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Well/Water System Construction Permit Page 1 of S <br />Loudoun County, Virginia Health Department <br />Division of Environmental Health Identification Number 1995WAB 2001 <br />Local Ph# 703 - 777 -0234 Fax #: 703 - 771 -5023 Map Reference /82/////////5/ <br />General Information <br />New _ Repair _ Abandonment X Upgrade _ Well Id <br />Based on the application for a well /water supply system construction permit filed in accordance with Charpter 1040, Codified <br />Ordinances, a construction permit is hereby issued to: <br />Owner: Subdivision: <br />Company: Loudoun County School board <br />Section /Block: Lot No.: <br />Address: 102 North Street Leesburg Va <br />Phone #: (703 327 -2326 ,e /',7 Q�-U 0 ` Ce ,cT c <br />) �� � e��sr 3�-�s— c_� -}ST �� STc y <br />s".�dl S,re o� E� <br />Construction Directions: Ft 4`-I�b�� )e <br />Design NOTE: Inspection Results <br />Yes No— <br />Water Suppy, existing (describe): drilled IIIC <br />Well Abandoned? <br />Water supply location: Satisfactory? Yes _ No— <br />To be installed: class <br />Cased and Grouted to Bedrock plus 10' or a minimum <br />Drillers Report (G.W. 2) received Yes No <br />cased Grouted whichever is greater <br />Well Construction Approval? Yes — No <br />Well Location (See page) <br />Sanitarian Date <br />Well Driller 6 Lic # <br />I. If well yield as determined by 30 minute airlift test is less <br />than 5 gallons per minute, a pumping test must be <br />Pump Installer Lic # <br />performed as follows: <br />Chemical quality data received? Yes _ No NA <br />Pumping Data Received ? Yes _ No _ NA <br />A. Pump and related equipment shall be installed and <br />the static water level measured. <br />As built sketch on page Yes _ No <br />B. Pumping shall begin at a rate of withdra al ter <br />Bacteriologica Sample Received? Yes _ No <br />than 5 GPM until water level drops tot close to <br />Water System Approved? Yes ___ No <br />the bottom of the well. <br />Sanitarian Date <br />C. At this point, the pump rate(kglp adjusted so the <br />11. Criteria for approval of well and well yield are as follows: , <br />water level remains cons <br />D. Measure and recgr ume of water discharge <br />and water level(el' 1 1 tape) at 15 minute intervals <br />A. Well must produce a minimum of 1 gallon per minute for 6 <br />throughout the test:' <br />continuous pumping hours after the well has b n pumped <br />E. Discharge wat rat least 50 feet from the well and <br />out according to Part 1, Sec. B of this permit <br />sewage di osal area. <br />B. The pump test can be terminated rly d sell yield <br />F. Inter ion of pumping longer than 15 minutes shall <br />considered adequate if: 0 N <br />re re extending the pumping time that amount of <br />1.The well cannot be purgrpo as stated in Part 1 B of <br />e <br />this permit.`` ll,� <br />2. The well yields Z. or greater for 3 hours of <br />The well /water system is to be cited as specified by <br />the permit `,or attached plans and Specifications _ <br />continuou i after Part I B of this permit is <br />This water system construction permit is null and void if <br />complet `1 <br />(A) conditions are changed from those shown on the <br />C. Sufficient s ge and yield may be considered for approval. <br />application. <br />D. Person co ducting the pump test shall collect a sample to <br />(B) conditions are changed from those shown on the <br />be analyzed for constituents described in Codified <br />construction permit. <br />9 penances of Loudoun County Title 4, Chapter 1040, <br />Upendix III. <br />E. Replacement wells are exempt from this requirement. <br />Date 12/11/01 Issued by: JSP Construction Permit Valid <br />Until 12/11/02 <br />Date iZ R l Reviewed by: <br />�ti-�-. <br />0--70' <br />