WWHP-2003-0496 - Laserfiche WebLink

County Of Loudoun Division of Environmental Health Leesburg, Virginia 20177 (703) 777 -0234 Metro (703) 478 -8408 Fax (703) 771 -5023 Automated Inspection Request (703) 771 -5331 WELL/WATER Permit # T30177370001 Owner Name: BROCKMAN, DARYL S & CHRISTINA F R/S Owner Name2: Drillers Report (G.W.2) Received Owner Address: 1012 KIMBERLY CT Well Construction Ap oval GREAT FALLS VA22066 -1545 Applicant Name: BROCKMAN, DARYL S & CHRISTINA Applicant Name2 : Applicant Address: 1012 KIMBERLY CT Pump Installer Lic # GREAT FALLS VA22066 -1545 Home Phone: Work Phone: Subdivision: CASCADES Lot: SEC 12C LOT 53A Bldg/Floor/Unit: Permit Active Date: 2003 -08 -19 Pin #: Tax Map #: Construction Purpose Permit Purp: Structure Type: Site ID : 002267444000 /82/I/1////53/ NEW CONSTRUCTION WATER FW STRUCTURE TYPE New Repair ❑ Abandonment ❑ Upgrade ❑ 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: BROCKMAN, DARYL S & CHRISTINA F R/S DESIGN I NOTE: INSPECTION RESULTS Water supply, existing: (describe) PUBLIC WTR To be installed: class Cased and Grouted to Bedrock plus 10' or a minimum cased ' Grouted ' whichever is greater Well Location. See Page 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 by the permit or attached plans and 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 construction permit. Date: 2003 -08 -19 Issued By: _ Date: '' `� Reviewed By: Water supply location: Satisfactory yes no ❑ Drillers Report (G.W.2) Received yes El o ❑ Well Construction Ap oval yes Z� no ❑ Sanitarian Date _6 3 Well Driller Lic # -7A L 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 11. 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 2004 -08 -19