WWHP-2009-0062 - Laserfiche WebLink

("nunty of r.nudnun pis ZG,is Page 1 of 5 Division of Environmental Health NOV 1 Leesburg, Virginia 20177 Office (703) 777 -0234 Fax (703) 771 -5023 Whitney Inspection Request (703) 771 -5808 WELL /WATER Permit # T90146340001 Owner Name: LINN, J W III & DEBORAH H R/S Permit Active Date: Owner Name2: Based on the application for a well /water supply system construction permit filed in accordance with Chapter 1040. Codified Pin #: Owner Address: 46604 HAMPSHIRE STATION DR Tax Map #: Water supply location: Satisfactory yes no ❑ Drillers Report (G.W.2) Received yes, no El STERLING VA20165 -7394 Construction Purpose: Applicant Name: LINN, J W III & DEBORAH H R/S Permit Purp: Applicant Name2: Well Driller Lic # Pump Installer Lic # Structure Type: Applicant Address: 46604 HAMPSHIRE STATION DR System Type Pumping Data Received yes ❑ no ❑ N/A ❑ STERLING As built sketch on page Bacteriological Sample Received yes ❑ no ❑ ZUUy -U0-u 011152372000 /81/X/1///124/ NEW CONSTRUCTION WATER FW STRUCTURE TYPE Home Phone: Work Phone: Ext i, (Nth' ( V Utf� Subdivision: POTOMAC LAKES Lot: SEC 6C LOT 124 Directions to property : Rt 7 East Cascades Pkwy North right on Hampshire Station Drive New X Repair _ Abandonment _ Upgrade _ Hydrofrack — Well ID # Based on the application for a well /water supply system construction permit filed in accordance with Chapter 1040. Codified Ordinances, a construction permit is issued to: LINN, J W III & DEBORAH H R/S DESIGN NOTE: INSPECTION RESULTS Water supply, existing: (describe) PUBLIC WTR Water supply location: Satisfactory yes no ❑ Drillers Report (G.W.2) Received yes, no El To be installed: class Cased and Grouted to Bedrock plus 10' or a minimum Well Construction Approval yes no ❑ cased N/A Grouted N/A whichever is greater Sanitarian ! Date Well Location. See Page Z £ 3 Well Driller Lic # Pump Installer Lic # I. If well yield as determined by 30 minute airlift test is less Chemical Quality Data Received yes ❑ no ❑ N/A ❑ than 5 gallons per minute, a pumping test mtyst be performed Pumping Data Received yes ❑ no ❑ N/A ❑ as follows: As built sketch on page Bacteriological Sample Received yes ❑ no ❑ A. Pump and related equipment shall be installed and the static water level measured. Water System Approved yes ❑ no ❑ B. Pumping shall begin at a rate of withdrawal greater than 5 Sanitarian Date GPM until water level dro s to a point close to bottom of the Il. Criteria for approval of well and well yield are as follows: well. The well must produce a: C. At this point, the mp rate shall be adjusted so the water level remains co stant. A. Minimum of 1 gallon per minute for 6 'continuous D. Measure and 'record the volume of water discharge and pumping hours after the well has been pumped out water level (electric tape) at 15 minute intervals throughout according to Part 1, Sec. B of this permit. the test. , B. The pump test can be terminated; early and well yield E. Discharge water at least 50 feet from the well and sewage considered adequate if: disposal area. 1. The well cannot be pumped out as stated in Part 1, F. Interruption of pumping longer than 15 minutes shall require Sec. B of this permit. /Mor extending the pumping time that amount of time. 2. The well yields 2.5 greater for 3 hours of continuous pumpi g after Part 1, Sec.B of this The well /water system is to be constructed as specified by the permit are comp ted. permit X and attached plans /specifications. _ C. Sufficient storage and yield may be considered for approval. This water system construction permit is null and void if (a) D. Person conducting the pump test shall collect a sample conditions are changed from those shown on the application to be analyzed for constituents described in Codified (b) conditions are changed from those shown on the Ordin4rices of Loudoun County Title 4, Chapter 1040, comstruction permit. Appendix III. E. Replacement wells are exempt from this requirement. Date: 200,9 -08 -27 Issued By: This Construction Date: !ti Reviewed By: �–s� Permit Valid Until 2010 -08 27