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Well /Water System Construction Permit Page � Of <br />Loudoun County, Virginia Health Department <br />Division of Environmental Health Identification Number 363 WAB 92 <br />777 -0234 Metro 478 -8408 Map Reference �o�000 ®ooaa ®ao <br />General Information 65:4E <br />New X Repair ❑ Abandonment X Well ID. # V' � ` -�- 9ti <br />Based on the application for a well; water supply system construction permit filed in accordance with Chapter 1040, Codified <br />Ordinances, a construction permit is hereby issued to: <br />Owner Cascades Telephone (703) 641 -9000 <br />Address 8081 Wolftrap Road Vienna Virginia 22180 <br />For I well /water sys em which is 1q be constructed on /at W v'% rA4 n -4- - <br />w A d rU ja Cl ,b <br />Subdivision Secti n /Block 65:4E Lot <br />DESIGN <br />NOTE: INSPECTION RESULTS <br />Water supply, existing: (describe) .4^ ) <br />L Water supply location: Satisfactory yes ) no ❑ <br />To be installed: class <br />Drillers Re ort (G.W 2) Received yes no ❑ <br />65 <br />Cased and Grouted tl ck plus 10' or a minimum <br />11 <br />Well , Approval '7f- no ❑ <br />cased routed whichever is greater <br />Is <br />Sanitarian �`- Date <br />Well tion See Page <br />Well Driller i Alit, Lic # <br />Pump Installer _Lic # <br />C <br />� <br />I. If well yield as determined by 30 minute airlift test is less <br />Chemical Quality Data Received yes El no El N/A El <br />than ll gallons per minute, a pumping test must be performed <br />Pumping Data Received yes El no 13 N/A El <br />as follows: <br />As built sketch on page <br />A. Pump and related equipment shall be installed and <br />Water System Approved yes ❑ no ❑ <br />the static water level measured. <br />Sanitarian Date <br />B. Pumping shall begin at a rate of withdrawal greater <br />than 5 GPM until water level drops to a point close <br />to bottom of the well. <br />II. Criteria for approval of well and well yield are as <br />C. At this point, the pump rate shall be adjusted so <br />follows: <br />the water level remains constant. <br />The well must produce a: <br />D. Measure and record the volume of water discharge <br />A. Minimum of 1 gallon per minute for 6 continuous <br />and water level (electric tape) at 15 minute intervals <br />pumping hours after the well has been pumped <br />throughout the test. <br />out according to Part I, Sec. B of this permit. <br />E. Discharge water at least 50 feet from the well and <br />B. The pump test can be terminated early and well <br />sewage disposal area. <br />yield considered adequate if: <br />F. Interruption of pumping longer than 15 minutes <br />1. The well cannot be pumped out as stated in <br />shall require extending the pumping time that <br />Part I B of this permit. <br />amount of time. <br />2. The Well yields 2.5 gpm or greater for 3 hours <br />of continuous pumping after Part I B of this <br />permit is completed. <br />The well water system is to be constructed as specified <br />C. Sufficient storage and yield may be considered for <br />by the permit ❑ or attached plans and specifications El. <br />approval. <br />D. Person conducting the pump test shall collect a <br />This water system construction permit is null and void if <br />sample to be analyzed for constituents described <br />(a) conditions are changed from those shown on the <br />in in Codified Ordinances of Loudoun County Title <br />application (b) conditions are changed from those shown <br />4, Chapter 1040, Appendix III. <br />on the construction permit. <br />E. Replacement wells are exempt from this <br />requirement. <br />i <br />Date: t Issued by: L <br />This Construction <br />itar <br />Per it alid until <br />Date: I d �l y Reviewed by: In <br />x/yApervismy <br />C L <br />anit r n <br />Original Health Department Copy / T g Department Copy Applicants Copy <br />3p,r3k <br />