WWIN-1997-0412 - Laserfiche WebLink

Well/Water System Construction Permit Page —/– Of y Loudoun County, Virginia Health Department �s y% Division of Environmental Health Identification Number 777 -0234 Metro 478 -8408 9 Map ReferenceMEZZZZO RIZZ2Z General Information New ( Repair ❑ Abandonment El Upgrade El Well ID.# tdVAI - l-I d 0'/12-- q 7" Based on the application for a well /water supply system construction permit filed in accordance with Chapter 1040, Codified Ordinances, a con permit is hereby issued to: Owner Nyhp4 Telephone Address 1E C-f- 1214 -1 �rG. �ix4.; y7wo , ins, <w�r rJ �'. .gi ,,,� - rA ..2 o. css- IFor a well /water system which is to be constructed on /at (24 5C- J&s x-c'w•r N 7V 'OW2.r 6,, 46,—r- � /- /Y1, .iyi-ti 1%&r- .S. iF .s a.�. F /AC P sE Subdivision Section /Block Lot DESIGN NOTE: INSPECTION RESULTS Water supply, existing: (descri be) //J/7 Water supply location: Satisfactory yes no ❑ Drillers Report (G.W.2) Received yes no ❑ To be installed: class -1 -41 Cased and Grouted to Bedrock plus 10' or a minimum Well Construction pro al yes no O cased *% ��'Grouted w Z whichever is greater Sanitarian Date Z Well Location See Page Z Well Driller 1a,711a Lic 4 Pump Installer Lic ft I. If well yield as determined by 30 minute airlift test is less Chemical Quality Data Received yes Vno O N/A ❑ than 5 gallons per minute, a pumping test must be performed Pumping Data Received yes ❑ no O N/A as follows: As built sketch on page Bacteriological Sample Received yes no ❑ A. Pump and related equipment shall be installed and the static water level measured. Water System A roved yes n ❑ ' � Date B. Pumping shall begin at a rate of withdrawal greater Sanitarian y (I 74M Il. Criteria for approval of well and well yield are as than 5 GPM until water level drops to a point close to bottom of the well. follows: C. At this point, the pump rate shall be adjusted so The well must produce a: the water level remains constant A_ Minimum of 1 gallon per minute for 6 continuous D. Measure and record the volume of water discharge and water level (electric tape) at 15 minute intervals pumping hours after the well has been pumped throughout the test out according to Part I, Sec. B of this permit E. Discharge water at least 50 feet from the well and B. The pump test can be terminated early and well sewage disposal area. yield considered adequate it F. Interruption of pumping longer than 15 minutes 1. The well cannot be pumped out as stated in shall require extending the pumping time that Part I B of this permit amount of time. 2. The Well yields 2.5 gpm or greater for 3 hours of continuous pumping after Part I B of this permit is completed. The well /water system is to be constructed as specified C. Sufficient storage and yield may be considered for by the permit O or attached plans and specifications ❑. approval. D. Person conducting the pump test shall collect a This water system construction permit is null and void if Sample t0 be analyzed for constituents described (a) conditions are changed from those shown on the in Codified Ordinances of Lrwdoun County Title application (b) conditions are changed from those shown 4, Chapter 1040, Appendix III. on construction ms's E. Replacement wells are exempt from this requirement Date: T / Issued by: 1 This Construction s Permit Valig until Date: G Reviewed by: --Z I-51 Original / Health 17epalntnent Copy / Applicants Copy