl'llt U.
llot.1:
If 11st. ts urwettrtd, est1111t.1 ~91 In boaes 111 l°"'r r111ht-l1111d conier.
0.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 GI 110M Tota Our 1"!1 llontll You o.,s I Operatlft!I tlll s llon U1 Dlt Dur IJ Awtra91 I 119 llonlll Meter Reading*
&lllons Used Y~z z 1 7-, cc:>
/
I Y. /~/ &,o=
I
/
Tot.II C..110III s;1~1, 600 111,rlllCJ ~eri.r 3 "Z-ToUI Operat1nt Dl,s Ulls Ou1rttr Z5"~ ~~'?
.,. i 1 J lwtr1~
O..r i"9 Ouerllr WI ter leve 1 **-
suuc-ll'lanlfta***
1.l,Z~74=c:>
'f z.
23//3"8'~
-:.-::;_;-:-.-;--;.* ;--;-,-;:;,.....---------~,TtU t ? ~ t 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)
--- Spr111CJ(I)
(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 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 No. ______ _
SWCB No.-------
Owner No. -------
0.,,ner No. -------
SWCB No.------- o-.ner llo. --------
SWCB No.
Owner llo. -------
SWCB No. ------ U.ner NO.--------
Meter readings are fn --~g5,!a... l...,l~o:!.!ns~---------------<g*llons, lOOO's of gallons. cubfc feet, etc.)
SWCB No.3 / - / o -s-z c. Owner No.
C...
Cnd of un l'onUI.3 / ';:j'f £;"2..00 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15 Id aetar Slllt tlae t1c11 d*1 (prtftr1bl1 tncl of d11)
Ultt1. rHd,t tnd of non-1N1111f119 per10d Ul111. rtld It end of IIHYy-pu-.pfng period If Ultn In ont i,ell fn I fltlf, 1pecffj..tilcll wll ----
t A11 prf,1taly or pvbltCJlly-owned public wit.tr supply 1yslt91 wf UI 11111 tll De1>1r*11t ptratu.
llote:
If system ts unaetered, nt1Nte ~91 fn boaas 111 lo-er rfgllt-llllld corner.
Tou Durt Tou Days Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I CIIIOM 11CJ llotlUI I Oper1t1119 UI Is Non t11 Dlf Our 1y AwtrlCJe 1119 Mofttll Meter Read f ng*
&allons Used 3 2 ~ lo ;foo / c, IS-Z.tt>e>
/
I 11°/~'Z.&>~
Tou I C:. IIOIII Durl119 Qu1rtar 32..-
ToUI Operatlnt Dl11 Ulh Ou1rter 31,72...5
.itily A,tr19t Dur i 119 Q.itrttr Miter lewel**-
Sutfc-l"-fna***
8 3 L:. k, ~c;,C>
f-z_
fo'/367 7
--- -~,-----.,....--o \\J*O'IJJ
-~>C.__w,11(1)
--- Sprt119(1J
___ lltll(s) and Sprt119(s)
GROUND WATER PUMPAGE AND USE REPORT S1ace lnpanmml of Hcalch ind Stale Wa1er Concrol loarlll Publtc.
~IICI cop, of ~rt to lt9I01WI Sutt 1111.t,. Co11tr-ol ao.,.. Offtc, alld.
- ,9t0ftll Sutt HHIUI l>el)tr'tNl\\t Offfce llldustr11l.
Stfld cc,py of,.,POrt to lt9ton,I Sutt Witt,. Co11trol aa.,.. Offtu Other.
Stlld coo, of report to Rtg1onal Sutt V.ttr Contl'Ol loiri Offtct Yeu iff(
l4otl di De Cd!?N/ ~ ~
Qu1rttr 1 2 J ~
(Cfrcle One)
County/City
. Surry
"*me of Waterworks Na11e of Ooer1tor _
1?-~~/7,A.--------------
Va. Electric & PcMer Co. - Surry Posftton/Title __ --;;:N;'-;/r..A:--------------
Co N/A Nt'A C>.t~r Va. Electric arxl Pa,.,er S1Qn1tur*-----'------ Date--------
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 No.-------
SWCB No.
Oimer llo. -------
SWC8 No.------- ~ner No.-------
SWCB No. ------- Oifner IIO. --------
Meter readings ue fn __...:g;lla,4.,llt.,l~o.ans~--------------C9*11ons. lOOO's of gallons. cubic feet, etc.)
SW\\:8 No.
llote: If systa ts uMeterld, est1Nte pu11p191 Owner No. "J:>
1n bons 111 lowr r1911t-llaftd corner.
Date Heter Reading*
Cftd of u It "°" tll Zot':5 zoo 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15 ad aeter SUit ttae Hell d17 (preferably tncl of d11l tak~, rNd at tlld of IIOll-~1119 p,r1od f Ul111. rHd It tnd of lltoy-pu-s,1119 period
- If Uktft 111 ont well tn I fltld, spectf7 wtilcll wll ----
t All prfntel1 or Ml1ul17-owned PIAlllc w1ttr supply s7sU.
w1tll He1lt11 De~ri.nt ptrafU.
Toti
~r1 Tou Dl1s O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 Callon, 119 Non t11 I Oper1tt119 UI ts Non t11 Dl1 Our ly Awtr191 1"9 llontll Meter Reading*
Gillons Used 2 l04-I 00 I
'8 "81 t:f oo
~8'1 'fot:>
Tot.II CilllOIII
~,1119 ~arter 32-rot.ti Oper1t1111 Da71 tlll s Quirttr
-z.. 77 B Jt ily Awtr191 Ouri119 Outrttr V.ur level***"*
Static-Pua,111Q***
Z. ~ '8, 4-oa 1-z-2.'j 17
~__..}C.___ Wc11(5)
~--Spr1119(sl
___ W.ll(sl tlld Sprt"9(S)
GROUND WATER PUMPAGE ANO USE REPORT S1a1t' ~partmffll or Hcallh ind Stare W11t'r Concrvl lou4 P11bllc.
Sud copy of rtPOl'"t to le9fon,I Stitt litter Control lotnll Offlct tlld
- 910ftll Stu, HetlUI ~rtN!lt Off1c1 llld11str1tl. Stfld copy of rtPOrt to le9f0ntl Stilt lltttr Control lotre Offlct Other.
Suld cooy of rtPOrt to R191o,wl Sutt lltttr COfltrol lotnl Cfflct
!'ton U1 D E"c=c:M !Sq
. Qu1rter 1 z J © (Cfrcle Ont)
County/Ct ty
- Surry
-'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 No.-------
SWCB No. ------ Oiffler llo. -------
SWCB No.
Owner No,-------
SWCB No.
~r llo. -------
SWCB No.------- 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.)
Cnd of
, '?. tI, 3 o S'"o o u st "°" tll 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15
- lead attar uae tfae ttch **1 (pr1f1rtbl1 tnd of d17) ttltn. rNd It end of IIOft*pyac,1119 period Ulet1 0 rttd It tnd of he1w7-~fng period r ul.111 111 0111 well fn I fttld, specify wtitcll wll ----
l11 prh1ul1 or pvt,1fe11l1*cwned plA>I tc wtttr supply s7sU.
w1 tJI Hell tJI Dtptrtiatnt perwfU.
Note:
If s1staa ts uNlltertd, est1Ntt pu11p191 1n boan fn 1owr rfgllt-llllld corner.
Tota Dur1 Tou Dlte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.IIOM 119 lbltll I Clptrttf119 tllls lion U1 Dai Our 17 Average Ing !bit.II Meter lteadfng*
Glllons Used 7Z,34~Foo z, 7,¥/300 z, 7,f 300 Toul Cilllons Dur199 Outrter 32-rota! Oper1tf"1 DI.rs Ults Outrttr i'~ 8z z.
- .11117 Aver*~
Dvri"9 0..1rt1~
~
Ila ter Leve 1 **-
St.n1c.. Puai111a*-
"8' I:, Jj~==c
'1--Z-f.3.'17g
/
_ __._.}{.__Wtll(sl
--- Spr1fto9(1)
GROUND WATER PUMPAGE AND use REPORT S1ac~ ~partmenl of Hcallh ind Su&c Wacer Concrof loar4 P11bllc.
~no cop7 1f re,por-t to ie9lo,wl Sut.a 1111.tr Co11trol lotrf Offtc,,..
lb'ldl "Dec.c""t E:,.E-"
Quarter I
2 J ~
(Cf~le Ont)
R19to,wl Sult KulUI o.p.rtMl'll Office llld11strt1l.
Stlld coc,7 of rtport to le910fll1 Sutt V.ttr Co11tr11l to.l'f Offtc1 Other.
Str1CI cao, of r,port to 119101111 Sutt W.t.ar C011trol ao.r11 Offtct County/Cfty
- Surry
___ 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 (specify------------------------
If meuurements ire for I s1ngle~ter field ruding, 11st wells included 1n field SWCB No.
Owner No.
SWCB No.------- o-.ntr lo.--------
SKB No.
Owner No.
SWCB llo.
~r No.-------
SWCB No.------- Owner No. -------
SWCB llo. ------- ~ner IO.--------
Meter readings Ire 1n --~g~a~i... i~o~ns!iiL,. _______________ (g11lons, IOOO's of gallons, cubic feet, etc.)
SWl:8 No.
Owner No.
i=
O.te Heter Reading*
Clld of Lut l'ontll 3~ 7 8' 2-0 1
2 3
4 5
6 7
8 9
10 11 12 13 14 r
15
- llt*d *tar,_, t1* Hell C117 (prtf1r1bl7 tlld of C117) t1ltt1, l'NCI It tlld of IIOll*P\\IIIIP1f19 period f Ultll, l'Hd It llld of llt1YJ*J)UIIIC)1"9 period If tltlft 111 one 11111 111 I fttlel, SPKHJ llf!ICII well -----
11,,.1,1taly or put>ll~ll7-owned put,ltc w1tar supply systltll w1UI KetlUI Dep1l'uat11t PtNIU.
Noll:
If 1ysta ts 11raettnd, tst1111tt puaip&9I 111 boos 111 lo.er rl911t-llllld corner.
Toti Durt Tot.
Days Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 CIIIOftf 119 llontll 1 0pel'lt1flt Ul1S lblUI Dal Our
,, Awtrl9I 1119 Nolltll Meter Read 1 ng*
Gallons Used 3"" 9/ 0 ZC>
/Zoo I
.{ 2-0c:::>
Toti 1 Iii 11 OIIS Dur1119 Querier 3"2-rot1I Operut111 Dl,s Ulh Qull'tlf' 3 '8'
- JI i I, Awera91 Ouri119 Quarter VI ter Level**-
St1ttc-l"8Dt11a***
4~qc:,
tf-z..
~3
-~X.__ w.11 !1 I
___ S1><'t119(1I
___ I/el 1(, I *na S,rl119(1)
GROUND WATER PUMPAGE ANO USE REPORT Sr alt lxpartmtnl or Holch and State Wactr Concrol Board Pvbltc. Sfnd copy or r~rt to ~ton.I Sult ll1ltr Co11trol lot~ Offlct lftd lt9I01WI Sult HetlUI ~PH~t Ofrtc1 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 YtU
/'f4!/
"oodl ""I>c=-=MF.3.c~
Quuur 1 2 l © (Cfrc1e One)
County/Cf ty
- Surry 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*--------- Date--------
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.-------
Sl<<:8 No.-------
SWCB No.------
Oimer No. -------
Owner No. -------
SWCI No. ------ Owner No.-------
SWCB No. ------ Owner No.-------
SWCB llo.
Oitntr IIO. -------
Meter readings are fn ---lga;t2..l1wll.!.Q.!!MJ2..--------------<11*11ons, 1000's of gallons. cubfc feet, etc.)
swce No.
Owner No.
Da~
Heter Readfng*
[ltd of 7'6 2.00 Lu t l'lontll 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- ~*d *ttr,.., ti* 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
-.. If Ut111 111 Ont 11tll 111 I fltlf, 111<<1f7 wfllcl1 well ----
t
- All prh1tal1 or P11t1llall7-owntd plAlltc wttar s11pp!7 171~11a w1UI HulUI Depert.ifnt Ptrw1ts.
llott: If 11st.a fs 111111tttrtc1, tst1utt ~91 111 bo.111 111 lo...r r1ght-hllld corntr.
O.te 16 17 18 19 20 21 22 23 24 lS 26 27
- 28.
29 30 31 1 S.ltw Toti Dlir t III flotl UI Tott Dl11 I Optrtt1119 tll ls Non tll 0,1 Our 1, Avtr191 1119 Montll Me~r Readtng*
6'1lons Used 7Y, z_oc::, Tou I Gt I Ions
-o-Dlir I 119 ~trter 52-foul Oc,er1t1111 D111 tllls Ou*rttr
~-
.it i 17 "lur191 O..ri119 Ou1rt1, Ila ter Leve 1 '*..
Stitt,.. IPumtM*..
a:> -
t:j'Z-W* tar Sour'Ct:
_-AX.__ Wt 11 (I)
___ Spr1119(s)
___ Wfllh) and Spr1119(1)
GROUND WATER PUMPAGE ANO USE REPORT S1a1e lkpartmcnl or Hcaflh and State Waler Control Board Public, ~no copy of report to lleg1oiwl SUtt W1ttr Control lo,rd Off1ct Ind R,gton,1 Sutt He1IUI ~Ptrtlleftt Offtc, 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, Teu
/4!/~ 1
!\\>nth Dcce-~ '8~
Qu1rter 1 2 3 t$) --
(Circle One)
County/City
- Surry "ame of Wa ter.orks Name of Ooera tor -,t-;-;-l/.,.A;;;----------------
Va, Electric & Po.ver Co. - Surry Posftion/Title __ ~N"/,.,.A _____________ _
Co N/A Nt~
e>wVer Va. Electric arrl Po.ver Sfqnature __________ Date---------
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 P11hltc + __ lndustrbl-X_ Other (specify
.a.:.ia.:.:. ________
Type of U(,e:
Jf measurements are for a single-meter field reading, 11st wells included fn field SWCB No.
Owner No.
SWCB No.------- Owner No.--------
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 Owner No.
H 1n bous tn lower r1gllt-lllnd COMll1".
SWCB No.
Date Heter Reading*
[nd of Lut ltontll 27"2..lOO 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- lleecl aeter suie ttae Hell cl11 (pr1f,r1bl1 tnd of d1y)
Uktn, rHcl 1t tl'lcl of non-,-p1119 period f t1k1n, r11cl It encl of 11t1v1*1>U11111"9 period If Uken 1n one ioell 1n I fftld, 1pectf1 wtiicll wll ----
- All prtntely or put,11u11y-owned putiltc wit.er supply S.Y'teli&
witll kt1ltll Oep1rt11tnt peraits.
Toti Durt Tote o.,s Dlte 16 17 18 19 20 21 22 23 24
- ?5 26 27 28 29 30 31 1 '-llonr IICJ "°""'
1 Oper1t1111 UI ts lion t11 0.1 Dur ly Av,r1ge Ing llontll Meter Reading*
&illons Used Z73.,t~
I c:>c:>O I
I Toul Glllons 000 Durt119 Qu1rter I
roul 09er1tt111 3z..
0.,s Ul1s Qu1rt1r 31
.11 i I 7 A,1r191 During Ou.rttr WI ter Leve 1 **-
Stlttc- "->tna*..
t::.., zoo
'f'Z-t,7
....... '.~...... lJ*l,;;J
_ _..X_ ~ II (I)
~--- Sp,-1119(1)
GROUND WATER PUMPAGE AND USE REPORT Scale tkpar1mcnl or Hullh and State Wa1cr Con1rol Boar4111 Public.
SfllCII copy 1f r~rt to ~1oiwl SUic Vtt,r Co11trol lot1'111 Off1et tlld lt9IOMI Sutt HttltJI OtP'rWftt Office llldu,trttl, S.,., cop7 of rtPOrt lo ~10,..1 Sutt lllter Co11trvl lotrt Offctt
- Other, Stnd coc,7 of rtPOrt to t.91~11<11 Su~ ~tcr C0ntroi ~1'111 Office
\\'Hr
/tJ?9/
~di Z>e~A/JB~
Quarter 1 z 3 ~
(Circle One)
County/City
- Surry
"*me of Witer,,orts Name of OoerHor N/A Va. Electric & Po,,ler Co. - Surry Posftfon/Title ---.N:;-:/;;;A:-------------
1).l/er Va. Electric arrl Pa,oJe.r Co.
Sfqn*turt N/A 0.te __
N_f_A _____ _
Address P 0. Box 315 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.....__ _______ _
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.-------
SWCB No. ------- Oitner No. -------
SWCB No.
Oitner No. -------
swca No. ------ Owner No.-------
swca llo.
Oitner No. -------
SWCI No.------- Oifner NO.--------
Meter rudings ire Ill __ _;ga-.1.,1.:ons~---------------- (g111ons, lOOO's of g111ons. cubic feet, etc.)
SWCB No.
Own N.::::,C,r-)S"T"fl;..uC,."i'LON er o.
-:s1-rc::
Date Keter Re*dfng*
G.11ons Wlttr Level**"
lti,iip t 119"
[lld of Z(.. Jz4,r;-ot:>
,111/HI/Hf.l.
Lut "°""'
1 2
3 4
5 6
7 8
g 10 11 12 13 14 15
- ~., acter uac tlat ttca ~, (pr1fcr1bl1 tfld of d11J
- If t1t111. rttd 1t tlld of --~1119 per10d
- If Ultt1. rttd It end of 11t1,,-~1119 p,,,ocr
....., lll111 fa ont totll 111 I fttlC, IPKlfJ llfl1cll 111tll ----
All,,1utel1 or p,AltCA1l17-owntd p~lfc ~tu 1uppl7 11~teaa wflJI Ku.ltll Dtp,rtJocnt ptratU.
Iota:
If 11stea fl ur,.iettrtd, Ht1.. tt ~91 111 boaes 111 lo,,er r19ht-hllld COl'Mf'.
Dite 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C. IIOllf Tota 111,r 1119 "°" UI I 0perlt111f Tota o., I tJl11 Nontll Ott o..,
1,,htrll)I 1~ "°"'"
Meter Reading*
S.1lon1 Used 27 I q S z.c:,o I
I 470 700 I
47~ 700 Toul C..11ons D1,r109 ~,rter 3Z.
Toul C)pfratt11t Dl7' Ult I Ol,1rtlf' 1</,74"/
Ai 17 l,tr191 O..ri"9 o.. uttr I
Vi ter Leve 1 **"
Stattc" 1,,_;,.......
I t::.z I 7co
/
/
~z.
17 t.z 7
... ~.,,,.,..... lJ*~J X,,__ 11t II h I
--- ~prt119(1J GROUND WATER PUMPAGE AND USE REPORT Sralt EHputmtnC o( Hutch and ~le Wactr Cone~ Boartll Pwbllc.
~ftd copy af rtl)Ort to lf110I\\II Sui. Vlttr C.Ofttr,il lotr11 Offlct 111d l191o,wl Slllu tlf1IUI Dti;i.rtMftt Office llldustrt*I.
Seftd c~y of rtpOrt to ~lo"II Sutt Vilar C.011trol lotr41 Ofhct Other.
