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Page 1 of 15 County Of Loudoun Division of Environmental Health Leesburg, Virginia 20177 (703) 777 -0234 Metro (703) 478 -8408 Fax (703) 771 -5023 Automated Inspection Request (703) 771 -5331 WELL/WATER Permit # T20261170001 Owner Name: LOUDOUN COUNTY SCHOOL BOARD Owner Name2: Owner Address: 102 NORTH ST NW LEESBURG VA20 1 7 6 -2203 Applicant Name: LOUDOUN COUNTY SCHOOL BOARD Applicant Name2 : Applicant Address: 102 NORTH ST NW LEESBURG VA20176 -2203 Home Phone: Work Phone: Subdivision: Lot: Bldg /Floor /Unit: IRRIGATION WELL ONLY Permit Active Date: 2003 -02 -13 Pin #: 013491408000 Tax Map #: /82/////////5/ Construction Purpose: OTHER Permit Purp: WATER FW Structure Type: NONE New �t Repair ❑ Abandonment ❑ Upgrade ❑ 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: LOUDOUN COUNTY SCHOOL BOARD DESIGN i NOTE: INSPECTION RESULTS Water supply, existing: (describe) PUBLIC WTR To be installed: class IV - I rZIMAT1013 0SWE ODfl C. y Cased and Grouted to Bedrock plus 10' or a minimum cased 55' Grouted 55' 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 by the permit X or attached plans and 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 construction permit. Water supply location: Satisfactory yes no ❑ Drillers Report (G.W. Received yes o Well Constructio p ov yes no El Sanitarian Date ��t 45 Well Driller Lic # - ( " CAN Pump Installer Lic # Chemical Quality Data Received yes ❑ no ❑ N/A ❑ Pumping Data Received yes 11 no El N/A ❑ As built sketch on page Bacteriological Sample Received yes 11 no El Water System Approved yes El no El Sanitarian Date Il. 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.B 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: 2003 -02 -13 Issued By: V tAZZ I'► This Construction fr� Permit Valid Until Date: 2 V Reviewed By: , r , 2004 -02 -13