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f <br />Well/Water System Construction Permit Page ,L of -45 <br />Loudoun County, Virginia Health DepartmentpjA!# 00$ /i- 0 y72- <br />Division of Environmental Health Identification Number 791FWR/WAB 2001 <br />Local Ph# 703 - 777 -0234 Fax #: 703 - 771 -5023 Map Reference /81/A/4////36/ <br />General Information <br />New X Repair _ Abandonment _ Upgrade _ Well Idw''� /l�r'- 2oc',' <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: Zangeneh, Said Subdivision: <br />Company Section / Block: Lot No.: <br />Address: 8370 Greensboro Drive #821 McLean VA <br />Phone #: (703) 855 -1819 <br />Construction Directions: Rt 7E - left on Algongian Parkway - left on Thomas Avenue <br />Design NOTE: Inspection Results <br />C 4JJ I`✓ <br />Water Suppy, existing (describe): JpW <br />Well Abandoned? Yes _ No <br /><<E4 a <br />Water supply location: Satisfactory? Yes �No _ <br />To be installed: class 1116 <br />Cased and Grouted to Bedrock plus 10' or a minimum <br />Drillers Report (G.W. 2) received Yes ✓ No <br />cased 60' Grouted 60' whichever is greater <br />Well Construc 'on App I? Yes ✓ No _ <br />Well Location (See page) 2 <br />Sanitarian r/ Date <br />Well Driller 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 LLiic # <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 withdrawal greater <br />Bacteriologica Sample Received? Yes _ No <br />than 5 GPM until water level drops to a point close to <br />Water System Approved? Yes No <br />the bottom of the well. <br />C. At this point, the pump rate shall be adjusted so the <br />Sanitarian Date <br />II. Criteria for approval of well and well yield are as follows: <br />water level remains constant. <br />D. Measure and record the volume of water discharge <br />A. Well must produce a minimum of 1 gallon per minute for 6 <br />and water level(electrical tape) at 15 minute intervals <br />throughout the test. <br />continuous pumping hours after the well has been pumped <br />E. Discharge water at least 50 feet from the well and <br />out according to Part 1, Sec. B of this permit. <br />sewage disposal area. <br />B. The pump test can be terminated early and sell yield <br />F. Interruption of pumping longer than 15 minutes shall <br />considered adequate if: <br />require extending the pumping time that amount of <br />1. The well cannot be pumped out as stated in Part 1 B of <br />time. <br />this permit. <br />2. The well yields 2.5 gpm or greater for 3 hours of <br />The well /water system is to be constructed as specified by <br />the permit X or attached plans and Specifications X <br />continuous pumping after Part I B of this permit is <br />This water system construction permit is null and void if <br />completed. <br />(A) conditions are changed from those shown on the <br />C. Sufficient storage and yield may be considered for approval. <br />application. <br />D. Person conducting 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 />Ordinances of Loudoun County Title 4, Chapter 1040, <br />Appendix III. <br />E. Replacement wells are exempt from this requirement. <br />j �� Construction Permit Valid <br />Date 8/22/2001 Issued by: JRS , �- ;�� �• s t-t - �= , Until 8/22/2002 <br />Date '� Reviewed by:'�� -.%� <br />60' <br />