Set>CI co01 of rtpOrt to lt9101WI Sut, tut.tr COf!t~! S.0.;11)fflct f.Hr
!'ff/
lfcntJI
/lfhv~ ~ c7~
Quarter 1 z J © (Cfrcle One)
County/City
- Surry
"*me of 1/Uen,orts Ka.,. of Ooerlt~r ---;?-:;-J/,;A.--------------
va. Electric & PcJ,..,e.r Co. - Surry Pos ft ion/Tit 1 e --~Nn/.,.A ____________ _
--..1 Co N/A t<lt~
e>wl/er Va. Electric cuu l'oNer SfQn.tur, ____
._c... ____ O.te --------
Address P O. Box 315 Poput1tfon Served (Publ1c 1 __ __._,NIL/..,A.._ _______ _
_ __,S""'ur=-=ry~,~V=a-=-. __,t..-=2=-=3=8-=-8=3-.Phone (804) 357-3184 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 No.------- Owner No. -------
SWCS No.
Owner No. -------
swca No. ------ Owner "°* -------
SWCB llo.
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.)
SWCB No. v/
/6/t> _ S-"c<>wner No, A Date Heter Rud1ng*
6111ons w,ter level**"
Used Sutt,** l,i,i,p11M1"'
[Ad of rt. 6/~~o
'///////1//////IJ..
(//
un fiol'IUI
'I////J/////I.*'
1 2
3 4
5 6
7 8
9 10 11 12 13 14 15 1oi.: If 11st. ts 1111DtUrtd, ttU.. u FUll)l91 111 llous 111 10"1tr r1ght-heftld corntf'.
Dile Keter ltead1 ng*
&allons Used 16 17 18 19 20 21 22 23 24 25 26 27 28 29
'1'7 7 z..900 7~ Soo 30 31 t C.11oru Toul C..110ftl Toti Dwr 111!1 ltoflUI 7~ ~.;e-"'
Dwr1eg ~1rter W.ter level**"
Sutt,-
"-i11111*...
Zs/ S-o=
- llof -ter ** tf* taca u, (pr1fer1bt1 tftd or d11)
- If t1te11 0 rttd 1t tt>CI of IIOft-""°1"'9 per10d
- If Ul1t1 0 rttd U tlld Of IIHYJ*p,,,ICl1"'9 PfrlOd 00**Jf Ulen 111 one "'" 111
- f1tlf, SPKlf1 wtilcll wit ___
t All,rh1tel1 or M1fu11y-c:,,,ned pl.Citic w1i.r su~t1 s11tea1 w1 UI ICtl.1 tll DtPirtlatnt pera1 U.
- Tot, Dl11 I Operat1119 tll ts llontll 0.1 O..r ty Avtr191 zr Tout Opfrlt111f 0.11 tllh °""'"
6=
.it il1 l,tr19t 1119 llofttll
- z. C:, "3 "is" O..rt"9 Ou1rttr 3 FS-8'
I
- ....,'* **R Ttu if-JI
.,.\\,,.,,,..,. --* lJ*&:iJ GROUND WATER PUMPAGE ANO USE REPORT
~Ui NO //6',"'1 (3 §""1:
vu,r Sovru:
~~}(...__. 11111(1)
--- Sp,-1119(11 S1a1~ Cxpu1m(nl of Huhh and Sta~ W11~r Concrvl Boar4 P.~llc. St..s cop, ef rt90r\\ to lf.tlOM I Sut.t V11.tr Co11tr"1>I ao,,... Olflu tlld Quarter 1 2 l (!)
(Circle Orie) lt9IOMI Sul.I HulUI Dfp.trtaflolt Offlct I...Su1trul. S~ c~, of rtPOrt to ~lol\\l I Sutt V. !.tr Co11t.rol lot** Offtct Ou,,r, Stnd coo, of rtport to ltglon,I Sutt~~, Cc:itrwl ao.,; OH1ct County/City
- Surry
"'"" of wuer.orts Name of Ooerltor ---;1':;-1/,;A.--------------
Va. Electric & Po,.,er Co. - Surry Posftfon/Title __ -.:N'f/r,;A;--------------
_..,;i Co N/A N1'1\\
CMM!r Va. Electric Cl.Ju Pa,.ier Sfqn,tur*------'----- 0.te --------
Address P 0. Box 315 Population Served (Public'--~Hu..lLlA.__ _______ _
_ ___,S""'ur=-"ry:...L..<1_..c.Va==-. _.,<--=2=-=3..;:.8-=-8=3-Phone (804) 357-3184 No. of Connect1onc; CPubl ic) _ ___.N....,_./A.,.__ _______ _
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 No.-------
SWCB No. ------ Olmer No,-------
SWCB No.-------
SWC8 No.-------
0.mer No. ______ _
SWCB llo.
Oiffler No. -------
Owner No. -------
SWCI llo.
Oitntr NO,--------
Mettr readings ire 11 ---lga;&.1li..ll,.!,odns.!Oil---------------<S1*llons, lOOO's of gallons. cubtc feet, etc.)
SWl:B No. "3e> - 19 o - '5/ctMner No.
I<
Date Keter Re1df119*
~llons W1ter level.. "
~~111-*
[lld of
'il't ?f //,300
'Ill, un "'°""'
1 2
3 4
5 6
7 8
9 10 11 12 13 14 15
- le14 *ttr u.. ti* HU "' (pref..-1bl7 tfld of dl1)
- If Ult11, rNCI u trod of,_.,.,..,1119 period
...,, tlltfl, rttcl It tM of llt1Y7*SIUIP1119 Pfrlod
....,, Ultll,. 011t wll 111 I fltlel, SPK1f7 wtilcll *11 ----
All,,111t.tl1 or i,wllca117-owlltd public w1tar suPCilJ,,,,_
wt UI Hu.I tll DtPlrblent Ptral ti.
Iota: If s11tea ts u1111et.trtd, ttt1Ntt puiip,91 111 bol.H 111 l°""'r right*helld cOMltf'.
Dlte 16 17 18 19 20 21 22 23 24 is 26 27 28 29 30 31 I C. IIOftf Tota Dwr 1119 "°"~
Tou o.,,
I Optru1111 Ults llonUI 0.1 Dur 11 lwtf'l'Je 1119 Nonth Meter Reading*
Gallons Used
'f c/ t9U ~o 1:t.lS-ooo Tou I C:.1 IOftS
- 7z1S-e>06 D1,rt119 ~trttr foul Oc>tr*t111f
.z...,
0.1' UIII Qu1rttr zl'8" 7j73
_.. i 1, l,,,.,t O..r1 "9 Qutrttr
~tar level**"
Sutt,- "'-'1.... ***
/ 3 0 f5"8"'=o bO Z./'if zb.3
GROUND WATER PUMPA
/~/If~
t I'"" I 1
- 1""
Ytu GE ANO USE REPORT lbldi d StAtc W11~r Concrof Boaul Quuter 1 Z l~
(Cfrcle
~__,,_>C.__ lltll(s)
~-- ~pt-1119(11 Sracc lxputmcnl or Huhh an Pvbllc.
~ftCI cop7 er rt90rt to ~IOMI lt9I0111l SUl.f Kf*IUI l)f~r~t l1'dustr1,1. S~ cop7 of rtPOrt to ~lo O~!Wr.
Stlld co01 of rtPOrt to lt9foiwl S Sutt lltllr Co11trvl loi~ Offltt IIICI Offtct Count1/Cft1 1'111 Sutt IIIUr Co11trol lolr* Off1u lilt lllllr Contrvl ao.t'f OH!ct
- Surry
--- Vtll(sJ *I'd Sfrl"'J(I) lf*me of W*terworts Na 111e 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,.,
_-..:Sur=ry"-'--'1_V.~a~.__._, """'2--'--38_8~3-Phone (804) 357-3184 No l*t1on Served (Public' NIA
- of Con~ct1on, (Public)
NIA Up Type of U(.e:
Public* __ !n<lustrf*l __x__ Other (specify_
Jf IM!Uurenents *re for I sfngle--11eter ffeld ruding, 11st well erltfon Perwf t Kuat>er (Publfc) Jj_LA 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.)
SWCB llo.,3/ J9o S-z.c. Owner No. C lloU: U IJSla h ul'f!ltUrtd, tstluU ~91 111 boaa 111 t°""'r rf9ht-llllld tonier, Date Heter Re1ding*
~llons WU.er Leve 1°"
Dlte Met.er Rudtng*
&.11ons Used Sut1,.. I P'i,ap 1 M" Used hd of Lot f'IMIUI :Z?~'f'Z. t.Jo~
16 1
2 3
4 s
6 7
8 9
10 11 12 13 14 15
- .... *tar ** t111f fftll ~, (pr1f~1bl1 1ncl of d11)
- ,, Ul.111, rNCII It Ind of --p,,,,,of119 jlltrtOd
- , Ullll, rtK It Ind of IIUYJ-puap1119 per10d
....,, Ultn 111 0111111ll I* 1 ff1IC11, spec1f1 wfllcll wll ----
t All,r1uul1 or ~ltcall1-owlltd p~ltc **Ur supplJ,,,t,.
wt UI ICU 1 UI Otpartlafnt ptnat ts.
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 t Ca"°"'
Tota 111.ir 1119 lloftt.11 I l)per1tl11t Tou o., s Ult1 llonUI Dlt Our
,,.htrl9e I 119 Non Ill 51 S-,S'ZRo Z foZ.,300 Tou 1 C. llo,i1 1~.0230-0 Dwrl119 f),trter 217 rout Optrut111 Dl.r, UIIS Qu1rttr
/oo 07.:,
.1til1 l,tr191 Dwr1"9 Qvtrllf llatff Level**"
suu,.. 1.._,..... _
7 gs;-I "Z<::>c::::,
~o
/Z.Z....S-z...o
,1*\\,*
- '" -~* 'J*l.;;J 1/Htr Sovru:
_ __,,.,X.._ llt II h I
--- ~1119(11 GROUND WATER PUMPAGE ANO USE REPORT Srate lxputment or *Huhh and StAtc Water Control 8oar4 Pvllllc. ~ncr cop, tf rt90rt lo ~1oiwl Sutt ll'tltr Coftll"OI lotrf Offlet *..,
l191oiwl Sult Holt.II ~~rtNftt Off1ct 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 Na111e of OoerHor -,Z.:;'1/T,A.--------------
Va. Electric & Power Co. - Surry Posltlon/Title __ ~Nfl/r..A _____________ _
/A Nt~
o.M!r Va. Electric arrl Po,.Jer Co.
Sfqn*ture N
O.te --------
Address P O. Box 315 PopulHlon Served {Public'--~HIL/L<AL--_______ _
Surry, Va., 23883 Phone (804)357-3184 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 No.------ 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.)
SWl:B No.
Owner No. -t::>
Date Heter R"dlng*
G.llons ll1ter Level**"
- f.
~
- lut l'Grttll I zrr 7t:?o 1
2 3
4 s
6 7
8 9
10 11 12 13 14 15
- leNI *w s-, ti* uca,., (Jlf'tftrtllly Ind of d11I
..,, Uttn, reed It tnd of 11011-p.,aipl119 jllfrlod
- 11 t.. lft, rtt4 ll tnd of lltoy-~f"t per,od
....,, Uttft la one "'" 111 1,1,1,, 1PKlf7 wtilcll wll ----
t All,"rh1tel1 or ~tlc,lty-owntd public wet.Ir supply s,,t_
w1UI kHltll Clt~rtlatnt PtNIU.
llote:
If srsta fs urwettrfll, tstlllltt ~91 111 bous 111 lowr rlgllt*htnd ctlnllf',
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.l11111t Toti
~r 1119 fton Ul I Operu 1111 Tou Dey I tll I S llontll Del Dllr 17 Anr191 1119 llontll Meter ltudf ng*
S.llons Used IZ,6"/~~
?'6 s-~
Toul C.llOIII 8"~ $00 Dllr 16CJ ~Ir ter vJ Tot.II Optr1t1"9 DIJ1 tllls Outrttr Zf8'3 JI ii J. l,e, 191 O..ri"9 0111rttr Viler Level**"
StAUc.. "->11111*-
17fsoo
,bo Z-7f z._
.,......,,,... -** (J*l,.jJ GROUND WATER PUMPAGE ANO USE REPORT Ttu l~f./
lb!UI Nova-~ a.z-~
11.cer Sowr,:e:
x.__ "'11 ! 'I S1ate lxputmcnc o( Hu Ith ind St.tt Water Control loar4 Pwbltc.
~,,ci cop1 of rt-p0rt to ~loiwl St,t, Veter Co11lr11I to.rill Offln 111d Qu&rttr 1 Z 3 (i)
(Circle One)
--- Sp,-1119(1) h91o,.,. I Sutt Kte llJI ~P'rtaflolt Office lr,du1tr11l. S~ coP1 of rtPOrt lo ~lo,wl St,le V.ter Co11trol to.rill Offtct Othtr.
Stnd co01 of rtport to lt91o,wl St,c, v,1.er Co,,trol ~rs!! Offfct County/City
. Surry IW*me of W&ter-..orts Na1ie of OoerHor _ 1?-:;-l/7,A~-------------
Va. Electric & PcMer Co. - Surry Pos 1t fon/T it 1 e __ -iNf:/r..A:---------,,.,..,....,------
- --~
Co N/A N1~
Owller Va. Electric arrl Paw1e.r SfQn*tur*--------- ~te --------
Address P o. Box 315 Popul&t1on Served (Public' __
-4lNIL/olllA,__ _______ _
_ __,S=ur=-=ry:....,1..........
V._a ___.~,.__2~3_8_8-3_ Phone (804) 357-3184 No. of ConMctfon~ {Publfc) __
N........,/A..._ _______ _
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 No.-------
swca No. ------- Owner 11o. -------
SWCB No.------- O.ner No. -------
SWCB No.
O.ner No.-------
swca No.
Owner llo. -------
swca llo.
Uifner IIO. -------
Meter readings,re 111 --~ga~li....li.:,,ol!_ns~--------------Cg*llons, lOOO's of gallons. cubic feet, etc.)
SWl:B No. JS° z -/tfo-7/ P Owner No. --
=
Date Heter Rt1d1ng*
Gallons Water level....
Used St1t1c**
[ltd of
~t, c./~1000 ~
Lut lbllJI 1
2 3
4 5
6 7
8 9
10 11 12 13 14 l5
- ~tf *tar n* tlat uc* 07 (,ref"°1bl7 tnd of d11l
- If t1le11. rNd It tnd of __,._.,1"'11 period
- If Ullfl, rud It tnd of ~01-~1"'11 per,ocr
.....,, tallft fa one wll 111
- rtelf, 1P<<ff1 wfllcll "'fll ----
t All,,h1tal1 u Plll)lfull1-0rned piiil tc **ter suppl1,,ueaa w1UI ICt&_l_UI Otp,rbotnt Pt,.lts.
llote: If s1sta fs unwttrtd, tst1Mtt IUPl91 111 bous 11, 1 o-er r 1 gllt
- Ila 11d COl"ftef'.
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.110III Toti 111,r Ing !bill I llper1t111t Tota o., I lJI h llon UI DII Dur 11 Artr191 1119 llotatll Meter Reading*
S.llons Used t,ft.3oS"oo ~113.S-60 31f3 S""'~
Tou I C.1 IOftl 111,,1119 Ql,,rur q
Tot.Al C)perat111t Dll1' UIIS Ou1rter
/o?J ~7
.it i 11 A,er191 O.,ri"9 Ov*rter W.ur level.....
St&Uc.. "-*-*...
~?3/ 7oc:::>
~o f y 1r&,2-
~..,.J,.}C..__w.11(11
~--~1119(1)
GROUND WATER PUMPAGE ANO USE REPORT S1.a1c ~putmcnl or Holch and Sute W11u Conc,V, loar4 Public. ~lld cop, er r~rt to ~lo,w I St.au V1Ur C611trol to.~ Offlct 1114 lt910MI St.at, Ht1IU1 OotPtrtatllt Office lodu1tr11I. S~ cop, of roort to ~10,,.1 St.alt V.Ur Col'ltrol IOi** Offlct Ot11er.
Stfld co01 of r1POrt to 1,910"'1 SlH.! !uur Cont.ol ;.;.,.. OHict Tur 16Y:f/
~th /!lo Ve-At Be:7S:
Qutrter 1 2 l c()
(C1rt1e One)
Ccxinty/C1ty
- Surry
"*me of Wtten.orts Na~ of Ooerltor -,1':,l/TiA\\ ____________ _
Va. Electric & Power Co. - Surry Posftfon/Title __ -.:Nf;/r..A:----------,,,-+.,.-------
-......:1 Co N/A N1"1\\
Owller Va. Electric oa..1 Pa,,,,er Sf Qntture --~-_c... ____ o. u --------
Address P 0. Box 315 Pop,.,lttfon Served IPublfc' __ _....Nul.... A.,.__ _______ _
_ __,See.:ur=.:ry~,__,_V-=a.:........,r..-::2:..::::3=8=8=3-Phone (804) 357-3184 No. of Connection,; CPublfc) -----H~IA....._ _______ _
Uperat1on Pel"llft Mult>er.(Pub11c).&N,../.._A._ _______ _
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 No.------ ~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.)
SWCB No.
Ol,tner No.
Date Heter Rud1ng*
Clld of 3~~'f8'o un "°"t11 1
2 l
4 s
6 7
8 9
10 11 12 13 14 lS lloU: If systea h unnettrtd, Htta.ett ~91 fl, boan 111 lo-er rfgllt*hllld conllf',
Tot.I
~rt Tott o.,s Dltt 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.110llt 1111 lb!UI I Oper1t1111 Ulh llonlll Oat Dvr 11 Avtr191 1119 llontll Meter Read 1 ng*
~11ons Used 3~ 732,o I 8'7'b
/ F,ra Tou I C.. llCHIS Dl.,rt119 Q,.,11rttr z.7 Tot.II ~ratlllf 0.11 Ults Ovarttr d,s A ilJ lvtr19t 111.,, i..g Q,,u ttr
~tar Levelee" St.alt,..,,._;,...,u.
'3~~~
~C)
C:,/
~
11 l'\\o,111**"
GROUND WATER PUMPAGE AND USE REPORT T
0 ttr 1/<Pf I lbltJI 4:PV~M~~
~arttr 1 2 J (!)
W* ltr Sowrt I:
_-..A}{..__ Wtll(1J
--- SPf'l"9(1J S1at1 ~partmtl\\C or Hullh and Sutt Water Control Boar4
- Pwbllc, Stlld cop1 1f rt-pOrt lo ~lo,wl Stu, IIHtr C.011trol lotrf Otflc,,..,
(Cfrtle One)
___ lltll(s) *lid S9rf"9{1) lt910fttl Sutt HulUi ~P'rtN<lt Office llldustrul, S~ cop, of rtpOrl lo R.vlo/\\11 Sutt W.ttr Co11ll"Ol lotrf Offtc, Otlltr. Strid cao, of rtpOrt to 1,910/\\II Sutt ii.ttr COfttrol ~~ OHie; County/Cft1
. Suny lf*IIII! of WHer.orks Na~ of OoerHor -,?-:;-1/,;A;.---------------
Va. Electric & Po,..,er Co. - Surry Posttfon/Tith __ ~N;';/r..A:--------,....------
Ow'l4r Va. Electric arrl Po,..ier Co.
