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~• <br />~~ <br />~t ~ u x Z~ <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) 77I-5808 <br /> WELLNVATER Permit # 750258260006 <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 Name2: C/0 EMERY & GARRETT <br />Structure Type: <br />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 tum left onto Snickernitle Turnpike <br />property is about 0.8 miles on the left <br />New X Repair _ Abandonment _ Upgrade _ Hydrofrack _ Well ID # ,`~ KW - l2 <br />Based on the application for swell/water supply system construction permit filed in accordance with Chapter 1040. 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 TO ' Grouted 70 'whichever is greater Sanitarian Date <br />Well Location. See Page Z `~ 3 Well Driller Lic # <br /> <br />I. If well yield as determined by 30 minute airlift test is less Pump Installer Lic # <br />Chemical Quality Data Received yes ^ no ^ N/A ^ <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 II. 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 /> continuous pumping after Part 1, Sec.6 of this <br />The welUwater 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) D. Person conducting the pump test shall collect a sample <br />conditions are changed from those shown on the application to be analyzed for constituents described in Codified <br />(b) conditions are changed from those shown on the Ordinances of Loudoun County Title 4, Chapter 1040, <br />comstruction permit. Appendix III. <br /> E. Replacement wells are exempt from this requirement. <br />1~! / ~ <br />i <br />J i <br />Date: 2005'11-22 Issued By: `~ <br /> <br />Date: ~ L 0 Reviewed By: This Construction <br />~J Permit Valid Until <br />~~`=~"" 2006-11-22 <br /> <br />