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County Of Loudoun Division of Environmental Health Leesburg, Virginia 20177 Office (703) 777 -0234 Fax (703) 771 -5023 Inspection Request (703) 771 -5808 � R '/ LMIS _ GIS Page 1 of 4 JUN 12, 2 Whitney M WELL/WATER Permit # T80130500001 Owner Name: NORTHERN VA REGIONAL PARK AUTH Owner Name2: Drillers Report (G.W.2) Received Owner Address: 5400 OX RD Sanitarian Date Well Driller Lic # FAIRFAX STATION VA22039 -1022 Applicant Name: NORTHERN VA REGIONAL PARK AUTH Applicant Name2: C/O VALLEY DRILLING Applicant Address: 9172 JOHN MOSBY HIGHWAY Bacteriological Sample Received UPPERVILLE, VA 20184 Home Phone: Work Phone: Subdivision: Lot: Est Permit Active Date: Pin #: Tax Map #: Construction Purpose Permit Purp: Structure Type: System Type : 2008 -06 -09 017398983000 /64/////////5/ NEW CONSTRUCTION WATER FW STRUCTURE TYPE IV 14 0)19.- fib$ --- V1C3 Directions to property : A LOCATIONAL CLEARANCE IS REQUIRED BY B &D - Rt. 7 E to L on Cascades Parkway, to L on Fairway Drive to 46666 Fairway Drive on R New X Repair _ Abandonment _ Upgrade _ Hydrofrack Well ID # Based on the application for a well /water supply system construction permit filed in accordance with Chapter 1040. Codified Ordinances, a construction permit is issued to: NORTHERN VA REGIONAL PARK AUTH DESIGN Water supply, existing: (describe) To be installed: class IV (g R ) &'-( Cased and Grouted to Bedrock plus 10' or a minimum cased 60 ' Grouted 60 ' whichever is greater Well Location. See Page I. If well yield as determined by 30 minute airlift test is less than 5 gallons per minute, a pumping test must be performed as follows: A. Pump and related equipment shall be installed and the static water level measured. B. Pumping shall begin at a rate of withdrawal greater than 5 GPM until water level drops to a point close to bottom of the well. C. At this point, the pump rate shall be adjusted so the water level remains constant. D. Measure and record the volume of water discharge and water level (electric tape) at 15 minute intervals throughout the test. E. Discharge water at least 50 feet from the well and sewage disposal area. F. Interruption of pumping longer than 15 minutes shall require extending the pumping time that amount of time. The well /water system is to be constructed as specified by the permit X and attached plans /specifications. This water system construction permit is null and void if (a) conditions are changed from those shown on the application (b) conditions are changed from those shown on the comstruction permit. NOTE: INSPECTION RESULTS Water supply location: Satisfactory yes �o ❑ Drillers Report (G.W.2) Received , yes �� El ❑ Well Construction Approval yes no Sanitarian Date Well Driller Lic # 11 Pump Installer Lic # Chemical Quality Data Received yes ❑ no ❑ N/A ❑ Pumping Data Received yes ❑ no ❑ N/A ❑ As built sketch on page Bacteriological Sample Received yes ❑ no ❑ Water System Approved yes ❑ no ❑ Sanitarian Date II. Criteria for approval of well and well yield are as follows: The well must produce a: A. Minimum of 1 gallon per minute for 6 continuous pumping hours after the well has been pumped out according to Part 1, Sec. B of this permit. B. The pump test can be terminated early and well yield considered adequate if: 1. The well cannot be pumped out as stated in Part 1, Sec. B of this permit. 2. The well yields 2.5 GPM or greater for 3 hours of continuous pumping after Part 1, Sec.6 of this permit are completed. C. Sufficient storage and yield may be considered for approval. D. Person conducting the pump test shall collect a sample to be analyzed for constituents described in Codified Ordinances of Loudoun County Title 4, Chapter 1040, Appendix III. E. Replacement wells are exempt from this requirement. Date: 2008-06-99 Issued By: This Construction Permit Valid Until Date: Reviewed By: 2009 -06 -09