S1QnHure ____
N_1/_A ____ Olte __
N_f1't. _____ _
Address P 0. Box 315 Popu!Ufon Served (Publtc'---..Hul.,._A._ _______ _
'S=-ur=.,ry:..,_,1'--'-V~a""'"._,._2~3_8_8_3_ Phone (804) 357-3184 No. of Connection~ (Public) __ N
........ (A...._ _______ _
Up era t ton Pe r11f t lut>er ( Pub 11 c).a;N"'L~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 No.-------
SWCB No.------- Owner No. -------
SWC8 No.
Owner No. -------
SWCB No. ------ thffler No.-------
SWCB llo.
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.)
SWCB No.
()o.ner No.
4 Date Heter Rei1dfng*
6'11ons ll1ter level**"
StH1,00 }P~fllll"
~
Cftd of 73'~o ult l'lontll 1
2 3
4 5
6 7
8 g
10 11 12 13 14 15
- lleM attar laat ti* HCI.., (~tftr1bly tftCI of d11)
- If u1,11. rNd It tftd of 11011-puapl119 pcrfOd
- If Ule11, rtld It tnd of lltlYJ-~1119 p,r10d
....,, llltn 11 Ont 11ell 111 I fltlf, SPKff1 wfllcll,-ell ----
t All 11rh1ttl1 or,wl1ally-owlltd p~llc w1ter sul)CIIJ 11\\ltta w1UI Ntel UI Dtp,rtiaut Pt,..tts.
Iota: U systa ts uNDettrtd,,u1.. u ~91 111 boza 111 1°'"'r rfght*hllld corMr.
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C. IIOllt Toll DI.or f 119 floft UI I 0perlt111f Tou o., I tit h llon UI DII 0..r 11 A*ff'l91 1"9 Montll Meter Reading*
&11lon1 Used 78 'Z.AO~
~
Tou I c.. "°"'
~
111.,,199 l).,rur Z-J Tot.ti Operat111f D111 Ulls Outrltr
-0
,11 ii,. l,tr19e O.,ri"9 Quarter Vlter level.....
St.tt1,.. "-1""....
C)
~o 0
\\:
.,.....,,,.,. --* lJ*l,;J
_ __...x.__ '"" h,
--- Sp,-1119(1)
___ llellh! '"" S,*!"9(!)
GROUND WATER PUMPAGE AND USE REPORT S111e lxpar1mcnl of Holch and Sutc W11u Conlrol Boar4 Public.
~lld cop7 1f rtp0rt to ~1°"' I Sutt Veur Co11tt"OI 1otr11 OH1u elld atglon,I Sutt HetlUI l>t~rtacftt Office llldustrlll. S...., CoPJ of rtPOrt to lt<a10ftll Suu li'lur Control loer, Off1c, Other.
Stnd coo, of rtPOrt to lt910,,.1 Suu Veur Contt"OI ~!'!! OH!c; ft-ar
/,'!% I
~tll /f/'Ot/'671,,/ B~
Quarter 1 z J Cl:)
(Clr-cle One)
~nty/Clty
- Surry N*me of wuer.orts Name of OoerHor N/A Va. Electric & Pc,.ver Co. - Surry Position/Tith --.N:;-:/;;;A:--------------
Co N/A Nt'A
().,l/er Va. Electric arrl Po,o}er S1qn.ture 1
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 No.-------
SWCB No.------- 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.)
SW\\:8 No.
Owner No. ;/
Date Heter Rtad1ng*
&. 11ons W*ter lev11**tt
- -~
[lld of z~ 8 7oc::::>
ust l'onUI 1
2 3
4 s
6 7
8 9
10 11 12 13 14 15
- lof *tar,.._ tlat ttca dty (Pf'tftf'1bl1 encl of d11) nu Ule11, rttd 1t tncl of IIOft*,.,..,11NJ period
- If UU11 0 rtMI It tnd Of IIUYJ*pua!pfll9 per1od
-Hlf ll\\111 111 Ont,..11 111 I fltlf, lpe<lfJ,,Mell -ell
- t. All 11rh1u1, or pv<<,ltul11-owntd p"61tc _.u, supplJ 111tta1 wl UI llul UI llepertiaut p,,.1u.
Iott: If systa Is uraettred, tst1utt ~91 111 ~.lft 1n l~r r19ht-llllld COM'II\\",
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C.IIOllf Tott Dl,r '"' lblta 1 Optr1tt111 Tou o., s tit 1 s lloll U1 DII Dur ly Awtf'l9' 1119 Nontll Meter Reading*
S.11ons Used 2.7z/ o~
,3 /C/0 3 "7'tc:>O Tou I C..110lll D1,r1"9 l).,1rter Z-7 Tot.el 0ptrlt111f DIJI Ulh Qu1rttr
//7 A i1 J l,tr191 O..ri"9 Ouerlt~
V.ter level.. "
Stat1,.. "'-t11C1***
S-z...o=
60
~
.,...., '" --* \\J*l,;,J
_........ X.__ 11t 11 h I
--- ~P,1"'9(11 GROUND WATER PUMPAGE ANO USE REPORT S111e lxputmenc or Hollh and Sut.e Waler Con1rul Boaul
,.111tc, StllCI copy tf rt1)0rt to la91o,wl Sutt llattr Control to.111 Offlct ll'td lt9f0t\\ll Sutt Ht1IU1 ~P'rtNftt Office l...:fuHrlll. S~ CoPJ of rtport to ~lo-wl Stilt "4ttr Control So.** Off1u 0~,,.r.
Stnd co01 of rtport to lt9fon,I Sllt.e "4ttr Control to.111 Offfct
'fHr
/99/
lbltJi ~E~8P'.\\
Quarter 1 Z l © (Circle Orii)
Count1/Cft1
- Surry lf*me of Wlten.iorts Ka~ of OoerHor _
1f:;-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 In boaes fn l°"11r rl9ht*llllld corner.
SWCB No.
Own No.:::::oNs~c..-r,oiJ er 51, e-Date Heter Rt1dtng*
6111ons ll1ter leve1°*-
O.te Meter Readf ng*
&.11ons Used - p tlld of fltttt~IT//1/J/I~
LHt "°"UI :z.G. zz I e:roo fH Used 16 1
2 3
4 s
6 7
8 9
10 11 12 13 14 15
- ~.. 11tUr,... ti* HCII.., (pr1ftt"lbl7 tnd of d11J
- If tll111, rt..S u end of IIOfl-pu,ilp1ft9 period
- If t,l1n, rud at end of llt1w1-~1119 per1od
".. If ut111 111 °"' wll 1* * '1tlf, s~HJ wtllcll 111tll ----
t All i,rh1ul7 tr pwllall7-owned Pl'll1c wit.tr suppl7,,u-w1 UI NHIUI Dt~r~nt p,,..1u.
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C, lion, Tot.I Our 1119 floftU I Oper1t1og Tot.a o., I Ulls KonUI OIi Dur 11 Awtt"19t 1119 "°"t"
~7z4c;;oo SoZ<:.o=
Tou I Gt I Ions
$"02..~oo Ourlog ~,rter rot.al Oper1t1111 Z-9 Dl,i tJII s Ou1rt1r r733/
,11il1.lur191 Durii,g Owuttr
~ter level....
StUfc..,.. _1AQ*<Nt I/~/ oo.o
&o lf/g'3
~~~inWA~~PlJW~;-;-~~-;--;;~~~~~-~r~~~r:;=:
lf<fl GROUND WATER PUMPAGE AND USE REPORT
- fontll ec..-:z:.:::,#~-1; S1a1~ IHpartm~nc of H ulch and Suec Wac~r Concrol Board Qu*rter 1 2 l tT)
(Cfrtlt One)
~ tcr So.ire,:
_ _...X.__ We II ( s)
--- Sprl"9(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
- ll\\d11strtal.
Send copy of rtp0rt to ~fOflil Sutl V,tfr Co11trol lolrd Office
- Surry
___ 1/fll(sl 1nd Spr1119(s)
Ot1~r.
Stnd ccoy of rtf)Ort to 1,9toiwl Sutt V,ttr Control Bo.rd Offtc1
*me of Waterworks Name of Ooeritor N/A ric & Power Co. - Surry Pos ft fon/T it 1 e -,N:.'/TiA\\-------------
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~nsUlll:. _______________ (g11lons. lOOO's of 911lons. cubic feet. etc.)
DAte Heter Reading*
G11lons Used t,i, of "4
1 2
5 6
1 8
9 10 11 12 13 14 15 tar,... ti* HCII.,., (pr1f~r1bl1 tftd o, dlyJ ttl, rttd It tnd of IIOA*~1"9 period ten, r11d at end of 11tlYY*Pll'll>1"9 per10d t1t1n 111 one 111111 111
- f1tlcl, IPK1fy.tilcll 11ell ----
t All prh1u1, or ~1tcall7-ownN publ1c **tar supply 11ste111 wi UI Hu I tll Oep1r1111tnt pu.. 1 ts.
Noia: If 111tea ts u,..tel"N. tsttlllu puap191 111 boaes 111 IOi.lr rf9llt*llllld COt"ftlf'.
Tou Durf Tota 0.,1 o.u 16 17 18 19 20 21 22 23 24 35 26 27 28 29 30 31 I S.110Rf 119 lloftUI I Optrut119 Ults NonUI 0.t Ovr ly htr191 1119 Montll Meter Reading*
&lllons Used ft fl,¥oe,
/r5:"'oo c::>
/S-S-oc::>0 Toul C.IIOftl Durl119 Qu,r~
di Tot.II Ot,erntnt 0.11 t111s Ov1rt1r S-Oc:>0
... ii,..,,.91 O..r, "9 011trt1r VI tar Leve 1.. -
St1t1c- '~t-*-
I S-5"' o~C>
3/
S-eoo
~G-ROUNO WATER PUMPAGE AND USE REPORT
,eu tff?I
"<>nth ~C-7'o.2!>??f Qu1rter 1 Z J ~
_--,,;;.X.__ lit II h J
___ Spr1119(s)
S1a1c lkpanmflll of Hcallh and Sc.~ W11cr Conlrol 1!011rd Publtc.
~IIO copy tf rfi)Ort to R.9fOMI St,U llettr Co11trol to.rd Offlct 1..i (Cfrtlt One)
Rt9ID111I Sutt MHIUI 0.p,rtMnt Offfct
-llldustrlll.
Stnel coo, of rtpOrt to le9fD111I SllU ltettr Control ao.l"CI Off1ct Otller.
Stncl coo, of rtPOrt to lt91on,I Sutt lttUr COlltrol So.1'11 Off1ct County/City
. Surry
___ 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. ______ _
SWCB No, ------- Owner No. -------
SWCB No.
Owner No.-------
swca No. ------- Oalner No. --------
SWCB llo.
O,,ner No. -------
SWC8 No.------- ~ner IIO. --------
Meter re1dings 1re 1n ___ g~a~l.,.l,,,.o..,ns=--------------- (g11lons. lOOO's of 911lons. cubfc feet. etc.)
SWCB No. 3o-1 ~ o - 51 C. Owner No.
8 Date Heter Read1 ng*
1 2
5 6
7 8
g 10 11 12 13 14 15 t1r,.., t111t HCII 11., (pr1f1ubl7 Ind o, d1, J
,>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 ----
t A11 prfnttl7 or ~lfc,117-owntd public **tar suppl7 s,,u.
wtUI Ht1IU1 Oep1r1Jlle11t Ptra1U.
llot.t:
If sysua fs u.-itttred. tst1Mt.t ~,.
tn bons 111 loo.er r19llt-llllld COffitr, rot.a Dur1 Tou o.,,
Dlte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.11Dftf "9 llofttll I Optr1t1119 tll 1s !loft tll O.t Our 17 Awtr191 1119 Montll Meter ltt1df 1'19*
Gillons USed
'j'~ <J//,3oO S-?3o ?oo ToUI C.IIOAI s-- ? 8' (') 8' oc.
Dur1119 Ql,uur 31 rot.II Opfratl"f 0.71 Ulis Ou1rt1r l~'f 703
_.. i 1 J l,tr19t Dur 1 "9 Qua r ttr Water Level.. _
St1t1c- "-111G***
S" 8'?o J?o e:>
3/
/8'tf 70 3
,~r tffl GROUND WATER PUMPAGE ANO USE REPORT
~di tt?c...700 e-1'
_ __...X.__ Wt I I ( s J
___ Spr1119(sJ
___ W.ll(s) *nd Spr1119(sJ S1a1e IHpartmffll or Hulth and State Wa1er Con1rvl Boar_.
P11bllc.
~nc, CDP! tf "f)Ol'"t to R191on.tl Sutt IIU.tr Control Boif"d Off1ct....
b9I011AI Stat, KHIUI ~rtMftt Office
- fl\\duHrU1.
Send COIIJ of ttPOrt to ~1on,I Sutt W.ltr Conlr111 loil'"III Offtct Other.
Stlld coo, of rtPOrt to lt9to111I Sutt V.ttr Control Boird Off1ct Qu4rter 1 z l(!)
(Cfrcle Oni)
County/Cf ty
. Surry 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 1 __
--'JN1L/£1A.__ _______ _
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 (specify------------------------
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 llo. ------- O-ner NO.--------
SWCI No.------- Owner No. -------
Meter rHdings ire fn __ _:g~a5iLl..l.loi.:os~---------------(g11lons, lOOO's of 911lons, cubfc feet, etc.)
S"'B No. 31 J'?O - S'Z:C.Owner No.
~
Dite Heter Reading*
Gillons
~ter Lev11*--
dl/lJj' IIYlll)1n..,
Clld of z/.z4c/o~&
~~
Lut l'cWIUI 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15 ter s~ ttae,,ca dlJ (pr1f1rtb17 tlld of d*1I p, rHf,t tlld of non-l)UIICl11WJ per1od
&lift, rttd It tnd of IIHYJ*Pl-.if "9 period
".. If t1t1n 1n Oll:t *II t11 a fltlf, sptc1f7.tl1cll wl1 ----
All prh1t.el7 or pvt,l1call7-owntd publ1c water suppl7 s,s~
wl U1 Hu I U1 Oep1rt111ut ptn1t ts.
Note: If 111 tea 1s UIVlf tend, H t111tt,1 Pl'IIPl9' fn boxes fn 1~r rt911t-llllld con11r.
Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.IIOftf Tou Our 1 ng "°11 U1 I Opcr1t1119
- Tot, o., I UI h Non UI Oat Dur IJ.AYtrl9I I 119 Monti!
Meter Reading*
&lllons Used z~~1Z'foo 9,,jej-3 'foe.
-'I- ~ if 8' 9&t::i Toul ei,l10A1 Our t 119 l),ar ter
..3/
rot.al Oper1tl"f 0.11 Ul1s Ov1rt1r 1.-/3 S-/,3
.1til7 btr19*
Our1119 Outrttr Wit.er level**-
Static.. 'l'lal t na*..
44~g 900 3/
/~3S-/3
- (;jnl..... ~ lJ-~)
~_.:X:......_ Wtll(1)
--- Spr1119(1)
--- 11tll(1) *nd Sprtr,g(I)
- ** 1~11'11'"'
GROUND WATER PUMPAGE AND USE REPORT SI.air lxpanmffll or Hullh Ind Sutt Waarr Control loartl P11bltc.
~nc, copy 1f ~rt to bg10MI Sutt Wei.tr Co11trol loa~ Office elld l19t0ftll Stitt H11IU1 ~rtaeit Offtc1 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
~ of Waterworks
~
of Ooer1 tor --;~:;-11,,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 No.-------
SWCB No. ------ Owner lo. -------
SWCB No.
Owner No. -------
SWCB No.
Owner llo. -------
SWC:8 No.------- Owner No. -------
SWCB llo. ------ Uimtr IO.--------
Meter re1dings 1re tn --~g~aa.l""l~ons,{Ui;i._ ______________ (g11lons, lOOO's of g1llons. cubfc feet, etc.)
S~I No.
Date Heter Read1 ng*
Clld of I ~~S-7d Lu t l'lon t11 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15 llota:
If system ts ur.etartd, est1Nta ~
Owner No. b 1n boxes fa low, r1gllt-llt..S corner.
IQ ter leve 1 *.-
Toti Ourf Totj 0.11 0.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I £1110ftf 119 llon tll I Operu1119 tllt I Non tll 0.1 Our ly Awere91 1119 Nontll Meter Re1d1 ng*
C..llons Used
/~2!.tf / e>O ~3 (!)00
~,3 c,OO Total t..llOAI Dwr 1119 l),ert.er 3/
roul Oper1tf119 O..rs tll ts (!ulr ter
.,._3 OC!>O
,11111 A,1re91 Our i"9 Ou1rt1r Vi ter Leve 1 **-
Stltfc- "-'fna*-
~,3oQC)
.3 /
3 ooc::>
-* *- * * * -* *,,,.....,,1,1'"'
TNr ___
~/~~~6",~f~~-
l\\:>n th _..;;t::?,:._c::.:_~....;:o;...=e,;..;;~~-
GROUND WATER PUMPAGE ANO USE REPORT Qu1rter 1 2 l (,1f)
(Cfrcle Oni)
~___..,}{.__Wt11(s)
--- Spr1119(s)
S1all' ~putmenl oC Health ind Su&e Wall'f' Con1rof lloarllll Publtc.
~nd copy of rt90rt t4 leglONI Sutt I/at.tr Control loal"I\\I Off1ct,.,
Rtg10ftll Sutt NttlUI Dfptrtatftt Offfct Industrial.
Stftd C09J of rtPOrt t4 ~IOIIII Stitt Water Control lotr-41 Offict Other.
Send coo, of ~rt to *,91on,I Sutt Wat.tr Cont~l loar-41 Offict County/Cfty
- Surry
___ 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 No.-------
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.)
SWCB No. /~2. -l9t> -7/POwMr No.
F Date Heter Reading*
Gallons W.ttr lev11*--
Cnd of
'{/////////"
Lut l'lolllll ~3 t f J'f'e:>O ~H~~
1 2
3 4
5 6
7 8
9 10 11 12 13 14 15 attar HIit t1ae ttcll d*J (pr1ftr1bly end of d1yJ 1l1t1, rttd It tlld of IIOft*l)ullCl1 ft9 period tll111, rttd at encl of 11t1w,-puap1119 per1ocl If t1le11 in one_ wll tn I fl1ld, specify lifllcll wll ----
t All pr1,1ttly or putillc,lly-owntd public **tar supply syst.elll wt UI Hu 1 lll Dtpartlafnt perwf U.
Nolt: Jf systa ts ~tend, est1-tt puap191 1n bolfl 1* 1~ r1911t *.._ corMr, 0.tt 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I ClllOAt Tot.I Dur 1119 l'on tJI I Oper1tl119 Toti Dey I tll11 llonUI 0.1 Ovr ly Awtr191 1119 Mofttll Meter Readfng*
C.llons Used
~(, 48'70(:)~ Z 7?8' 2.eJv Toul C.11Ms Z 7'?f.t z.e,o Dl,T1.. ~arter
..3/
fot.11 Oper1t111t Dl,s Ulh Quarter
'8'9 9,4z.
.MilJ A.. tr191 Ovrillf Ouart1r VI ter Leve 1.. -
Static" '--1-*..
