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Well/Water System Construction Permit Page ✓ Of 3 <br />Loudoun County, Virginia Health Department <br />Division of Environmental Health Identification Number 207 FW 96 <br />777 -0234 Metro 478 -8408 9 Map Reference 22 LEI <br />General Information <br />New Repair ❑ Abandonment ❑ Upgrade ❑ Well ID.# <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 Bondy Deyelo=ent Corp Telephone ( 301) 986 -7260 <br />Address 8401 Connecticut Ave. Chew Chase, Md 20815 <br />IFor a well /water system which is to be constructed on /at Meet at Lowes Island Club on Lowes Island <br />Blvd call Jim McCarron for direc,tinns <br />Subdivision Section /Block 65 Lot 4 <br />DESIGN <br />NOTE: INSPECTION RESULTS <br />Water supply, existing: (describe) <br />Water supply location: Satisfactory yes no ❑ <br />Drillers Report (G.W.2) Received yes no ❑ <br />To be installed: class <br />Cased and Grouted to Bedrock plug 10' or a minimum <br />cased Grouted �� _whichever is greater <br />Well Constructi proval y s no ❑ <br />Sanitarian �/ Date <br />Well Location See Page 2 3 <br />Well Driller P Lic # <br />Pump Installer Lic # <br />I. If well yield as determined by 30 minute airlift test is less <br />Chemical Quality Data Received yes ❑ no ❑ N/ <br />than 5 gal ns per minute, a pumping test must be performed <br />Pumping Data Received yes ❑ no ❑ N/ <br />as follows: <br />h <br />As built sketch on page <br />A. Pump a\ape) lated equipmelit s all be installed and <br />Bacterialogical Sample Received yes ❑ _ no <br />Water System no ❑ <br />the statier level me s�Jred <br />B. PumpinI begin at t of it rawal greater <br />ved yes <br />Sanitarian Date <br />than 5 Gu it water dro s o point close <br />II. Crit is for approval of well and well yield are as <br />to bottohe ell. <br />follows: <br />C. At this the ump rate sh I be adjusted so <br />The well ust produce a: <br />the watel rem ins constant. <br />A. Minimu of 1 gallon per minute for 6 continuous <br />D. Measur record a volume o water discharge <br />and watel (electri ape) at 15 minute intervals <br />pumping urs after the wel has been pum ped <br />throughe test. <br />out accordin to Part I, Se . o this permit. <br />E. Discharater at least 5 feet from the well and <br />B. The pump to can bet n early and well <br />sewage osal area. <br />yield considere ade <br />F. Interrupof pumping longe than 15 minutes <br />1. The well can of pu out as stated in <br />shall require extending the pumping time that <br />Part I B of this rmit. <br />amount of time. <br />2. The Well yields .5 g or greater for 3 hours <br />of continuous p ping after Part I B of this <br />permit is complete . <br />The well /water system is to be constructed as specified <br />C. Sufficient storage and field may be considered for <br />by the permit Kor attached plans and specifications ❑. <br />approval. <br />D. Person conducting the ump test shall collect a <br />This water system construction permit is null and void if <br />sample to be analyzed fo Constituents sample <br />conditions are changed from those shown on the <br />in Codified Ordinances of oudoun County Title <br />application (b) conditions are changed from those shown <br />4, Chapter 1040, Appendix I <br />on the construction permit. <br />E. Replacement wells are xempt from this <br />r uirement. <br />Date: Issued by: This Construction <br />s ria Permit Valid until <br />Date: C L Reviewed by. <br />Sy ankarian <br />Original / Healthyepartm4t Copy / Applicants Copy <br />