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~,'~ <br />UtL ~ ~ L~ <br />~~ County O, f'Loudoun <br />Division of Environmental Health <br />Leesburg, Virginia 20177 <br /> Office (703) 777-0234 Fax (703) 771-5023 <br /> Inspection Request (703) 771-5808 <br /> WELL/WATER Permit # 750258260005 <br />Owner Name: DOUGHERTY, GAIL G ET ALS TRUST Permit Active Date: 2005-11-22 <br />Owner Name2: % SCHNADER,HARRISON,SEGAL & LE Pin #: 614469655000 <br />Owner Address: 1600 MARKET ST STE 3600 Tax Map #: /42////////93/ <br /> PHILADELPHIA PA19103 Construction Purpose: NEW CONSTRUCTION <br />Applicant Name: DOUGHERTY, GAIL G ET ALS TRUST Permit Purp: WATER FTW <br />Applicant Narne2: C/0 EMERY & GARRETT Structure Type: STRUCTURE TYPE <br />Applicant Address: P.O. BOX 1578 System Type : IIIB <br /> MEREDITH NH 03253 <br />Home Phone: Work Phone: Ext <br />Subdivision: Lot: <br />Page 1 of 5 <br />Directions to property : Rt 7 W to Rt 719 S then tun left onto Snickersville Turnpike <br />property is about 0.8 miles on the left <br />Abandonment _ Upgrade _ Hydrofrack _ Well ID # , kV` ~,~, <br />New X Repair <br />_ <br />Based on the application for swell/water supply system construction permit filed in accordance with Chapter .040. Codified <br />Ordinances, a construction permit is issued to: DOUGHERTY, GAIL G ET ALS TRUST <br />DESIGN NOTE: INSPECTION RESULTS <br />Water supply, existing: (describe) Water supply location: Satisfactory yes ^ no ^ <br />To be installed: class IIIB Drillers Report (G.W.2) Received yes ^ no ^ <br />Cased and Grouted to Bedrock plus 10' or a minimum Well Construction Approval yes ^ no ^ <br />cased 70 'Grouted 70 'whichever is greater Sanitarian Date <br />Well Location. See Page ZE Well Driller Lic # <br /> Pump Installer Lic # <br />I. If well yield as determined by 30 minute airlift test is less Chemical Quality Data Received yes ^ no ^ NIA ^ <br />than 5 gallons per minute, a pumping test must be performed pumping Data Received yes ^ no ^ NIA ^ <br />as follows: As built sketch on page <br />A. Pump and related equipment shall be installed and the static Bacteriological Sample Received yes ^ no ^ <br />water level measured. Water System Approved yes ^ no ^ <br />B. Pumping shall begin at a rate of withdrawal greater than 5 Sanitarian Date <br />GPM until water level drops to a point close to bottom of the 11. Criteria for approval of well and well yield are as follows: <br />well. The well must produce a: <br />C. At this point, the pump rate shall be adjusted so the water <br />level remains constant. A. Minimum of 1 gallon per minute for 6 continuous <br />D. Measure and record the volume of water discharge and pumping hours after the well has been pumped out <br />water level (electric tape) at 15 minute intervals throughout according to Part 1, Sec. B of this permit. <br />the test. B. The pump test can be terminated early and well yield <br />E. Discharge water at least 50 feet from the well and sewage considered adequate if: <br />disposal area. 1. The well cannot be pumped out as stated in Part 1, <br />F. Interruption of pumping longer than 15 minutes shall require Sec. B of this permit. <br />extending the pumping time that amount of time. 2. The well yields 2.5 GPM or greater for 3 hours of <br /> f this <br />B <br />S <br />1 <br /> o <br />ec. <br />, <br />continuous pumping after Part <br />The well/water system is to be constructed as specified by the permit are completed. <br />permit X and attached plans/specifications. _ C. Sufficient storage and yield may be considered for <br /> approval. <br />This water system construction permit is null and void if (a) <br />ti <br />li D. Person conducting the pump test shall collect a sample <br />to be analyzed for constituents described in Codified <br />on <br />ca <br />conditions are changed from those shown on the app <br />(b) conditions are changed from those shown on the Ordinances of Loudoun County Title 4, Chapter 1040, <br />construction permit. Appendix III. <br /> E. Replacement wells are exempt from this requirement. <br />.- ~ .~ ~ <br />./ This Construction <br />Date: 2005-11-22 Issued By: `~. <br />Date: (! Z y (~ ~ Reviewed By: ~' Permit Valid Untif <br />t ~~~ 2006-11-22 <br /> <br />