27?8' z..e;o
-3/
?761'~"2-_
_...... x...__ ~11<11
--- Sprlft9(1l
___ ~ll(s) Ind Sprf"9(1)
Teu
/ff/
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)
(C1~1e Oni)
Pwblfc.
SellO copy 1f ~rt to it.gfon,l Sutt ll1ttr Control lo&rd Offlct 1..,
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 Ottier.
Stlld cao, of ~rt to lt9ton.1l Sutt W.t.tr Control brd Offlc,
---..=:-------
me of Waterworks Name of OoerHor ---;1':-;-J/,,A.--------------
va. Electrl*c & PcMer Co. - Surry 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 + __. _ 1 ndus trii 1 _x_ Other (specify-----------------------
1 f 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 No.-------
SWCB No.
Oi,,ner lo.-------
SWCB No.------- 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.)
SWCB No.
Nott: If int.a fl u..ettrtf. estilllte ~91 Owner No.
"F fn boaes 111 1CMr rfpt... lld COMllf'.
O.te Meter Reading*
[Ad of
_ I I.Ht flolltll 5'- 't° [ ~
0 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- Ur 1,- ti* HCII **1 (pr1f1r1bl7 tnd of d*yJ 1l1t1, rNd It tnd of 11011-pu111pt119 period t1l1n. rttd It end of 11t1w7-~f119 period If Ultn tn one 11111 tn I ff,1,. 1pectf7 llfltcll wit ----
+ All p,1,,u1, or Pllbltc,117-owned put,ttc w*ter 1u1>9l7 171la91 wf tll Hu 1 tll Dtptrt.ent pu11t u.
Dite 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C.IIOIU Tot.I Our 1 "9 !loft tJI I C)ptrU1"9 Tott o., I UI ts llon tll 0.1 Our 17 Avtr191 1119 Montll Meter Readf ng*
C.llons Used 3~S-Cf8o
/~oo
/
Tou I GI I IOftl
~00 D1,rt99 l),,rter rout C)ptr1t1"9 3/
~JI ui11*0u1,ttr S-"ii'
.11 i lJ A,e,191 0..r i 119 Qv,rttr wuer lev11--
St1t1c- "-1-*-
/Yoo 3/
~o
I Yeu /'97'/
l4on di t!:) C-7'"0 ~ ~
GROUND WATER PUMPAGE AND USE REPORT II* t, r So,.,rc,:
_ _j.x.__ 11, 11 1, >
--- ~~rl~(I)
S111e ~partmenl or Hullh and Sulc Wa1er Con1rol Board Pvblfc.
Sf,., copy of rt90rt to l,,glor..l SUU V1t,r C1Mt111l So.~ Office 111d ltglon,I Suu Ku!Ui ~i;..rtaeftt Off1c1 Qu1rtar 1 2 J (!)
(Cfrde One)
County/Cf ty ll'>CluHrUI.
Se<,c1 c09y of rtpOrt to ~lorwl SUtf V.Ur C4ntrol So.rd Off1et
- Other, Send coo, of rep0rt to ltgloM! Sut: 11.tir tootrvi to.r11 Offlct
- Surry Name of llatel"wOrks Va. Electric & Po.-Jer Co. - Surry Owlle r Va. Electric arrl Pc,...rer CO*
Address P O. Box 315
__;S=c.ur==..,'[V=..,...,'---'V.c..::ac..:.---L*--=-2.::..3-=-88=3~~ Phone (804} 357-3184 Name of OoerHor ---;t-:-;-7/7,A;;---------------
Posi t fon/T it l e __ ---.N-.'-/r.A.-------.............. ----~
N/A N/.A Sf qn* turP---------- O.te ---------
Popu I at f on Served ( Pub 11 c' __ _...N.JJ/uAi_ ________ _
No. of Connect f On!. (Pub I !cl __ _.N.1JluA"'----------
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 No.------- 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 1n boaes 111 l~r r191tt-hlllCI corner.
SWCB No.
O....ner No. G Date Heter Reading*
Ga 1 lons Watar Leve1°-
O.te Heter Reading*
&.lllons
~tar Level**-
Used
~utlc" I a Cnd of Lu t rton t11 782-~o WBA,,,
Used Static" "-i1na*-
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 7a~o - ~-
- lle*d atter,.., t111t t*c-day (prefft'*bly tnd of d*1I 1 ;.11°"'
Toi.I C..11ons
,r::, -
- 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'~
Toti Dur1 Tott o.,,
"9 llonUI 1 Optra tf 119 1111, Non tll During Qutrter
~,
Tot.II Os>er*tlnt J/
Dt,s tllls Outrter vi tll He, I tll Otp1rt11e11t Pfl'III ts.
O.f 0.,r
,,,lvtrl91 f "9 llontll o-
..11 i 17....,,.91 -
0.,rir,g Ouarttr
I iilnll blr*O l J-&O)
GROUND WATER PUMPAGE AND USE REPORT Tt.r if tf/
lb\\UI
~?-7~,4,lf QIJ1rter 1 2 l *4 w, tt r So..ru:
~~}{.__Vtll(s)
--- SP...1ft9(S)
S1~1c lxpartmcnl of Hu Ith and State Waccr Con1rot Board Pwbllc.
~nd copy of r~rt to t.<.llon.1 SUt.t lltt.tr Co11t~I Sotr'd Off1ct lf'Wf lt910ftll SUt.t Hult.JI ~~rtMftt Off1ct (Clrtle One)
County/Cl ty
___ lltll(s) 1nd Sprlng(s) lndustr111.
St11e1 copy of rtPOrt to ~1ollil SUU lilt.tr Contnil Sot,.. Office Ot~r.
S*nd cc,oy of rt:>ort to l~g1i>Nl $t,i.. V.t.tr Cont~I So.r,1 Offlct
- Surry "ame of Water-.,orts va. Electric & :ec,..ier Co. - Surry o..ller Va. Electric arrl Po.ver Co.
Address P O. Box 315 Surry, Va., 23883 Phone (804)357-3184 N.i~ of OoerHor N/A Position/Title -,N:,/,;A~-------------
S1Qn1turt N/A O.te __
N_/_A _____ _
Popu I* t ion Served ( Pub 1i c' __ __.N.,_.luA~---------
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. ______ _
SWCB No.-------
SWCB No.-------
Owner No. -------
Owner No. -------
SWCII No. ------- Owner No.--------
SWCII No.
Owner No. -------
SWCB llo. ------ Oimer Ro.--------
Meter readings ue 111 ___ 9~al,d..,.1,.lo~ns~---------------C9a11ons, lOOO's of gallons, cubic feet, etc.)
SWCB No.
O..ner No.
J Date Heter Reading*
~11ons W.ter level*.-
---~
Crtd of Lot 11MUI -z.l,~ 900 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- lud atter s111t tl111 11c11 o, (pr1fcr1bl7 tnd of d17)
- If ut111. rHd It tnd of --Pi-o1119 period
... If tlllfl, rud It end of llt1v7-puapt119 period
....,, ut111 111 one 10tll 111 1 fltld, specify wt.tell -ell ----
All pr1,1ttl7 or P\\IC)11e111y-owned public w1ttr supply s7slelll w1UI Huhll Dep,rt11e11t l)fnalts.
llott: If 17slell fs 11111ettrtd, tst1Ntt ~99 1 n bo.us t n 1 CMt" rf 9'tt
- MIid corner.
Toll
~rt Toti o.,,
0.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I '-lloiu "9 "°"UI I Opert ti "t UI ts IIOfl th 0.1 Dur 17.btr191 1ng llofttll Meter Read! ng*
Gallons Used 2.{,~ 700 /8'-
f!!:;J
/ ge:10 Tou I Gt llC1111
~r181J C),1rt.tr
,3/
Totll Ol)erlllllf O.,s Ulls Ou,rt1r
~
.i1il7 Avtr19f Owri"9 0.,1rllt' Va ter Leve 1 **-
St1t1c-1,...;1,..,...
/~(!:)O 3/
s-~
W,ttr ~r1:t:
---"}{..__Well(s)
___ Sp,-1119(1)
--- iltli(sj Ind Spr1"9(S)
- I'-' I I. I"'
GROUND WATER PUMPAGE AND U'SE REPORT S1a1t' ~p.artmt'nl of Heallh and State Walt'r Conl~ Board Pvbltc.
~nd copy of rt90rt to l~10NI Sutt ll1ttr Co11trol lo.l...s Offtct Ind ltglllftll Stilt He1lt.11 ~~rtN!ll Of'1ct 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 YHr lf9/
~th pc.. 7b 6$ffl Quuur 1 2 3 ~
(Circle One)
County/City
- Surry l'(c1,ne of Waterworks Na~ of Ooerltor -,?-.,.l/7A;;;---------------
Va. Electric & flo.ler Co. - Surry 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, ______ _
swce No. ______ _
swce No.-------
Owner No. -------
Owner No.-------
SWCB No. ------- Owner No.-------
SWCB llo, Owner No,-------
SWCB No, Owner IIO. --------
Heter readings ire fn __ _;ga~.. l.. lo~ns-_______________ (g,llons, lOOO's of g11lons, cubfc feet, etc.)
SWCS No, Owne N
..:.orJs-r~u""'--noN r o.
s,-re llotAt:
If systaa. fs 11raettrtd, tSt1Mtt JIUIIPl91 In bo&11 fn loooer r19llt-lllnd Cornet'.
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 I C.110llf Tou I Gt lions
- ~*d attar,... tfae uc11 d1y (sw-1fer11>>ly tfld of d*yl
- ff ut,11, rttd It tnd of 11011-P1-of"9 period
- If Ult11, rttd It tnd of lltny-pu111pf119 period
-**If Ultll 111 ont iotll 111 I fltlf, S~1fy wfllclt *11 ----
t *All prh1tAtly or put,llully-c:wntd 1>1,ellc w*tAtr supply S)'lt.e91 Tot.I Dl,r f ng llonUI Tou 0.ys I Operu I llf tll fs !Ion tit
"'...t 8 i"'o c:
Dl,rf119 Ou*rur
/p~e, ¥00 3/
Toul Operat111f Dl)'1 t.llfs Ou1rt1r
$/
wftll Httltll Otputioent perwfts.
0.1 Dur ly Awtf'IIJI 1 n9 Monti!
z.a? / &>
.J1ily lwtr19t z_o~/~
O.,r i "9 OMuttr
;G~Ri:uio:iiuj;::NirOlWW~A~T"°iERR°""iP>IU~M~PPJA~G;E~A;N;-;:D;;-;US;;E :R~E~PO~R~T;----:~:c*~--J v L ;(rt!
_ __....x.__ *11, 111,,
-~~
Spr1119(s)
___ W.ll(sl *nd Spr1"9(S) s,~1e ~partment of Heahh and Stace Warer Con1rvl Board Ovui.r 1 Z (J) 4 (Circle OM)
P11bllc.
StllCI copy of r~r-t to bglo,wl Sutt V1t.1r Co11tl"Ol Solnl Offlct,11111 l*9lcwl Sutt llfflUI ~~rtNtit Off1ct County/Cfty 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
=
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 No.------ Oaffltr llo. -------
SWCB No.
Owner No.
SWCB llo.
Otomer No. -------
SWCB No.
Owner No.
SWCB llo.
~ntr NO.-------
Heter retdfngs ire fn __..;g~asa.1.ll.:o~nsU2---------------Cg11lons, lOOO's of 91110M, cubic feet, etc.)
SWl:B No. z.f- /9o -S-oc::Owner No.
A Date Heter Reading*
611lons
~ter ltvtl**'*'*
Used St£t1c..
-"-~
Clld of Lut 11onUI 'i' <i? <i?S' 3 o D 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15 ttr Slat tlae HCII dlJ (prtftf'1bl1 tnd of d11) 111 1 rHd It tlld of IIOft-PYIClf 119 periOd 1t11t, rud et tlld of IIHYJ'*pulllpf 119 per10d
- If t1t,11 111 ont.. 11 In I fftlf, spteffy wtifch --.11 P"""fn,-*
~~
t All pr1nttly or pVblfc,lly-owntd public **tar 1uP<<)lJ' systeaa wiUI HulUI Oep1rt*Ht puwtU.
llota:
If 1y1taa ts umtttred, tstiNtt ~99 fn boos 1n lo.r rf9ht-llilld CONlff.
Tot.I Ourf Tott O.y1 Dlte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I &I 110ftf
"'i.u.
I Oper1 ti 119 UIII NoftUI 0.1 Dur 1y AYer19t f ft9 Mofltll Meter Readf ng*
Gallons Used 91~r100 ZG? lf"OO Z~ ~ ?co Tot.a I C, 110ftl Our1119 ~1rter 3/
Toul ~r1tlllf 0.y, UI 11 Qv1rttr 7//35
.11 i ly A,tr,91 During 011,rur V1ter level**-
St.lttc.. "'-1-***
z.t.7/ 3"0CJ 3~
7,f~ S"
GROUND WATER PUMPAGE ANO USE REPORT
- ~ Actt~r =
_ _...,X..__ Wt II ( s)
--- Spr1119{1)
S1.u~ ~partrM-nl or Hulch ind Stace Wa1u Coner-vi Board Pwbllc.
Stl'ld cop11f rfi)Or-t lO le1fONI St.Ht llattr Co11trol to&rf Offfct.,..
()Jut.tr 1 2Q) 4 (Cfrtle One)
_____ Wtll(sl 1nd Sprf119(s)
- ,91Dftll Sutt MNIUI ~~rtatftt Offtc1
- l"<lustrt1I.
St/Id coo, of rtPOrt to le1fONI Sutt V.t,r Co11trol lo,sr-4 Office Other.
Stnd co01 of rtPOrt lO *,9101111 Sutt V.ttr Control ~,.., Offlci County/Cfty
- Surry of Wa te!"'cOrks Name of Ooer* tor _ 11';:;--T/TiA~-------------
a, Electric & Po.ver Co. - Surry Posftfon/Title __ 1N:,-/r,Ar--------,1n"+:,.,._-----
v Elect l. c
--...1 n.-.~- Co N/A Nt'A e>.M!r
- a.
r cuu rvw-=.
Sf<1n*turt---------- OUe --------
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 ------------------------
1 f 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 No.-------
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.)
SWCB No. Z,
- /!::o -.5o~Owner No.
DAte Heter Reading*
1 2
5 6
7 8
9 10 11 12 13 14 15 tar,... tfae ttcft d11 (pr1f1r1,11 efld of d11J
, rHd,t tl'ld of non-~flllJ periOCI 111 0 rt1d at end of IIHwJ-~1119 period
....,, Ul111 fn Ollf *II tn I fl1lf. spectf7..tlfcll.,..11 ----
t A11 prhU.elr.or pwllcall1*owned publtc w1tar suppl7 s7sle99 w1UI Kt1IUI Oep1rt11ent perwtU.
llote: If S)'Sta IS UNleUl°t'd, tstillllt pu111199 tn bo1n 111 l°""r rtgllt-llllld COMIIP, Dlte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I ;a 110ftf Toti Dur '"' llofttll I Oper1tf119 Toti o., s UI Is lion U1
. 0.1 0..r 1, A_werlCJt f ng Noftlll Meter Readf ng*
C.llons Used f 37~/DO z.19000
'Z I ?,r:n:, e:>
Tot.a I GI llOftl Durlog (),1rter 3/
rou I Op,re tt"'
0.11 UII I Qv1rttr 7 Ob S---
.,. i IJ l,trt91 0..r, "9 Outr ur Wit.tr Level**-
Sta Uc.. l"'-i1na*..
~2' ff; 3'0 0 b<
7~:z-0
uHOUND WATER PUMPAGE AND USE REPORT t tH ---- -/,.? P,r./
Quutar Se-P"7e"(1~
1 zl'f),
(C1rcl'e6ne)
_........ x.... *_ we"<, 1
-~- ~Pr1MJ(sl S1.11~ tkputm~nc or Hcaflh and St.ate Wac~r Concrvl 8oar4 P11bllc.
Sflld copy,, rfPOr-t to ie9IONI Suu lllttr Control ao.r111 Offlct lllf Rt9fon,I St.alt HttlUI O.p,rtNftt Office
. lndustrltl.
Stftd c097 of rtport to ~lon,I St.au 14Ur Co11tr11l lo.1'11 Offftt Otner.
Stncl caoy of report to Rtg1oNI St.at, w.ur Control Sotrd Ofrtu County/City
- Surry
___ 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 --------
Address P O. Box 315 Population Served (PubHc' __
_..,N,.../._.A...._ _______ _
NJA Surry, Va., 23883 Phone (804) 357-3184 No. of Connection" {Pub1fcl __
Nu.u!Au,._ _______ _
+
Uperllt1on Per111t Huilt>er (PubHc)...
N...,IJ.._A..__ _______ _
Type of u~e:
Puhl1c __ !ndustr1a1__.X_ Other (specifY------------------------
lf aieasurenents are for I s1ngle-11eter field reading, 11st wells included 1n f1eld SWC8 Ho.
Owner No.
SWCB No.------ !Mier No.-------
Sl<<:B No.------- Owner No.-------
SWC8 Ho.
Owner No.-------
SWCB llo. ------ Owner No.-------
S\\iCB No. ------- Uifner NO.--------
Meter readings are in ---:.i9:),>a.,..l...,l,,,.o;:.,ns..._ ______________ (gallons, lOOO's of gallons. cubic feet, etc.)
SW\\:8 No. Z 9 -/5'0 - ~o c Owner No.
A Date Meter Reading*
Gallons Wattr level*_.
Sutic" P'IIICI f 119-'
End of f37_//oo I
lUl l',ontJI 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15 aeter SAllt tfae,ecll d*1 (Pf'tftr,bly tnd of d*y)
~. rHd It tlld of IIOfl*P\\IIIIPfllCJ period le11, rud It tnCI of IIHYJ-~1119 per10d t,ttll Ill Ollt iotll !11
- f1t1d, IPK1f1...t\\lCII 111tl1 ----
t A11 pr1Yl\\.11J or publtc,117-ow~ put,11c w1tar supply sys~
wfUI Hu1UI Oep1rt111t11t peratu.
llow: Jf 11st. ts unaettrM, estwtt ~91 111 boau h J~r r19)1t-11111d corner.
Tota Dwr1 Tot*
Days Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I &tllOM 119 "°""'
I Optr1t!nt thh MonUI Dal Our 17 AYtr19t 1119 "°ntll Meter Reading*
&lllot1S Used f 5".r/; loo /~J 3oO
/~7 300 Toul Gtl10fts Durt119 Quarur 3e;,
Toul Operu1119 Da71 Ulfs Ov1rt1r
~5'77 AilJ A,trt9t 0..r i "'9 Ovtr ttr W1 ter Leve 1 u-St.a Uc-IP\\ai111Q***
h~h /oo
'Yr;;-
~fob
GROUND WATER PUMPA GE ANO USE REPORT d St.ate W11~r Control loar4 S1a1~ ~par1m~n1 of Hullh an P11blle.
~IICJ copy of r~rt to Re91on,I l1910NI Stitt twtlUI ~p.er~
- lnd11strt1l.
Stfld coc,1 of r,p0rt to le9lo Other.
Send CDOy of rtPQrt to l191on,I S
_ _,.X.__ II~ 11 ( s J
--- Sprt119(s)
Stitt Vat.tr C411trvl ao.r11 Offfct IN t Offfct
___ W.ll(s) *nd Sprl"9(S)
IWII Stitt V,t,r C411trol lo&ro Office Ult V.ttr Control lo,a~ Office of Waterworks Ha N of Ooer* tor N/A ric & PoNer Co. - Surry Po va. Electric and Pa,..,er Co.
