Airmont Meadows Subdivision - Hydrostudy - SKV-22

County Of Loudoun Division of Environmental Health Leesburg, Virginia 20177 Office (703) 777-0234 Fax (703) 772-5023 Inspection Request (703) 771-5808 WELL/WATER Permit # 750282010001 Owner Name: DOUGHERTY, GAIL G ET ALS TRUST Owner Name2: 1 % SCHNADER,HARRISON,SEGAL & LE Owner Address: 1600 MARKET ST STE 3600 PHILADELPHIA PA19103 Applicant Name: DOUGHERTY, GAIL G ET ALS TRUST Applicant Name2: C/0 EMERY&GARRETT GROUNDWATER Applicant Address: P.0. BOX 1578 MEREDITH NH 03253 Home Phone: Subdivision: Work Phone: Ext Lot: Permit Active Date: Pin #: Tax Map #: Construction Purpose: Permit Purp: Structure Type: System Type ~+~ JAI 17 2006 Page 1 of 5 2006-01-05 614469655000 /42////////93/ NEW CONSTRUCTION WATER FfW STRUCTURE TYPE IIIB ~ I DlreCtlonS t0 properly : Rt 7 W to Rt 719 5 then tum left onto Snickersville Tpk property is about 0.8 miles on the left New X Repair _ Abandonment _ Upgrade _ Hydrofrack Well ID # Based on the application for a welllwater supply system construction permit filed in accordance with Chapter 1040. Codified Ordinances, a construction permit is issued to: DOUGHERTY, GAIL G ET ALS TRUST DESIGN ~ NOTE: INSPECTION RESULTS Water To be installed: class IIIB Cased and Grouted to Bedrock plus 10' or a minimum ~ cased 60 'Grouted 60 'whichever is greater Well Location. See Page ~ ~ 3 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 the permit X and attached plans/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 comstruction permit. Date: 2006-01-05 Issued By: Date: ~ 0 Reviewed By: Water supply location: Satisfactory yes ^ no ^ Drillers Report (G.W.2) Received yes ^ no ^ Well Construction Approva! yes ^ no ^ Sanitarian Date Well Driller Lic # Pump Installer Lic # Chemical Quality Data Received yes ^ no ^ N/A ^ Pumping Data Received yes ^ no ^ N/A ^ As built sketch on page Bacteriological Sample Received yes ^ no ^ Water System Approved yes ^ no ^ Sanitarian Date II. 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. This Construction Permit Valid Until 2007-01-05