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Page <br />Well/Water System Construction Permit _ of <br />Loudoun County, Virginia Health Department IV <br />` <br />Division of Environmental Health identification Number —1193 FW 00 <br />777 -0234 Metro 478 -8408 9 Map Rsfsrence Z9R2ZZZZ222a©Z <br />General Information 6 <br />New Repair ❑ Abandonment ❑ Upgrade ❑ Well ID.# tywllt - A000 'd i a, <br />Based on the application for a well /water supply system construction permit filed In accordance with Chapter 1040, Codified <br />Ordinances, a construction permit is hereby issued to: <br />Owner Northern Va. Regional Park Telephone (540) 352 -5900 <br />Address 5400 Ox R -. Farifax, Va. 22039 <br />1 For a well /water s %em which is to be constructed on /at R t. 7 E. to Cascades P cwy . go N. on— <br />Cascades Pkwy. to Park entrance L. at first Rd. to P-0-07— <br />Subdivision Section /Block Lot <br />DESIGN <br />NOTE: INSPECTION RESULTS <br />Water supply, existing: (describe) <br />Water supply location: Satisfactory yes V no ❑ <br />Drillers Report (G.W.2( Received yes bl no ❑ <br />U t-0, 4"V <br />To be installed: class <br />Cased and Grouted to Bedrock plus 10' or a minimum <br />Well Constructio A proval yes Vno ❑ <br />cased U(1 Grouted � whichever is greater <br />Sanitarian ` Date <br />Well Location See Page ` <br />Well Driller Lic ft <br />Pump Installer Lic tt <br />I. If well yield as determined by 30 minute airlift test is less <br />Chemical Quality Data Received yes O no ❑ N/A ❑ <br />than 5 gallons per minute, a pumping test must be performed <br />Pumping Data Received yes ❑ no ❑ N/A ❑ <br />as follows: <br />As built sketch on page <br />A. Pump and related equipment shall be installed and <br />Bacteriological Sample Received yes ❑ no ❑ <br />the static water level measured. <br />Water System Approved yes ❑ no ❑ <br />B. Pumping shall begin at a rate of withdrawal greater <br />Sanitarian Date <br />II. Criteria for approval of well and well yield are as <br />than 5 GPM until water level drops to a point close <br />to bottom of the well. <br />follows: <br />C. At this point, the pump rate shall be adjusted so <br />The well must produce a: <br />the water level remains constant <br />D. Measure and record the volume of water discharge <br />A. Minimum of 1 gallon per minute for 6 continuous <br />and water level (electric tape) at 15 minute intervals <br />pumping hours after the well has been pumped <br />throughout the test <br />out according to Part I, Sec. B of this permit <br />E. Discharge water at least 50 feet from the well and <br />B. The pump test can be terminated early and well <br />sewage disposal area. <br />yield considered adequate it <br />F. Interruption of pumping longer than 15 minutes <br />1. The well cannot be pumped out as stated in <br />shall require extending the pumping bme that <br />Part I B of this permit <br />amount of time. <br />2. The Well yields 2.5 gpm or greater for 3 hours <br />of continuous pumping after Part I B of this <br />permit is completed. <br />The well /water system is to be constructed as specified <br />C. Sufficient storage and yield may be considered for <br />by the permit �� attached plans and specifications D. <br />approval. <br />D. Person conducting the pump test shall collect a <br />This water system construction permit is null and void if <br />sample to be analyzed for constituents described <br />(a) conditions are changed from those shown on the <br />in Codified Ordinances of Loudoun County Title <br />application (b) conditions are changed from those shown <br />4, Chapter 1040, Appendix Ill. <br />°n X181On'� <br />E. Replacement wells are exempt from this <br />requirement <br />Date: o Issued by: �`''^ '- <br />This Construction <br />Perm' 1 1 until <br />Date: Reviewed by: <br />� -S TJ <br />Original / Health Department Copy / Applicants Copy <br />Iv <br />6-oJ7'— <br />