5 sf t fon/Tit Je N/A fQn1turf N7A Addl"ess P O. Box 315 Po pulat1on Served (Publfc' Surry, Va., 23883 Phone (804) 357-3184 No
- of Connection~ (Publfc)
+
~
Type of U\\e: Puhl fc __ 11'\\dustrf.t 1-.... X_ Other (specify_
er1t1on Perait Nu=t>tr (Publfc)
Jf measurenents ire for I s1ngle-11eter ffeld re1dfng, 11st well s included 1n ffeld SWCB No.
Owner No. ______ _
SWCB No.
Sll.:8 No.
Owner No.-------
SWCB No.
swca No.------- Owner No. -------
SWCB No.
le-tr 1r r,
!%>nth Tc.;Tr Qv1rter 1 ~~
(Cfrcle
)
County/Cfty
- Surry Dile N]~
NlA NIA tU6 Or.mer No.
C>wner No.
O.ner IN>>.
Meter rHdings ire fn __ -.:;;:1g"'"a""'l,.l.:.cO:£.Jns=c...---------
(g1J1ons, lOOO's of g111ons, cubic feet, SWl:B No. '3 c, -
I 'f o - $°I c.. Owner No. "6 Note: r, system h uMetem, 1St1Ntt ~,.
111 !loan 111 I~ r 1 gllt-llllld COl"fter.
etc.)
Datt Heter Readfng*
Dile Meter Re1dfng*
Glllons wuar Level.. -
1 2
5 6
7 8
9 10 11 12 13 14 15
- .ter s~ c1ae ucll d11 (prefercbl1 end or d11J
'"* rHd It end of 11011-pu111p1119 period
&lift, rt&d ll end of ~e1v1-~1119 ~r10d
.... If t,t111 111 one wll 111 1 field, SPK1fy wtlfcll liftll ----
- All pr1w1tal1 or i,vbllcall1-owned publ1c w1tar supply systeaa wf UI lltl I tll Dep1rt,1t11t ptraf U.
Tota Dur1 Tot*
Di11 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I S.IIOllf "9 llollUI I Operu1119 tllf I llon UI 0.1 0..r ly Anr191 f 119 Kofttll Used Stattc.. "-nt-flQ*-
~17~~S"oo f 327 /oo 9 :3Z7 /00 Tou 1 Iii I IOftl Durl119 Quarter
'J 3"2-7 /0=>
33 rota! Operat111t 33 Di,i tllfs Ouarttr Z8'Z.'-3 f
.11 i 1,,.,,,191 28 2.!-3 &J O.,r1119 011*rttr
GROUND WATER PUMPAGE ANO USE REPORT I Hr t J 7f
~
th
- ru L.-'(
_ ___...x._ Ile 11 ( s J
Spr1119(s)
___ W.ll(s) and Sprt119(1)
S1a1~ [kpanment of Health and Sta~ Wa1~r Conrrvl Board Pwbllc.
~nd copy of "90r1 to ft~IOM*I Sutt llattr Colllrol to.rd Offlct alld
- ,9tonal Sutt IIHIUI ~p,rtNftt Office
. lftdustr111. S~ cooy of rtport to fte910flll Sutt V.ttr to11tN1l io.l"d Offfct Ou~r.
Stnd cooy of rtPOrt to llt9lorwl Sutt V.ttr COlltrol loi"1 Office Quirt.er 1 Z ~
/4 (Cfrcle One)
Cnty/Cfty
- Surry me of Waterworks Name of Ooer1tor _ 11'::;-l/11A~--~----------
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 t
Type of U<1.e:
Puhlfc _
11\\dustrflJ--X_ Other (specify _______________________ _
Jf measurements ire for I sfngle~ter ffeld re1dfng, 11st wells fncluded fn ffeld SWC8 No.
Owner No,-------
SIICB No. ------- Owner No. -------
SWC8 No.
Owner No.-------
SWCB No. ------ Owner llo. -------
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.)
SWCB No. 3 I-I 9o - 5"" z.. C Owner No.
Date Heter Reading*
Clld of Lut NontJI Z I Zt:j 7 9-0 o 1
2 5
6 7
8 9
10 11 12 13 14 15 tar sa.e ttaa tic* day (prtf~1bl1 tncl of d11J tt1, rNd,t tncl of IIOII-P-IIIP1119 period 1*1n, read At tncl of 11,1,7,pu.pl119 period
.... f tallR 1n OM "'" In I fltld, IPK1f7.tllcll 'dll ----
All prh1ttl7 or pw1full7*0WIIH puC,llc wit.tr 1uppl7 s71U..
wlUI Hteltll Oep1r1-11t perw1U.
Nott: If s11ua ts u..-ttrtd, Ht1Ntl ~9' fn t,ous* 111 la.er rfgllt-hllld conwr.
Tou Dlirf Toti D171 Olte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 Gillon, "9 llofltll 1 Operatfng tll 11 Mon tll 1111 Our 17 A,er191 1 INJ Month Meter Reading*
&lllons Used z{-07/ ooo 2 773 ~00 Toul C.IIOftl Z 77 3 ~OG>
D1,rt119 Ql,arter Total Operattnt 33 D111 tllls Ou1rt1r 8/o~r
.>4i1J btr191 O..rl"9 011trttr Vilar leve1**-
Static- !"-fftQUI 277 3 ~Oc::::>
..33 g-_,/ of-'f
_-.A.X..__ I.le II (,)
-~-- Spr1119(1J
--- lltll (1) *nd Spr1119(1)
GROUND WATER PUMPAGE ANO USE REPORT Su,ce ~partm~nl o( Hullh and Suc.e Wac~r Concrul Board Pvbllc.
~l'IG copy of rtP(>rt lo l~10NI Stilt Waltr Co11tr-ol ao.n1 Offfct 11111 llt9lon1l Stitt KHIUI ~rtM!ll Office
- Industrial.
Stftd CoPY of rtpOrt to le91on.l Stitt W.ttr Co11trol to.r-ci Office Other.
Send ccoy of rtpOrt to 1,910~1 Stilt W.ltr Control ao.rf Office f
!!ton tJi
..:;T v L ;/,
Qv1rter 1 Z & 4 (Cfrcle Ot,e)
County/City
- Surry 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: Public_ !naustr1411--X_ Other (specify _______________________ _
Jf measurements ire for I s1ng1e-11eter field re;id1ng, lfst wells tncluded 1n ffeld swca No.
Olmer No.
SWCI No.------ 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.)
SWCB No.
Owner No.
p Oat~
Heter Read fng*
Glllons Wlter level*.-
Clld of
/cJ6CJ 600 LHt l10ntll 1
2 3
4 s
6 7
8 9
10 11 12 13 14 15 atttr saae t1at tecll d*Y (pr1ftr1bly tlld of dly)
"'* rNd It tnd of IIOll*PYII01"9 periOd
"* rttd It tnd of 11t1w7-pu111p1119 per10d
"**If tiltll 111 Ont 11111 111 I fltlf, IPKtfy llfl1CII ~11 t
A11 prh1t.tly or pwllully-owfttd putil1c wetar supply 171lt111 wi U1 Hu I tJI Otp1rt11e11t Ptl"III U.
Nott: Jf 111ta ts ul'lllft.tnd. tst1Mt.t pu11p,&91 fn boxa 111 IO!iler rfgllt*llllld CONllf'.
Toti Our1 Toti 0.111 O.te 16 17 18 19 20 21 22 23 24
- ?5 26 27 28 29 30 31 I I.I I lORt 119 l'lotlUI I Oper1t 1119 UI 1s Non t11 0.1 Dur ly*.her191 1n9 Monti!*-
Meter Readf119*
Gillons Used I 31S:-7e,o 32.S-/Ot!?
Toul C.IIOAI 3 z_,S-/oo Dl,rl09 ~1rCAr roul Optrllfllf 33 0.1' Ull 1 0,.,1rttr 18' ~Z-Jt I I 1 l,tr19t Ovr 1119 Ou1rttr Water level**-
St1t1c- '"--t-***
J2-s- /60 33
- r g_s-~
~-'}{~ ~11(1)
~-- Sprl119(1)
___ llfll(sl 1r-d Spr1119(1)
GROUND WATER PUMPAGE AND USE REPORT S1Ht' ~~nm~nl of Hullh ind St.lite W1:11ev Con1rvl loartl Pub I le.
~ncf copy of ~rt to t.g lo,wi I Sutt Vlttr Co11trol ao.n11 Off let lllf Rt9fOt11l Sutt ~tlUI ~rtNrtt Offl(I llldustrlll.
Stnd coc,y of rtp0rt to ~lon,I St.Ht V.ttr Contr11l ~,... Offlct Othtr.
Str.d coo, of rtpOrt to ltg1o,wl Sutt V.ttr Control ao,,... Offtc, hlr /~v
'%)n~ ~~
. Quirt.er 1 z 4 (Cfrclt One)
County/Cf ty
- Surry 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 No.-------
SWCB llo.
Owner llo. -------
SWCB No.------- Owner No.-------
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.)
SWCB No. /5'2.. -190 -
Date Keter Reading*
1 2
3 4
5 6
7 8
9 10 11 12 13 14 15 aettr saae tlat Hell d17 (Pf"tftr,bly encl of d*1I u,1, rHCI,t tncl of IIOII-Pl-o111CJ period 1t111, rud at encl of llt1*1-~1119 period Ultn 1n one iotll 111 1 f11lf, 1Pte1f7 1.tilcll wll ----
f All,r1wuel7 or publfct11J*OWlltd P\\Allic w1ttr supply S)'Sltaa w1 UI Hta 1 UI Otpari.tnt penal ts.
llote: If systa ts u..ettr"td, Ht1Ntt ~
1n boan 111 lowr r1gM-~IICI corner.
Toti Dur1 Tott o.,,
0.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C.11*
11CJ llollUI I Open ti 119 Ul1s llonUI 0.1 Our 17 Awtrage 1119 Moll tll Heter Reading*
C.llons Used S-e, b 3o oo~ 2 722. 700 Toul GIIIOAS z7zz. 700 Dur 1119 1)1 Ir tet' 33 rou 1 C)pfra t1 "I Da 11 tllf s Quarter
'8 ZS-o C,.
.11111 lvtrt~
Dur i "1 Outrttr VI ter ltve 1 **-
St1t1c" P\\a,f,,.,...
272-'2.. 700 33
'8 Z-S-00
....., ""' ;,--(>, lJ*&....,
GROUND WATER PUMPAGE AND USE REPORT Tur_--.:.l~~'--7'9:..._:._I ___ _
!fton di __
...;:U:..f:.;;;._'-11----
l 2&c (Cfrde One)
_ _j.}{.__~11(1)
___ Sprl119(sJ S1.11~ Cxpartm~nl of Hrallh ind Su~ Wac<< Conrrol loar4 P11bllc. ~,., copy 1f "'90r-t to ~loiwl Sutt 11,tt,. C.011tl"OI S.C.t"41 Offlct u*
h9lon11l Sutt IIHIUI ~r'taellt Off1c1 lllduHr11l.
Stftd coc,y of rtpOrl to ~101111 Su~ ll.ltlr C.011V"OI lott"41 Off1ct Other.
Stnd coo, of ~rt to lt91o"'I Su~ W.ttr COfltl"Ol 8o.at"41 Off1ce County/Cfty
- Surry
___ 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_1_/A ____ 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 No.------ Owner lo.--------
SWC:8 No.
Owner No. -------
SWCB llo. ------ Owner llo. --------
SWCB No. ------- Owner No.-------
SWC8 lo.
Oimer "°* --------
Meter readings *re fn __ _;g:;l!a.i..l._l...:a..::ns~--------------<Vlllons. 1000's of 911lons, cubfc feet, etc.)
SWCB No.
Owner No. F D.!tt Heter Reading*
Gallons
!Qt.er Level*.-
Cnd of Lut PlontJI 3S-7330 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15 11tUr saae tfae HCII d11 (prtftr1bl1 Ind of d11) 1lffl, rHd 1t,,., of --~1119 per'1od Ul111, rud It tnd of 1111,,-~1119 pe,-1oe1 If Ultn 1n one '"'" 11, 1 f11IC1, 1p,c1'y wi1cll i.ell ----
t All pr1,1u1, or put,llcall1*owntd public **tar supplJ,,,r.e.a w1tJI HUltJI Oepjrt;9ent Ptralts.
Iota:
If,,,i. Is UlllleUrtd, Ht11utt ~
fn bolff 111 l~r rf9M*Mlld COl"ftlr.
O.t.e 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 Cillcw Toti Dwr 1119 lloflUI I Oper1tf119 Toti Day I Ulls NonUI 0.1 Our
,,,btrlljlf 1119 Nontll Meter Readfng*
S.1lons Used 3.S-8' 381)
/DS-0
/o S-o Toti 1 Ca IIOlll Dl,rl119 l),1rter 33 rot.al 0perlt111f Dl,r1 Utfs Qvirttr 32.-
.11ily A,trl!lf Our i"9 Ovtrlft' Ill ter leve 1.. -
St1t1,- 'P\\aifM*-
/o 'S".o 33 Jz.
_.....,){.__ W~ll(s)
___ Spr1119(sl GROUND WATER PUMPAGE AND USE REPORT tt l
,qt...:... __
%Jon tJt _ _.,.._/ __ d_L.;;.."7';"--*---=-
Quui.r 1 2 l 4 (Cf~le Ont)
S1ac~ O<<-panmtnl or Hullh and Su~ Waler Concrul Boar4 Pwbllc.
~ftCI copy,, rlH'Ort to ~IOMI Sutt 1111.tr C411tr,il..,.,.. Offfct ll'f h9fon,I Stu.a NttlUI ~p.arbNftt OH1ct
. !nd111tr111.
St11d copy of rtoort to le-9101111 Sutt W.ttr C411trol 14.1"11 Off1c, Other.
Stnd CDOJ of "1)0rt to h910111 I Sutt W.ttr COlltr,il ao,,.. Off1ct County/City
. Surry
___ 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 _____ _
..,. \\.C --------
Addrus P O. Box 315 Population Served (Public' NIA 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 No.-------
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.)
5WC8 No.
Owner No.
6 Date Heter Reading*
£/Id of
~1 z__oo ust r10nt11 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15 ter,.., tfae ttcll dtJ (prefer1bl1 end of d11J fft, rNd U tnd of no11-P,..,.P1"9 periOd 1len, rt1d 1t end of lltlYJ*P\\111111119 per10CI f Ulen 1n one -ell fn I f1t1d, SPKlfJ wfl1CII wll ----
All prhattlJ or pvc,lfull1-owned public w,tar 1u1>9IJ systeaa w1 tll HU I tll Otp1rt,aut Ptl"ll1 U.
Nott:
If lyltA!a fS U!'Mlt,-.d, tstiallt ~ge 111 bo1as 111 lo-er r1911t-ll&lld corner.
Cite 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 ;.110ftf Tou Ol,r 1119 ftotlUI I Opern t 119 Tot*
o., I Ult I llontll 0.1 Oo.ir IJ Anr191 1119 Montll Meter leadfncJ*
6111ons Used 7?/ao
- 2. "3 '1 e:, e,
- Z 3 1'0 e:,
Toti I C.11 OIII Dur1119 l)itrur 33 roul Oper1URf D111 tllh Quarter 72.~
_,. i 11 lwtrt9t O.,ri "9 011trttr
'111 ter Leve 1 **-
St.attc-IP\\ai1-*..
Z3 900 33 7 z.r.f
e I I I"" I I ** r-\\
GROUND WATER PUMPAGE ANO USE REPORT S1a1c lxputmcnt or Hcallh ind Sute Warcr Con1rol Board Pwbllc.
~nd cop, of report to laifONI Sutt V1ttr Co"trol loirel Offlct IIICI THr~L-;/fe'r--,t-~..:../~~~
Mon di __ >{;::o..,:cJ~f-=-=,.G/~--
Qu.arter 1 Z (14 (Cfrcle One)
-~X.__ 11t 11 ort to Rtgiorwi Sutt luttr Control Sofrel Off1ct tounty/C1 ty
- Surry
~ame of Water,;orts Name of 0Derltor --;?-.,-l/7A;:---------------
Va. Electric & Pc1Ner Co. - Surry Pos1t1on/Title __ --.N-.'"/7iA;---------.er-+4------
--- --~
N/A N/:A Owlrer Va. Electric arrl pa,,.,er Co.
S1Qrwtur*--------- Dile--------
Address P 0. Box 315 Population Served (Publ1c 1 __
_...,NLL/AaA._ _______ _
_ __,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 No.--------. Owner No.-------
SWCB No.
0-ner No.-------
SWC8 No.
Owner No. -------
SWC8 No.
tAitner IIO. -------
Meter readings 1re fn --~ga~lr...l~oens-.... ______________ (g,llons, lOOO's of gallons, cubfc feet, etc.)
-SWCB No.
Owner No.
Date Heter Reading*
1 2
3 4
5 6
7 8
9 10 11 12 13 14 15
- letd *tter u* that t1U **, (pr1fer1bl1 tnd of d11J
- 1r tllt11, rHCI It end of --~1"9 period
- If tel111. rtlCI at end of lltnJ-~1119 period
"..,, tilffl 111 one 11tll 111
- f1t1CI. spec1'J Wlfcll wll ----
t All prh1ttl1 or,u&1fct11J*Olfned p\\Al11c wit.er supplJ 1,ittaa wfUI Nttltll Otp1rt1111ent ~111fts.
llou: If systa 1s ul'IDtttred, est1uu puill)l91 1n boan 111 10\\ler r1gllt*hllld COl'ftff.
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C.1111111 Tote 111,r fng l'lollUI 1 Clpfrat1111 Tot.
Diy s tllf s Roll tll Dil Dur 1, lYer191 fng Nofttll Meter Reading*
Gillons Used Z.~2 300
~
/Dt0
'.,//t:>~
Total GtllOIIS 111,rtng Quarter
..33 Total Opcrtt1nt Di,i tllfs Quarter
- z.f
..,. ilJ l,er19t O.,ri119 Ouuttr VI ter Leve 1 H" St.Ute-,,._,11111*-
-,t /a.:::,
.33
/Z.j
... -~* tjr,a ~**,J-&:;,;J II Ht r So.. re, :
-~x..__ 11,11c,1
--- S~l119(1J
___ lltll(sl And Spr!"9(S)
- *'*.,..., ** I"'\\
GROUND WATER PUMPAGE ANO USE REPORT s,~,c CHpu1mcnr of Hcallh and State Water Con1rul Board P11bllc.
~nci copy of r~rt to ~ton,I Sutt ll1ttr Co11trol to.l"CI Offlct llld ltg1on1l Sutt HulUI ~p,rtat,it Office lndustr111. S~ cop7 of rtl)Ort to ~101111 Sutt W.ttr CGntrol lolrd Office Ot~r.
