017398983 FW-2011-T10232310002 (Well ALT-A)

County Of Loudoun Page 1 ofk Division of Environmental Health �� co A'7 Leesburg, Virginia 20177 Office (703) 777 -0234 Fax (703) 771 -5023 a Inspection Request (703) 771 -5808 :• WELL/WATER Permit # T10232310002 1757 Owner Name: NORTHERN VA REGIONAL PARK AUTH Permit Active Date: 2011 -11 -08 Owner Name2: Pin #: 017398983000 Owner Address: 5400 OX RD Tax Map #: /64/////////5/ FAIRFAX STATION VA22039 -1052 Construction Purpose: NEW CONSTRUCTION Applicant Name: NORTHERN VA REGIONAL PARK AUTH Permit Purp: WATER FPW Applicant Name2: C/O EMERY &GARRETT GROUNDWATER Structure Type: STRUCTURE TYPE Applicant Address: PO BOX 1578 System Type : I MEREDITH NH 03253 Home Phone: Work Phone: [ xt Subdivision: Lot: Directions to property : Rt 7 E to Cascades Parkway Northeast the park entrance is located at the end of Cascades Parkway A LOCATIONAL CLEARANCE IS REQUIRED BY B &D 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 NOTE: INSPECTION RESULTS Water supply, existing: (describe) DRILLED WL Water supply location: Satisfactory yes ❑ no ❑ To be installed: class I h of) a 0 mM do 1 Drillers Report (G.W.2) Received yes ❑ no ❑ Cased and Grouted to Bedrock plus 10' or a minimum Well Construction Approval yes ❑ no ❑ cased 100 ' Grouted 100 'whichever is greater Sanitarian Date Well Location. See Page Well Driller Lic # Pump Installer Lic # I. If well yield as determined by 30 minute airlift test is less Chemical Quality Data Received yes El no El N/A 11 than 5 gallons per minute, a pumping test must be performed Pumping Data Received yes ❑ no El NIA El as follows: As built sketch on page A. Pump and related equipment shall be in lied and the static Bacteriological Sample Received yes ❑ no El water level measured. Water System Approved yes L1 no ❑ B. Pumping shall begin at a rate o ithdrawal greater than 5 Sanitarian Date GPM until water level drops t a point close to bottom of the II. Criteria for approval of well and well yield are as follows: well. The well must produce a: C. At this point, the pum rate shall be adjusted so the water level remains cons t. A. Minimum of 1 gallon per minute for 6 continuous D. Measure and re rd the volume of water discharge and pumping hours after the well has been pumped out water level (e ctric tape) at 15 minute intervals throughout according to Part 1, Sec. B of this permit. the test. B. The pump test can be terminated ear and well yield E. Dischar a water at least 50 feet from the well and sewage considered adequate if: disposal area. 1. The well cannot be pumpe ut as stated in Part 1, F. Interruption of pumping longer than 15 minutes shall require Sec. B of this permit. extending the pumping time that amount of time. 2. The well yields 2.5 or greater for 3 hours of continuous pumpi g after Part 1, Sec.B of this The well /water system is to be constructed as specified by the permit are comp ted. permit X and attached plans /specifications. _ C. Sufficient stora and yield may be considered for approval. This water system construction permit is null and void if (a) D. Person con ucting the pump test shall collect a sample conditions are changed from those shown on the application to be a lyzed for constituents described in Codified (b) conditions are changed from those shown on the Ordin ces of Loudoun County Title 4, Chapter 1040, comstruction permit. Appendix III. E. Replacement wells are exempt from this requirement. Date: 2011-11-98 Issued By: This Construction Date: 1 Reviewed B Permit Valid Until Y 2012 -11 -08