Stnd co0y of rtl)Ort to ltg1on,I Su~ ii.~r Cont~l lo.NI Offict Yeu
- /'?'f /
lbn th ::ru '-i Quui.r 1 2 (j 4 (Cfrcle One)
County/Cfty Surry N,une of llater.orks Na111e of Ooerltor _ 1fi:;-l/7iA~--------------
\\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 ___ 8.... 3_ Phone (804) 357-3184 No. of Connection" (Public) __ Nu..t.,/A~--------
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 No.------- Owner No.-----------
SWCB No.
Owner No. -------
SWCB lo, Oiitner No.-------
SWCB No.------- Owner No.-------
SVCB llo.
~ner 110. --------
Meter readings are fn ---'ga_.1... 1...,oo<:ns-=---------------Ciillons, lOOO's of g11lons. cubic feet, etc.)
SWCB No.
n..-
No C:::::...NS.~cJc..-r-iol\\l llote: If systa Is 1111Dttlt"ld, esUutl IUIPl91 u,,rrer
-:s1-re:
fn bous tn !!*tr r1911t-llllld COt'ftff, Datt Heter Reading*
!Ater leve.l**H
[lld of z</3/,//a Lut "°"tll 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- llud *tt1r,.. tla, HCII dlJ (pr1ftr1bl7 Ind of d17J
- Jf t1t1n, rttd 1t,ncr of IIOft*~lng p,rlod
- If t1l1n, r11d It end of llt1v7-puapfng period
....., Ultn 111 Ont "'II 111 I,1,1,, 1pe<if7 llftlcll wll ----
- . All prh1t1ly or pvblfcally-awntd publfc w1t1r supply 17'\\1111 witll Hul_UI Otp1rt11ent Pt,.fts.
Tot.I Durf Tou o.,s Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I Cl 110llf 119 flontll I Clptr1t1111 tll ts Non t11 0.1 Our
,, Avtrll)e 1119 Montll Meter Reading*
G.lllons Used ztf 7s-~ t.oo 4~z 5"oo
,14z..
Tou I C..110ftl Soo DurflMJ Qy,rur 33 Tot.II Oper1t1111 0.71 Ulls Quarter
/,3-¥o"f
.11 il7 l,er191 0..,rin, 0111rt1r lqter level....
St.tttc" l"->11111...
- z. S""""c:> 0
,33
/37',o~
... --~--.--
GROUND WATER PUMPAGE AND USE REPORT THr _____ (;~~.,,z-.:,-J.~I--
~
tJI __
Ay......._ __ 6;;...;.J._s-:...7 __
1 2 d) 4 (Cfrcle Ont)
_ _..,X._ w~111s1
--- S1>rl"9(S)
Srur lkp.utmrnt of Hullh and St.ale W11rr Con1rol Boartl P11bllc.
StllCI cop1,, rmrt to *~10MI Sutt Wet.tr C.011trol to.r,11 Offtc, 1-,
- ,9to,wil Sutt KttlUI ~P.,.~t Offtct
- lft<111strl1l.
Stftd copy of rtpOrt to b91on.l Sutt W.t.tr C.011trol to.I'd Offlct Ottier.
Strwl ccoy of rmrt to h*gtorwil Sutt II.et.tr Control loui Offlct County/Cfty
- Surry
___ 11,ll(s) 111d Sprl119(s) 6"" of Water...orks Name of OoerHor N/A
~* Electric & Pc:Mer Co. - Surry 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. ------- 0-ner No. -------
SWCB No.
O.,ner No. -------
SWCB No. ------- Owner No.--------
SWCB llo.
Owner No.-------
SWCB No.------- Uifner IIO. --------
Meter re1dings ue in --~g:ida.cl.-1.:.:o~os~-------------- (g11lons, lOOO's of g11lons, cubfc fttt, etc.)
S~B No. 3o -l'f o-5"/C. Owner No.
B Date Heter Reading*
G1 l 1 ons Wlttr Level*._
Used iUJ r,IJII/.//J fl///////./J Clld of 6%78~~c:> ~,
Lut r.onui 1
2 3
4 5
6 7
8 g
10 11 12 13 14 15 ter S&at t1ae,1cft d*y (pr1fer1bl1 tfld of day)
"* rHd It tnd of IIOft-p,,aci1119 per10d t
Ill, rtld It tnd of ~IYy-~1119 per10d
"""" f lt4-
~
~
- ,, ut,n 111 Ol'lf "'" Ill I fltld. SPKtfJ wlllcll wll ----
- All prt,1t.1l1 or pVblfCJll1-owned public wet.Ir supply systeaa wl U1 HH I tll Oep1rt.,flll Ptrwl U.
1
- f RE.AJ:>INq 13r\\SE1) ON IZ MoN~s p~-rA 8/i:fo-7/f/.
Nott:
If systa ts urwettnd, tst1Ntt ~91 In bou1 h lowr r1911t-1'111d COl"ftef'.
Toti Dl,rl Tota o.,s O.tt 16 17 18 19 20 21 22 23 24
~5 26 27 28 29 30 31 1 Gallon, 119 llotltll I Opertt 1119 Ulls NonUI O.f Our ly Anrage 1119 Montll Meter lleadf ng*
Gillons Used 7'i?~/ 233 1t,t:,zt,, 733 7 '8'<-/1 z 3 3 Toul C..IIOIII Dl,rl.. (),art.Ir 3/
Totll Opernhit 0.71 tlll_s Ou1rttr zs-z, 6/J:f-3
..,. i 1 y l,tr19t
°"""9 Ov*rttr W* ter Leve 1 **-
St.attc- !~f11Q***
/7/~g333 r:,,/
Zt,,'tz~s;-
_.....JJX.__.,, II ( s)
SprlftCJ(S)
____ V.ll(s) *nd Sprt119(s)
GROUND WATER PUMPAGE AND USE REPORT S1a1~ ~panmtnl of Hullh and St.le Wa1~r Control Board Pwblfc.
~no copy of rt90rt lo lt110l\\al HH1 ll1tar Colltrol 10.,'f Offlct 1iw1 Rt9lon1I Suta tw1IU1 ~P.,.tNflt Office
- lfldustr111.
St/Id coe,1 of r,p,ort to b9IOf\\ll Sue.a V.tar Coftt.rol ao.r11 Offlct Other.
Stnd CtiOJ of rtp,Ort to b91orwl Sutt V.tar COfttrol lolr'11 Offlct 1 ~ r
,/1 197:t...
- bn tti
.A7;GcJ s 7 Quarter 1 Z cf) 4 (Cfrcle One)
County/Cft7
. Sun:y 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 C specf fy ------------------------
1 f 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.)
SWCB No. 3 I - 19' o - 5 :z.c. Owner No.
C Dau Heter Read 1 ng*
Gillons W.ter lev11*.....
l'iaiplM-'
Cftd of Lut t'onUI z/07/00,..,
1 2
4 5
6 7
8 9
10 11 12 13 14 15 ttr,.._ tlllf,1c11 dlJ (pr1f1r1bl1 end of 01,J
,11, rHd u tncl of r,o,1-l>'JIC)lll9 period ll111, rud at encl of 11t1w1-~1119 per1ocl
....,, tlltn 1n 0111111111 1n I fltld, specify Mfllcll ~11 t
All prluu1, or put,llull1*owntd public w1t1r supplJ 111tea1 w1UI kUIUI Otp1rt.nt Ptl"lllts.
I
!Iota: If systea ts u..-tlrtd, nt1111tl ~91 In boau 111 lowr rl911t-llind COMlff.
Toti Dllr1 Toti o.,s Oite 16 17 18 19 20 21 22 23 24
- ?S 26 27 28 29 30 31 I C.llon, 119,tonUI I Opernt119 UI 1 s Pion tll 0,1 0..,r ly Awtr191 1"9 Kontll Heter Readf ng*
Gallons Used
- zt/o 7/000 -- ci-o-
Toul C.IIOAI Dur 1119 Ou Ir tar rot.al Orllratt119
..3/
~Tl Ul1s Q..,1rt1r o-
.>ti I 7 A,tr191 D..tri~ Oulfttr Wat.tr level**-
St.1t1c- '"-i1M*-
2773/boo
&:>/-
~,3 3_~8"
GROUND WATER PUMPAGE AND use REPORT s,ac~ ~partm~nt of Hullh Ind Staie Wat~r Control Boud
_......,X.__ W*ll(s)
Pvbllc.
SfftCI copy of ~r1 to lt,gfONI Sutt Vtttr' C.011t'1II lo.lrf Offtct 1~
~Ui Au6u57 Qu1rur 1
- 2 (1) 4 (Circle One) l*9I0111I St.Ht IIHIUI ~r'1afftt Offtc1
--- SPr'1ft9(SI
- lnd11Strlll.
St!IO copy of rtPOr't to ~tonel Sutt IIU.1r C.011tn1l '°"' Offtct County/City Other.
Stnd coo, of rt90rt to l*gton,I Sutt W.ltr COfltr-ol 1o,a,.., OHfct
--- Wtll(s),nc1 Spr1"9(S)
- Surry me of Waterwo,.ts Hal!W! of OoerHor N/A Va. Electric & Pc,.,Ter Co. - Surry Position/Title ___ ---.
-.:N;/~A~============~=============
--..l CO 1/A Nt'A Owlrer Va. Electric c1H-..1 pc,...ier S1qnaturl' N
"*te 119 Add r us P O. Box 315 Population Served (Public' NIA 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 No.------- <>.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.)
SWCB No.
Owner No. y Dau Heter Reading*
[nd of LUt l'ontll / 3 8'<::'7 00 1
2 5
6 7
8 9
10 11 12 13 14 15 ttr s1a1 ttae ttcll d*1 (pr1fertbl1 tlld of dly)
,,., rttd u tl'ld of IIOfl-p,,ac,1119 per,ocr 111, r'ftd It tnd of llt*w1-~f119 period
- 1, tattn tn one _.11 fn
- fitld, IPt<tf7 -.felt wll ----
t All Pr'hltely or put,llcally-owlltd Public **tar luP917 sysu.a with HulUI !)ep1ri.ent perwtu.
Note:
If systea ts u.-ttred, tst1Mte ~91 fn bou1 111 lor,,er rtgllt-tlllld CorMV.
Olte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I &.a 1 IOllf Toti O..r f 119 lloftUI Toti 0..11 I ~,.*tlllf tllil NonUI 0..1 Dur 17 Anre(Je 1119 14ontll Keter Reading*
&lllons Used
/ S-'f~~e)C, Z.o 'f 70(:)
Tot, I C. I IOftl
- zo.? 70c, 0.,,11119 Qvnur 3/
roul ~rltfftl Di1' tJ\\11 O,,trttr
~ 76s;-
...,,,...,,.9t D.,r1i,g Outrttr V1ter Level**-
St.Ute.. "-tna***
5: 3 ~
8""00 6-i 3' 3 ~t:,
D WATER PUMPAGE ANO USE REPORT lb\\ tll -~'-"'-'6=v.;;;.s;....;-r __ =
Si.ate lxpartmenl o( Hullh and Sta~ Wa1cr Con1rol Boar..
1 2(])4 (Cfrtle One)
~_..:,C...__Wclt(,)
~-- ~pr1119(sl Pwbllc. ~"° copy of ~r1 to bglo,wl Sutt Wat.tr Co11trol IOll"d O'fftc, 1-,
ll19IONI St.U.t He1IUi ~putatnl Off1CI lnduHrf&l.
Send copy of rtp0rt to lt'gt0111l Sutt Wit.tr Colltrol 1o.,,.. Offtca Other.
Sfr.d coo, of rti,0rt to lfg1oNI Suu \\I.It.tr Control to.rd Offfct County/City
- Surry
--- IHll(s) Ind !>prl119{s)
H*me of Waterworks Name of OoerHor --;:~:.l/,;A.---------------
sOr 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 No.-------
SWCB No.
O.tner No.
SWCB llo. ------ O.ner IO.--------
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. -
c Datt Meter Reading*
Gallons Wlttr ltvel*._
SI/a -
'Ill (nd of un 1tont11 S'o t, '3oe,oo,,,
1 2
3 4
s 6
7 8
9 10 11 12 13 14 15
- lea, aetar 11111 t1* ttcll '*Y (preftr1bl7 end of d11)
I ltfl, rHd,t tlld of IIOfl-pu11pt119 period 111 0 rttd *t tnd of llto7-pq,ap1119 ptrtod t.en 1n one IOll1 tn I ft114, specify lifltcll wit ----
rh1ttl1 or pwHullr-owlltd p\\bltc **ttr supply s1ste111 wiUI ttultll Oe1>1rtiaent pe!"ll1U.
llott: If systta ts 11Mtwed, nt111itt ~
tn tloqs 111 1Glllff rtgllt-1111111 corner.
Olte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I 5-llcw Tot.I Our 1 "9 llontlt I 0pcrlt1ftt Toll Day S Ult I llontll Oat Our ly Awft'I~
1119 Mofltll Meter Reading*
C.11ons Used
~fZ'35""000 'i" 'e; 5",:;,c;, 0 Toti I C. IIOAS
'j? hO~
e;,t::>t!>
Dur I 119 1),1 r tet' rout Opcr1t1nt 31 Ol,s UIIS Qu*rter 277, 58'/
JtilJ lwtr19t 0uri"1 Qv1rttr Vlter level.. -
Static-i"-itna*H I/ 3 Z 7 7oc:;,
6+
17 ~ '??S-
,1,
~~X.....__ ~ll(s)
~~~
S~r1119(sl
(.;ROUND WATER PUMPAGE AND USE REPORT Sc.ale CHpanmfflt or Hralch and State W11er Concrol loari, P.. 1111c.
~ncl copy,r ~rt to b,giONI Stitt ll'1tt,. C.011trot IOI~ Offtc, '"'
lbtth A-t,/6(.).5 7'
. Qu1rter 1 2 &_ 4 (Circle Orie) a,91<11111 St.au KHIUI ~,.~t Offtce lnd.. str11l.
SMC! cooy of rtPOrt to lle910f\\ll Sutt W.tt,. Control ao.,.. orrtc, Othe,..
Str.d coo, of rt9QP't to lt-910,wl Stitt W.ttr Control 9ol~ Offtct County/City
- Surry
___ lltll(s) *I'd Spri1>9(s)
_All!,, 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 __ 1 ndustri.11 _x_ Other ( specf fy -----------------------
1 f ineasurenents are for I stngle-eeter field rudtng, 11st wells included in field SWCB No.
Own.er No.-------
swca No. ------ Ovner lo. -------
S~B No.
Owner No. -------
SWCB llo.
Owner llo. -------
swca No.------- Owner No.-------
SWCB llo. ------- Uwntr IIO. --------
. Meter re1dings *re 111 __ _;g;;,a... l._l..,ons,a.,:,,._ ______________ (g*llons, 100011 of gillons, cubtc feet, etc.)
S\\i\\:8 No.
Owner No.
DAte Keter Reading*
1 2
3 4
5 6
7 8
9 10 11 12 13 14 15
- lt1d atteP' Staf U* flCII -., (prtftr1bl7 tnd Of d11)
"41""'* rHd It tlld of --~11111 pertod 111, rud It end of 11e1,y-pu111p11111 period lt11 tn one "'" tn I fltl4,,pec1f7 ~tell wll ----
t
,rh.-tel7 or Mllc:1111-owllld plA,ltc w1ttr 1u1>11l1 sy,ttal wtUI Hu1UI 0ti,tP'1-llt ptrwfU.
Nott: If 1,Stla ts UMeUt"ld, tst1Mtt pulilC)l9I flt boxes 111 1 owr rt 91tt-11&M COC'1llr.
~te 16 l7 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 &.i l10ftf Tot.a 111.,r 1119 lbltll 1 Oper1tl119 Toti Dl7 I Ulh NollUI Oil 17 A,er191
°""
Ing Montll Meter RHdfng*
&lllons Used
$k, 7 00 2 32-0 Tout &.111**
Z 3"z.£'
Clurf 119 Qwtrett' rou1 OperntAt 3/
Dl,s Utll o,,&rter 7,s;-
..llilJ lwtP'I~
1Nri"9 Ovtrtlf vuer level.. _
Static" l'-tna*..
3.3 70 6~
~3
- -;-, ;-;.,-;-, ~~------~Y~H~r 1'1.f_ I
- '.ns ""*t lH,;i GROUND WATER PUMPAGE AND USE REPORT l\\:>nUI---A~,__,"'""~:.~u;::c:c):s:=-7..:... ---_-_-
_ __._X.__ Wt 11 1 s >
___ Spr1119(s)
S1a1e CHpartmenl of Hcahh and Staie W11er Control loarlll Public.
~ftd cop, of r~r-t to le9fon.il Sutt V1ttr Co11trol ao,,.. Offtc, 1,..
Quirter 1 2 l 4 (Cfrcle One)
- ,9f0ftll Sui. HHIUI ~Ptrtafllt Off1ct 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 County/City
- 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. ______ _
Oimer No. -------
Oitner No.-------
SWCB No. ------ Owner No.-------
SWCB No.
Or.mer llo. -------
SWCB No.-------
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.)
S~B No, Owner No. 6 Date Heter Readtng*
Gallons W.ter level*....
,,,,,,,,"'.~-
Cftd of Lu t lton t11 7 8' /oc:>
'//////,
fllll 1
2 3
4 5
6 1
8 9
10 11 12 13 14 15 meter 11111 tfae 11c11 d1y (pr,f.,-lb1y 1nd of d*y J 1ltt1, rtU,t Ind of IIOll-~1119 period Ulen, l'Ud It end of IIHYJ*~1fl9 per1ocJ
'" *If Ul111 1n Ont "'" In I f11ld, specify ""'tell wll ----
t All prh1ttl1 or pwlful 11-owntd public w1ter supply sys~
w1 UI Ku I UI Dtp1rtiae11t Ptral ts, llote: If 11st. ts 11ratterld. tstfMte pul!Cllge fn bous fn 1owr rfpt-llltld corner.
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C.llOM Tota Dur 1119 btll I Operuf119 Tou Dly I tll ts llon UI Dlf 0..r 17 Awtt191 1 ng Nontll Heter Readfng*
&illons Used 78 :z._c:::>c:::>
/e,O
/oo Tot.ti lil110AI Dur I 119 ~lr\\ef' 3/
Tot.ti Os>erUfllf DI,s tll ls Ou1r ttr
?
.11il1 lytr1~
O..r i "9 Q,,,rt1r Ill ter lewe 1 **-
St1t1c- "-it1111*-
z~oe,c,
~.,t 375
. ***~****~
GROUND WATER PUMPAGE AND USE REPORT
_ _.J.X:....__Wtll(1)
--- Sprt119(1J S1l11r lxpu1mrnl or Hulth and St.re W11rr Control Board Pwbl le, SfllCI copy of ~rt to ~IOM I Stilt 1111.tr Cofttrol to.l"CI 0,ftce llld Qu1rttr 1 Z/3) 4
( C 11-c t<'One) ltgt0111l Stilt Hr1lU1 ~P'rtaconl Office llldustrt1l. S~ COQy of rtp0rt to ~fOllil Stilt !Ill.tr Co11trol '°4rel Offtct Other.
Stnd coe, of rtp0rt to Regto~I Sut: ~~r C0ntroi &o.l"CI OHtct County/Cf ty
- Surry
!fame of Waterworks Name of Ooer.tor _ 1r;.,J/7A;;;---------------
Va. Electric & Power CO, - Surry Posftfon/Tith __ ---.:N:."'./r.A.---------.....+1------
CO 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 No.------- Owner No.-------
SWCB No.
Owner No. -------
SWCI llo.
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.)
SWCB No.
Owner No. 14 llote: If systa fl 11.-Urtd, tst1UU SUIPl91 fn boaes fn ll*tr rf9llt-lllnd corner, Date Heter Reading*
Gallons Wat.tr level**..
Date Meter Read1 ng*
&.llons Cnd of Lut 11ontll z.~z 300 Used 16 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
- llttd attar seat tfat Hell day (prtftr1bl1 tnd of d11I
- If Ult11, rHd It Ind of --puapf"t period
- 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 w1tll Huhll Otpartlllf11t pera1U.
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I 'altOllf Tota Dur Int llollUI Tou Dll11 I Clptntl119 tll 1s !Ion tll 0.1 Dur 11 A,er19t f r,g !loft t II
~floe
/~c:, 0
. / 'i?' t::> c::>
Tot, I C:. llOIII D11rf119 Quarter 3/
Total Opernf11t Dll)'I Ulfs Ou1rttr bB' AilJ l,tr19t During Qutrttr V. tar Leve 1 **-
Stllfc-,111,-11111***
5'"700
&,I'
'?2-
~_.....){.__~11(1)
___ s~1119(11
--- llell(sJ alld Sprl119(1)
GROUND WATER PUMPAGE AND USE REPORT 51:11~ ~putmul of Hullh and State W11er Con1roJ Board Pwbllc.
~lld copy of rf'P()rt to ~lo,wl Sutt Vat.tr Co11trol Icard Offtu 1114 h9fDftAI Sutt Holt.II ~~rtNftt Office 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 YHr
/f'?'/
lbnth AveicJST Qu1rtu 1 26) 4 (Cfrc1e One)
County/City
- Surry 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 No,-------
SWCI No.-,------- Owner No.--------
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 z..f75" ~t,oo ust lloftUI 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
- lead aew 1eae tfae Hell **1 (pr1fe,-1bl7 end of day)
I 'a IIClllf Tou I Gt I ICNII
- 1f ut111, rNd It tnd of IIOll-~1119 Pfr1od
- If t1l111, rtad at tnd of 11t1,7-P1111111"9 p,r1od
.... 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 Tou Dl,rf Tou Dlys "9 lblUI I Oper1tl11t tJI t 1 !loft U1 3~6300 Dl,r I 119 Ql,1 rter
'ii a '8, '8 c;) o 3/
roul Oper1tt11t Dl11 tJII I Ou1rt1r
~4' wlUI HuJUI Dep1r*11t ptrwCb.
Dlf Dllr 17 AwtrllJI Ing Montll 1z7114'
.11 i Ir l,rr1q1
/3/o&:,
Dllri"II Quarttr
GROUND WATER PUMPAGE ANO USE REPORT S1a1~ Cx-putm~nt or Hulch and State Wat~r Control loud Publlc. ~,., copy ef r~rt to ~tonal Sult ll1ltr Control loi...a Offtct 1..i
~Ui S~1>7e.-N1..9Ef'.
Qu*rt.r 1 Zri) 4 (Cf re W'One)
_ _..cX.__ w<< II ( I )
--- ~prt119(1)
- tg!ONI Stitt Ht1IUI ~Ptrtatllt Office lftdustrtal.
Sfftd cop7 of rtP<>rt to Re9to,wl Sutt V.ttr Co11l1'1>l loil"f Office Other.
Stnd coo, of r'fl)Ort to l~ton,I Sutt lllttr Control ao....i Office County/City
- Surry
___ 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. ______ _
Sl<<:8 No.
Oitner No.-------
SWCB No.
Oitner No.-------
SWCB No. ------- Owner llo. --------
SWC8 llo.
<>.mer No. -------
SWCB No. ------- U-ner IIO. --------
Heter re1dings are 1n ___ g~asa..l.l.:lol..:ns!.!:il. _______________ (g11lons. lOOO's of 911lons. cubfc feet. etc.)
SWCB No. so -1 Gf o - Sl C. Owner No. '"B Datt Heter Reading*
Cttd of 1
2 5
6 7
8 9
10 11 12 13 14 15 ltr,.., tfllt,,ca d17 (pr1ftf'1bl1 ~
of d*1)
- 11. rHf at tlld of IIOll*Pl'I01"9 per10d 111. rod It end of 11t1w7-~f119 periOd
.... 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.
wlU\\ Hult/I D,ep1rt.ent penatu.
r "1>1\\,7'\\
¥-KE"A-"t>!NG
°l,A-SE!> ON I Z MON-ntS 0/~o - 7/ttl,
- Nott:
If 1,sta fs UIWlfUr'N, tSt1Mtt l)UIICll9t fn bous 1n la.er rtgllt-t.alld corMr.
Toll
~rt Tou 0.,1 D.lte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I C, lion, "9 llollt.11 I Oper1U119 tll 1 s Non tll 0.1 Dvr 17 Anr191 1119 ~lll Heter Read1 ng*
6111ons Used o't:> f3o S-oo.,/ 303 7t,,7
~~3 7~i Tou 1 C.. llCNII
~rl119 l),artAr
.3o roul Operattnt 0.11 Ulls Qu1rt1r
/,¥ 3~5""'7 Mi IJ lwtr19t O..r1119 Qutrttr W1 ter Leve 1 **-
St.ltfc.. "-t-***
Z 1~7 Z. /o,::;J 7'~
zz8',,/-z7
_....J.Jx.__ 11,11(,i
--- S1>r1119(1J
___ 11tll(1J 1nd Sort~{5)
GROUND WATER PUMPAGE AND USE REPORT S1.a1" ~putm"nc o( Hullh and Stace W11"r Concrol l!loar..
P11blfc.
~IICI copy of rt90r-t l4 l~fon,I StHt W1ttr Co11t"11l to.iii Offfct 1-,
119 t OtWI I S t,t1 tiff 1 UI Dti,,. rtlleft t Of ff Cl
- llldustrl1I.
Send C09J of rtPOrl to ~fon,I St.ti lltttr Co11~l loil"CI Offfct Ouwr. Stnd co0y of rtPOrt 14 l~lorwl St.tt lltttr Control &o.iil Offtc, 1e-.r 1n1 -
~
th S P 77:::7Vf B ~
Quarter I z Ci) 4 (Cfrcle One)
County/Cfty
- Surry of Water..orks Na111e of Ooerltor :---;?-.,J/7A;;----------------
ric & Po,,,,er Co. - Surry Posftfon/Tit1e __ --;;N:t/r.A.--------------
_ _,.::i n,..._.,..._ Co N/A N1'1v Va. Electric c:uu ~
Sfqnatur*--------- 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 -------------------------
1 f 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. ------- 0-,ner No. -------
SWCB No.
~ner IIO. -------
Heter re1dfn9s ire fn ___ g:.,.asa-.l-.lons~~--------------Cg11lons. lOOO's of g11lons. cubfc fett. etc.)
SWl:B No. 3 /- 190 - ~2 C Owner No. C.
Date Heter Reading*
611lons Wiler level*.-
Used St.tic" l'IIIC)111 -*
Clld of z.~7/ooc:> -
Ult l'lanUI 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15 ttr saat tfat,,ca d*y (l)f'tftr,bly ~
of d*y) 111. rHd,c tnd of IIOll-~1"9 periocJ 1l111 0 r11d U tnd of llt1WJ*l)Ull'l)fll9 per10d
....,, t,t111 In Ont"" !11 1 fftlf, 1p~lf7 wtilc~ 11111 t
All prh1ul1 or pub1ful17-owntd public water supply 1ystt11a wl tJI Hu I UI Dep1rtsie11t Ptl'III ts.
m llote:
If 171tea ts u!llfltrtd, tst1111lt ~,.
1 n boan f II I o.r r1 gllt -1111111 COMllf'.
Toti Durt Tou O.ys
~te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I G,11Dftt "9 llonUI 1 Clperlt I llf tJI Is "°" tll 0,1 Dur 17 Avtr19t l1t9 Montll Meter RHdfng*
GI 110III Used z./ -z.../~ooa 173 ooo 1J3 c:>O~
Toul C.IIOfll Dvrl119 ~,rt.er 3o ~i,..ij Total Clper1ttnt 0.71 Ulfl Ov*rt1r 5" 7(o 7
.itily l,tr,9f Our 1119 0111rur W1ter level.. _
Stltfc-.,_,tna***
z.t:;>~<-600
- ?~
3/ 34' 7
1eu
/9,Y/
GROUND WATER PUMPAGE AND USE REPORT
~UI S"E:P-rd,;11 B <'= ~
Quari.r 1 z(J) 4 (Cfrde Ont)
_..-,;;.){.__ Well(5)
___ Spr1119(s)
S1&IC! ~putmenr of Hullh and Sule W11cr Conrrvl Board Public.
~nc, cop, of rt?Qrt to ~fo,wl Sutt Wit.tr C411t1"11I to.l"d Offfct *~
- ,9fonal Sutt HHIUI 0.PtrtMftt Office 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 County/Cf ty
- Surry
___ 1/fll(s) 1nd Spr1f>9(5) of Waten<<>rks Name of Ooerator N/A
- a. Electric & Po,-ler Co* - Surry Pos flt on/Tit 1, -==~N;/;,A~==========================
e>,.,ller Va. Electric aoo po,.,er Co.
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 -------------------------
1 f measurements are for* sfngle--uter ffeld re1dtng, 11st._ells fncluded 111 field swca No.
Owner No.
SWCB No,------- Owner llo. --------
Sl<<:B No.
Owner No.
Swea No,
().mer No. -------
SWCB No.------- Owner No. -------
SWCB Wo, ------ Owner IIO. --------
Meter readings are fn __ -.:ga~..,.l.lo""ns,.,,.., _______________ (g1llons, 1000's of gallons. cubic ffft, etc.)
SWCB No.
Owner No. "}:>
Date Heter Reading*
6'11ons Wiler level**-
di/IA P'~ln...
Clld of un 110nt11 / S--'1 s-fo.:9 1
2 4
5 6
7 8
9 10 11 12 13 14 15 ter,..,. tlae tacn d17 (pr1f~1bl7,net of d17J
'"* rHd at tnd of IIOfl-~1"9 period 1l111, rtld It tnd of lltlYJ*P11-c>f"9 period
- If t,t111 fn one wll In a f1tlf, SP>Klfy _..fell _,.11 t
All prfwattlJ or P\\lt)lfCJIIJ-owne-d put,lfc water supplJ systetia wiUI HulUI Oep1ri.nt ptrwlU.
I Nolf:
If 1ysta Is urNttred, tst1Mtt ~91 1n bans 111 lower rl9Prt 0 llllld CONlff.
Toti Dlirl Tota o.,.
O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 &a 1 lont "9 "°"UI I Qc>eratln9 UIII NonUI 0.1 Our IJ Avtr191 f ng Kontll Heter lleadf ng*
&illons Used 18" 3S-7oo Z. rfo 3 oc;;;,
z_e/o Tou I C. llllftl 3oD Dlir f 119 Ov* r ttr 3o roul l)pfrttl"I Di.rs this Ovarur
?"o /0
.>1 i I 1 l,trlqf Dwri "9 Qui rttr WI ttr Leve 1 **-
St.a Uc.. '"-1ft0***
77s- /oo 9'~
F Z~0
GROUND WATER PUMPAGE AND USE REPORT S1a1~ CHpu1m~n1 or Hnhh and St.ale W11~r Control li!loar4 P11blfc, ~"'° copy 1f rtP()r-t to ~to,wl Sutt Vttar Co11trol lo.ll"d Offtc,,,.,
b9f0Nl Sutt ~IIUI Dtp,rtafftt Office lnc:!11strl11.
Stfld coo, of rtPQrt to ~1on,I Sutt V.tar Co11trol lo.I~ Offtct Other.
Send coo, of rtP()rt to ltg1o,wi I Sutt V. ttr Control lol~ Offtct Teu ~ /f'fl
~di 6~.P7E7J18§!_
Quuw l 2 CJ2 4 (Cfrcle OM)
_...... x....__ 11c 11
--- Spr1119(1)
___ Vtll(sl *nd Spr1119(s)
County/Cf ty
- Surry a
N/A of Waten.iorks Nuse of Ooerator _~,;.--------------
- a. Electric & :E'cM'er Co. - Surry Posftfon/Title __,:N,:/r;;A.--------------
Ow~r Va. Electric arrl Po,,Jer Co.
Siqn.tur, N/A O.te __
N_i_A _____ _
Addr,ss P O. Box 315 Population Served (Pub1fc 1 __ -.JoJNu.lA:JA~--------'--
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 No.------ 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*...
Used I Sut1c.. I Clld of
~
List ltontJI 5"'1 Z. 3 ~"° 1
2 3
4 5
6 7
8 9
10 11 12 13 14 15
-ter saait tfae ttCII,., (pr1f~1bl1 lfld of d11) ket1, rHd 1t end of IIOll*pullC)1ft9 period Ullfl, r11d It end of lletYJ*l)ulllp1f19 period If Ulen tn one 11111 111 1 fte1f, l1>tctf1 *Mell 11111 ----
t All prfnte17 or pvb1fc.ll1*0lfntd pielfc i,,ter suppl7 sysU.
- 1 UI Hu 1 tJI Dep1rtiae11t penit u.
lote: If 111tea ts Ulllftued, 11t1allte IUIPlta in bo11u fn Jo-er r1glrt*llllld corner.
Dlte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C.llonr Toll
~r fng lb\\UI 1 Oc,trl\\1119 Toti Day I UI h !bl tJI 0.1 0,,,r 1, her19e 1119 "'>ft tll Meter Reading*
C.llons Used J, '3t.'?&' ?,u~.t/.-,/~ 3 5' DD 4'~t,3 8'o~
Tot.ti GlllOAI
~rf119 Qt.,1rur
..3o roul Oper1tf119 0.1' Ull1 Ou1rttr
/ 7'? 7f'3 JAilJ A,1r1ge O..r i "9 Qvarter V.Ur Lev11**-
Sl1t1c- "-f11Q*-
/ s-7'? I f;"o <=
~~
l/b7 '19'~
_ _.....x.__ Wtll(s)
___ Spr1119(s)
___ lltll(s) 1nd Sprfrt9(sl
- II...... I I 'I l I""\\
Teu lff/
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 Public. ~no copy of ~rt to t.gfOMI Sutt Vattr Control to.rd Offfct allf (Cfrcl Ont)
- ,9to,wl Sutt KE1IUI ~rtNftt Offtc1 County/Cfty ln<Mtrlll, Stftd copy of rtpOrt to ~lon,I Sutt w.tttr Cont.1'111 lo.rd Offlct
- Surry Other.
Stl'ld cooy of re-port to ltgforwl Stilt llattr Control Board Off1c1
=-------
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 Qnitur*--------- 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 No.-------
SWCB No.
Oirmer No. -------
SWCB llo. ------- Owner No.-------
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.)
SWCB No.
llote: If 11sta h ur.ettr-ed, est1-tt ~91 Owner No. 'F 111 bous 111 tor,,er rfght-llind comer.
Date Heter Read1 ng*
Cnd of LI st l'on t11 3',S-i "5 'i?" 0 1
2 3
4 5
6 1
8 g
10 11 12 13 14 15 attar SMI tfat t1cll,uy (prtf1f'1b1y tnd of day) alffl, retd at 1nd of IIOll-l)UIIC)flllJ pcr10d tel111, rod at Ind of 11t1,y-~f111J pcr10CI f Ultn 111 one "'II tn I fl1ld, specffy -'llcll wll ----
t Al 1 prhataly or pwltcal ly-owntd plAll1c *at.tr su1>9l7 sysU.
w1UI Htaltll Departiaent Ptl"IIIU.
Tou Durt Toti Days O.te 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I &.llonr IIIJ ftontll I Operat1119 tll ls "°" tll Oaf O.,r 11 Awlf'&~
Ing Molltll Meter Reading*
S.llons Used
..3'-+ (g'o Tot.II &.110III
$"'8'00 Dur1119 ~arter 3c:::>
Tot.al Oper1tf119 o.,, UI Is Qua r ttr
/'73
.itlly A,tra~
O.,ri119 Quarter V..ur lev11**-
SUt1c- '"-iffta*-
61/7° 9-/
98'
GROUND WATER PUMPAGE AND USE REPORT T~r~~l~f~?~(~~~-
~
tJI
- SEP "'Ti!::/11 e ~
-... -* --... -*. ***""-"'~
~ tc r Sovr-c r:
1 2 l 4 (Cf~le One)
_ _..LX._ ~ 11 ( s I
___ Spr1119(s)
S1a1e ~pu1ment of Huhh and Su~ Water Conrrof Boar_,
P11bltc.
~ncr copy tf,-.port to l,,glOMI St,tt ll1ttr Co11trol loir,11 Offtc, llld lt9to,wJ St,tt Ht1IUI ~rt:Mftt OHlct 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 County/Cf ty
- Surry me of Water.,orks Nuie of OoerHor --;?-~T/7A;----------------
Va. Electric & Pc:Mer Co. - Surry Posftion/Title __
~N;'i/r;A ____________ _
Owlrer Va. Electric aro Pc,.,Jer Co.
s i 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 1 i c +__ 1 ndustr111 __x_ Other (specify------------------------
1 f 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 No.------ 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.)
SWCB No.
Owner No.
Q Date Meter Reading*
Gillons W.ter Level*....
Used Stutc**
Clld of 7&" Zoo runn,uur, ust 11ont11
,,,//,.....
1 2
3 4
5 6
7 8
9 10 11 12 13 14 15 aeter uae tfae 11c11 d11 (l)f'tftr1bl1 tnd of d11l 1ltt1, rttd 1t tncl or IIOft-~hlCJ perloel UU11, reld It tnd of lltlYJ*l)Ulllll1ng jltl"IOCI P'IIIIIC'1IICI-'
.... If Ultn In one... 11 1n I fftlll, SPt<ffy WIICII -ell ----
- All prhately or put,lfully-cwned publ1c.. ia, supply s,su.
wiUI Ktaltll Deparant ptralts.
Nota:
If systa ts ur.eterld, tst1Mte puilC)l9I fn boaa fl ICMr r1pt-lllnd corner.
Dlte 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 Ca lion, 1119 "°" tJI Toti
°"r Tou n.,,
Dt1 Dur I Oper1tfn9 Ults lb!UI ly AvtrAC)e 1119 lbltll Meter Re!d1 ng*
&lllons Used 7 F "'2-C> o c::::> -
Toul litllOAS
- o-111,,1119 Quarur
..30 Tout 0perlt1"1 Dt,s Ulls Quuter o-
..,.11, lwrr19t
~
Dwr i"9 0.,1rttr W. ter leve 1 **-
Stit1c-1"->1na*..
z r/===
9'+
2 s-5""
I iC, '1111** \\J-~J 11, ur So.,ru:
-~}{.___Wtll(1)
--- SP<'l"9(II
___ 11,ll(1J Al'ld Sp,1119(1)
....,..,,... ~
GROUND WATER PUMPAGE ANO USE REPORT S1a1~ IHputmcnl of Hullh ind State Water Control Board P11bllc.
~M cop, of r~rt to ~1oiwl Sutt ll1ter Co11trol to.l"fl Offlct 1..s lt9lonal Sutt HultJi ~~rtlltftt Office lllduHr111.
Send CDP1 of rtport to ~lo,wi Sutt 11.iltr Co11trol to.rd Off1ct Ott~r. Stnd co01 of rtport to lt9lon,I Sutt W.ltr Contr-ol Bo.l"fl Off1ct
'"' tf't/
. l
~UI S:-§°PW-11dB"
- 1.
Quuter,
2 ti>c I
(Cfrcle One)
County/City
- Surry 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 No.-------
SWCI llo.
Owner No. -------
SWCB No.------ Oitner No. -------
SWC8 No.
Uifner IIO. -------
Meter readings ire in __
..,:ga~l...,l..,o.::.ns,...,_ ______________ (~11ons, lOOO's of gallons. cubic feet, etc.)
SWCB Ho.
Owner No.
rf llott: If 1y1ta ts uNDettred. tst1Mtt pu11p191 fn bollH 111 Jo-er r1gllt-~nd corner, Date Meter Reading*
Gallons Water ltvelu'"
Date Meter Reading*
Gallons
"'W/ilj Clld of z.(p '-f / 0 e:,
WI/ID."'
Lut l'iontll Used 16 1
-2 3
4 5
6 7
8 9
10 11 12 13 14 15
- ltlf aettr sMit ti* 11c11 4117 (pr,f.,-1bl7 tftd of d*JI
..,, tOt11 0 rHd 1t tnd of IIOll-~1119 perlOd
- If Ultn. rtMI It tnd of lltaw7-p,.-p1119 period
....,, Ultn In one""" 111
- flt1f, spec:1'7 lllfllcll wll ----
t
- At I prh1ttl7 or,wl1all7-oirned public Wlttr supr,17 11stta1 wit.II kulVI Dtp*rtiaent pera1ts.
- Tot, Durt Tott o.,,
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 C.1111111 "9 llonU I (lperaUnt tllh Monti!
OIi Dvr 17 Awer1ge 1119 Montll z.~~ 700 2.-8' e, c:::>
2-?e:, t::,
Toul C..IIOftl Duri 119 ()itrter 3t:::>
rou I Opern 1 nt Dl,i Ulh Qu1rttr 93
.,. il1 l,1ra9t Dvr i "9 0111 r ttr Va ter Leve 1 **'"
Static-IPiaa1.......
?700 9.../
93
~--------------~-----
_-£.X..__ Wt 11 ( s)
--- Wtll(s) Ind Sprf119(s)
'***'-1****~
GROUND WATER PUMPAGE AND USE REPORT Si.ale Cxputmcnl of Hcallh and SUte W11cr Conlrol Board Pwt>llc.
Sfnd copy of rt90rt to ~!ONl Suu V1ur Control to.rd Offtct 111d lt9lon,l Suu 11f1lt.11 Dci;i.rtllfllt Offfct
!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 Other.
Selld cooy of report to le,9torwl Suu V.ur Control So.rd Offlct YHr 1711 l4on th S" c:,P-T'E /11 2S~
Qvart.r 1 2 J 4 (Circle One)
County/City
- Surry 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 No.--------
Meter readings ire 1n __...:ga~l..,.1-:o""ns!=. _______________ (gallons. lOOO's of gallons. cubic feet, etc.)
SWCB No.
Heter Reading*
1 2
3 4
s 6
7 8
g 10 11 12 13 14 15
- lte14 aetar s11ae tfllf ttca 111 (prtf~1bl1 tnd of d11J
- If tlktn, rttd 1t tnd of IIOft-Pl,Olll)fllCJ p,rfod
- If t1lt11, rt1d It tnd of 11t1,7-~1119 p,trlod 09**1f t1lt11 111 ore wll 111 1 fltld, specify wtitcll wll ----
t All prhlttlJ or PIA)lfully-owned public ~tu supply sysu.
w1UI Hultll Otp1rbltnt ptrwlts.
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RPM 3!19 Pt..
j
~.,
__ °l)!"'Su=.~ar~*~~--~---O~pdw----*-M_*_. ____
- }
Mab Pl"*"*_.
1'1,laeNe.
}:
. ~- i.
..: *..., * -~*
~
'. *1 ***
- ., *,.. *...... c.
- t**
... ; ~.. *.
.* r,**.**. * *.* ~* **
.1}!:
-'i****\\.,
.H....
..-~--q*****'-* *-
--*~-. *.*.
I..
I.
-.. *-*.,..,~
STATE WATER CONTnOI. IJU/\\HD 2n1 1f.'o1011.:'-:---------
1
- l
\\
,~- ~*
VERIFIED
- 0. Box 11143. 2111 North Hamilton Street Richmond. Virginia 23230 fin-,* rr,.~\\ r* ~,
- I I
~
.* 1n--*
,J
- r'"
oJ
- al ru Phone (804) 770-1411 ev: * &-Yc4&}!jiv.J/b I 61 o** - 7 /
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
.>uth (di rec:tion) of intake cene.l and
~
feet/mi Jes ~(direction) of i *western end ot canal *
~-t.J.t'....c FIL.c...-7<:..-
tt WELL IS NEWLY CONSTRUCTED,f"'
OR IS AN
. ALTERAtlON, REHABILITATIOtf:0R EXTENSION OF AH EXISTING WELL NUHBER OF CERTI Fl CATE OF GROIJNOWATEn RIGHT OF EXIST-ING WELL, IF APPLICABLE -------
FOR OFFICE USE:'
°?;;~--:~~~::~,~~{~};;:-'*
VA. PLA.~E COORDINATES: ~
0 N ~
TOPOGRAPHIC HAP NUMBER: -----
BASIC DATA CI TY:
--iH.c-:hJll-o-n-=-d--~--------
STATE: Va.
ZfP: 23261 __
WATER WELL USER NAME:
Slrry Pouer Plant STRF.ET: -Rt. 650 Off llwv. 10 CI TY :
Surry-*-~;:_.;.;__..::_..;;;;.;;._ ____
STATE:-Va.
ZIP:
23883
_CONTR/\\CTO~,, \\. /'> i l/,,..._1,..,
. S IGUAl LJP.L: 7_?_~1?-/1:.""!_;1. ~:,1 f~ I'<:.~.,
NAME ( type) :'l'i.Ur.-,an rJe Service:{
s T RE f T: 1 6W~ "JoIIITI""Tld.
1 C I TY :
CiiEwfiii~ af:e 5TATE:.\\1i\\:
ZIP: 2332\\
DATE STA~TEo/lugust 8, 1978" DATE COMPLETED: Augiu;t 30, 1978 1ok1 D,fk. ~
DEPTH DRILLED: 420 ---
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 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br />.
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 BRAND NAME :
Reda Pump Co.
12 o
b2S HOLE SIZE:
in,hes from to feet TYPE:
QN 63/8
-inc.hes from -to -feet NODE L NUMBER: 7"'-S=f,_.n--as...___,.... ------
RATED CAP AC I TY : 200 gpm at 310 feet of head.
-inches from to -feet CASE SIZE: _6_i nchcs from _Q_tol.l2o_feet DEPTH OF INTAKE: 1uhu.7..i..{.1,1,ta.., ------
.RATED H_QRS EP O\\lE R :* _.2...i.0'6.IH...... P...,,..._. ____
R.ivc,,. B~ -t2 i 1:...-
4,.(Z"'\\1 ~.,,,
Pre,\\( -
I e,......-
Fo.--.:rho-; - k PTX-inches from to feet
-inches from -to -feet GROUTING7 Yes/Ho; from surface to n
c_ -..
...:._...._ =--
C
{Cfo-71
-~
.. 'LOCATION Of SCREE-...,,:..:':.._./ Give the diameter and depth of all scrce:ns or sec;;tic~s,of slotted or perforated pipe.
6 inches from 400 to 420 feet i nchcs from to feet Inches f ro.11 to feet i nchcs from.
to feet inches from to feet inches from to feet QUALITY DATA DID AAY STRATUM CONTAIN WATER WHI qi WAS UNUSUABLEr!~s TYPE OF WATER_
DEPTH OF STRATUt1:
from380 to420 feet; from _to 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, color, etc.)
screen~ sa~ples, etc.)
.....-----1--------------------11---------- -------*--
From To 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 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:: & C ouri:o
,i10-ft:!ld le !-~diUJ"', ~ Coarse J.2~:l:..."ld ls l:ediu-:i t, C_c,urse_*
\\
\\
\\
0
,**-..-w* -7
/t;C_-7/
6"\\t:ell
-~~*'.'.
(
I l
l.
12"Bole I
I 1
t I
SO,Cement l
. i 0
I
- -~
- ,-
~.:
20 1.3()4 St.ain.leaa St.eel Well S:reen w u
~
w V1 a.:.r
,,,... I z-
<t.
~*
..., ~
i==
. j,W*2
.1-10,000 Stat* Wauu Cunirul lc:rd P. 0. Bo* 1110 2111 North Hamilton St.
Richmond, V*. 23230 VJ~! C-. r COMMONWEAL TH OF VIRGINIA WATER WELL COMPLETION REPORT (Certification of Completion/County Permit)
- BWCM No.
SWCB 11erm*t County Perm, t
County/City ____
- ,-*..:._...,..:. __ ____.:5=--.::a:;.:..~::-~---1.'"?~--:-:~-::-------
£ounty/City StMnp
,nspecting official Certification of This-II does meet code/low does not reQuirernenu.
- V org,n,, Pl*ne Coordin*tes N
_________ e
- owner v t/iLM,..,,
P()wt:X-
- s. ___ _
Date ___ _
F or Offic. Uu
- well Design*tton 1>r Number Address_ "1.lv1.a~er- ~~
Qa&,a\\,~,a "P,c;,. "'h6 2..,-c.. ____ _
__ _.._~~o~, J4,
%-Sf1:wl Taa Map 1.0.
Latitude & Lon<<Jitude N
No.
Phone
(!5 * "';) i77,.- - '5 '"1 Subdivision Section w
- Top o. Map No. ___ _
- DrillinQ Contractor ~~:1-jf:,,,.,., ~,
Block Address ~ a, ~~~~
G:.
Lot ___ _
- Elevation ______
fl.
- Formation _____ _
- ,, ) 5,!,)0 Cl.. Well I
Phone~ai),l,S 2-~/i()(}
118 me __ _
- L1thOIOCJ'I _____ _
- River Basin _____ _
- Province ______ _
---. IIA IIIA
. 1118 1110 Ill[_
- Type Logs _____ _
- Cuttings ______ _
WUL LOCATION:
1'fi @miltt 3QC?* direcliont of Se' CA*,.u._locat..
and Bo
(!Si)miies~ldirectionl of# H1Nf!t WP M'-' 'F4Cnn!M I If possible pie.. include map showing loc11ion ~kedl
., ~--'i=KJ
~~-1L.~ *
- water Analysis ____ _
- AQuifer Test ____ _
Date started Jo 1' t:'.
I. WELL DATA: Newd,_Reworlted Oeepensd ___ _
- Total dept.ti 3,,
ft.
- Depth to bedrock ft.
- Hole size IAlso include reamed zonnl
' j'r,r inches from 0
i,lj: 1ncnn trom
- i'SQ to.3&C to:3f..
ft.
tt.
- ____ 1ncnn trom ----- to ______ ft.
- Casing size 11.0.1 and mate,ial Material
- 't" inches from __ _.,Q,.__ to _).. IC--...,..--.!'*
_J... AC I~ A L.V:
~ y Y/
Wt. per toot---- or wan tnican111 __..,..,,.-__ in.
t?, inches from is><< to i W:I,
- h.
~terial S C I-/ Y<2 LJ <<' ~ e. 1.4ttfl'-dt Wt. per toot o'rw;.(tnic*,l,;. ______ in.
- ____ inchn trom _____ to ______ ft.
Material _________________ _
Wt. per toot or -.II ttlickNIII
___ 111.
e:icreen sia and mnh f~.-91_. IOIII twlllfe IPPlicmle1
- 1 '" inc"-\\~ -
J,tr..2 10..32.-~----ft. -
- Mmsi11 ~
Type 'MIi<<* ace e-ecrl~.S..
inc~~
__so n_
- h. '
~.j: **
- Mesl'I si11 ------ Type -----*-----
- ____ inches lrom ----- to _______ ft.
- Mesh size ______ Type-----*-----
- ____ inches trom ----- to It.
- Mesh sin ______ Type
- Gravel pack
- From------- to --------- ft.
- From to ft.
- Grout e,a4<<1 ree::r -~
jl
- From __..(J__ to _.s_O __ ft., Type
- From to ____ h., Type OVER Type rig h:.L,.,..
-~.--=~--~
- 2. WATIR DATA
- Water temperature_
eSiliiie... ca, !;,:c! lun:Nmaed i..,ei-menu
- Stlbil:zed meaa.ted pump1NJ water !eve
- St1biliZed yietcl KO gpm a,,,r -
I 1..a t.
~--t,.
NMural Flaw: Yn ___ No _,/_. flow rate Q
~ -
COfflffllllt OIi QUality --
- 3. WATIR ZONII: From~To~
From---- To
. From To From To From To ___ _
'* USI DATA:
I Type of ua: Orinkiftt V. Ln,estoclt Watering lrr_ion _F~es11ng ___. Household ___ I Manufac1Urlfll __, Fire safety
. Cleaning AecrNlioll_. Antheuc __ ~Cooling or ne;.1nca_ i llliection _, Ottlat __ -*-----
- TVDe of fa:il1ty* Oomesuc
, Pubhc water supc,ly __..-
flulalic iflltitulion
--;;,m __ -*. I ndustrv _ _L_ '
Commerc..
. Omer I. fl\\W DATA: T.,,,. f 11/F --;-;;,;;-;:; P.
___ f_,,___.
- 1n1atl16-tttl ti,,c.--;,v _!-~~ ;,-
{,d/'S lt..e I. WILLHaAD: Type. MIi..
, ~: ~
4rOUt dM '
,,_,. lank / 2" gal., Loe._, Nrrl-:fC SlfflDlt tap.--::::. Mwurement pcwt **------
Well '1111111.L::_.. Preaure rehJf valve _________ _
G* velwe ~.
U..C11. vlllWe llllohefl requirldl _/""'
Electrical dileone** Mitct'I on power supply_
- 7. DIIINPICTION: wi.1 dili11fec1ed._d. __ yn o... :J~-, 0111nfect:int used_ y 6(T b' Afff0Uft7 ~
. tt,>u,s u*------~
I. AMNOO NT lwllere _..icablll *yee ___ no (~
.Califttpuled Yft __ "°*--- not apglcat>le __
'lutlifll pout Fl'Offl ___
10 --- --"'*ter,al_
8WCM PIia.
- 9. S1e11,_ req11,,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<>ndt"'
c,iy ord1Nfteft llld lfle '- 11111 rula of die cornmo._.,11 of v,,g,n,1 WIii c,n1,11 A... OH.
Eaec:111,.. P1r11 5512 119tars CrNII ROH Aa.no11e. V1. 2*011 10a-11a-1oz Nortnern Vir*"..... OH.
5515 CllflOIIN A-UI Su111 *CM A11unar11, v,. 21lll 70l*7S0*911I
-oMMONWEALrH OF VIRGIN"" :.v~,1 eSc-l..J, MAILING ADDRESS:
DEPARTMEh.
CF CONSERVATION ANO ECONO...,C DEVELOPMENT /f0-ZS.
DIVISION OF MINERAL RESOURCES OFFtCE*A.DOREs.!
P.
3667
~-..... lottesville, VA. 22903 JAMES L. CALVER, COMMISSICiNER McCormick Roac Charlottesville, '
WATER WELL COMPLETION REPORT
>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 LOCATION: C ounry _...,Su..,r.._ry
.... _________ Approa. ----" --------<
dUtCI
..... a~o,Qg,.__,.I... s;a..l.... a~o~d......:,VEu;,..P;__,;;Su,t,a,AJ,t..1,i~owni.__ ______ ond _____
1111 ltl ------<
d If *c I I on) of ------
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 E P 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
_ __.21.liiiO:..-_ i;al. OH ffllA.
6_, ft C IU!I fr O Ill to _fil I set
~
ncllii hoiii_to --
Duration 48 lln.,__Q_m,11.
SCREEN SIZE:
4 nrlle 1 "o"' 40s ro _ill NATER ZONES: lrom 405 ta 415 nClltl lrom 10 __
from to _____,..,
,,c " lrom __,o __
from to ----!"""'
CASE SIZ E: _ _,4...__,nc1111 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 Cemen t 0111111 SC lnd1,11try
- X Other*~------------------
PUMP:
ru, Pemi nq 60 cyc;lo Suh.
11,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 U PON REQUEST I
, __,ARK s: _______________________________ _
e Depth
(!!!!)
0-20 20-40 40-60 60-80 80-100 Tidewater construction co.
MA9ette Surry (HOCJ Island)
GEOLOGIC~
Wit:
2799 Cl:
132 TOTAL DEPTH:
415' 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.
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*.
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 Clay -
yellowish gray, sandy, fiaa to..U.ua grd.Bed, tw pet61.e*1
~gulm: to s~, ~-~ly sorbld, qu&rtS1 blade phoa-ph.at.ic material, saa viviaite (bladecl an4 balla), forau (inc
- 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
- r_. -
OWdlh Tidewater Const.ruction co. WI:
2799 180-200 200-220 220-240 240-320 320-340 340-360 360-380
. 3S0-4Git.
,f~:::;
'*f~
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.
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.
No aaple.
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*.
No aaapla.
Clay -
yellowiah gray, *andy* 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.
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.
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
- Sand -
light gray, moderate clay, mecil.Ulll to very coarse 9Z'&iDN, *ubanCJUl&r to subrowmed, moderately sorted, qua.rez:
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
t;.
- ONIIBll~:. 'l'idawaur Conatructicn eo. W#r 2799 viYianit* verified by X-ray diffraction occurs as bladed
~-
matrix and finer grained bluish balls *
. e:~F
~
-I}-
~ Depth ~fe*t) o-2of
- 20-2~+
'.240-320i
- 20+-4~
I,:
).
GEOLOGIC
SUMMARY
'nlicJcness (feet)
Rocle Un!.t 20 alluvium, Norfolk For.
220+
Calvert Foxmation 80 No Sampl*
95+
Patwcent Fonsation VUGD1U DIVISIOII OF MIDJW. RESOUJCES D~vid. Ae Hulm~, Jr., GQolo,ut:
Jilly 7, 1978 Time Rocle Unit Recent-Pleistocene Miocene-Eocane Cr*taceoua
~.
I
~
.. ~*
-'\\11
L. r,'IA\\.Ji::.11 t LUidl" AU -
Wo.rw-Supply Co1unctor Smithfield. \\'irp..1.1 l~iC I ;.._,
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
-**----------------------------.------:~---=---------
\\ 011pLh or :
To'-! Len1th I Lenith or ! Speciry I Size or Tolnl Dcr,th Of All SLral11 Each Formation Found At Each Stratum Of All ScreeM Each Sec. or: Scre.n Or \\ Scnen Stratum l And Cuin11 ScrNn Or \\ c
- Or Cuinr UIDI CuinK Ft. I In.
Ft. I In. \\
*----'-....:...._--:----------------+---+--+-~-+---4---
1 I
Ft.
In., Ft.
In.
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Mah Ueming 6AHF4 Fume No.