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Well/Water System Construction Permit Page 1 Of 4 <br />Loudoun County, Virginia Health Department 430FW91 <br />Division of Environmental Health ,y . Identification Number ZM <br />777 -0234 Metro 478 -8408 Map Reference <br />IRRIGATION G,ELL NON POTABLE USE General Information 65/4 <br />New N Repair ❑ Well ID. #T!A� I J 3 <br />Based on the application for a well /water supply system construction permit filed in accordance with Chapter 1040, Codified <br />Ordinar8A jyc9Rssyu n�ermit is hereby issued to: 703 - 641 °9000 <br />Owner ��NN Telephone <br />Addresg/O Xp-t--tlpr and Scott, 8081 1�7olftr= Rd., Suite 300, Vienna, VA 22180 <br />For a well /water system which is to be constructed on /at Rt 7 Fast into Fairfax County, L on Rt. 193 <br />f rst r on Rf 602 (Senc-ca Rd- ) fcl1 em to nd <br />Subdivision Section /Block Lot <br />DESIGN I NOTE: INSPECTION RESULTS -, <br />Water supply, existing: (describe) <br />To be installed: class IV <br />Cased and Grouted to Bedrock plus 10' or a minimum <br />cased 50 Grouted 50 whichever is greater <br />Well Location See Page 3 <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 performed <br />as follows: <br />A. Pump and related equipment shall be installed and <br />the static water level measured. <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 />C. At this point, the pump rate shall be adjusted so <br />the water level remains constant. <br />D. Measure and record the volume of water discharge <br />and water level (electric tape) at 15 minute intervals <br />throughout the test. <br />E. Discharge water at least 50 feet from the well and <br />sewage disposal area. <br />F. Interruption of pumping longer than 15 minutes <br />shall require extending the pumping time that <br />amount of time. <br />The well /water system is to be constructed as specified <br />by the permit N or attached plans and specifications ❑. <br />This water system construction permit is null and void if <br />(a) conditions are changed from those shown on the <br />application (b) conditions are changed from those shown <br />on the construction permit. <br />Date: 9/9/91 Issued by: <br />Date: `4/1 2��/ Reviewed by: <br />Water supply location: Satisfactory yes 9 o El <br />Drillers Report (G.W.2) Received <br />yes ❑ <br />Well Construction App <br />yes yes Y no El <br />Sanitarian Date //% 4 -11 <br />Well Driller ✓u / ,e, 6 <br />is # <br />Pump Installer i <br />Lic # <br />Chemical Quality Data Received <br />yes ❑ no ❑ N/A 1! <br />Pumping Data Received <br />yes ❑ no ❑ N/A 0 <br />As built sketch on page <br />Water System Approved <br />yes ❑ no ❑ <br />Sanitarian <br />Date <br />II. Criteria for approval of well and well yield are as <br />follows: <br />The well must produce a: <br />A. Minimum of 1 gallon per minute for 6 continuous <br />pumping hours after the well has been pumped <br />out according to Part I, Sec. B of this permit. <br />B. The pump test can be terminated early and well <br />yield considered adequate if: <br />1. The well cannot be pumped out as stated in <br />Part I B of this permit. <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 />C. Sufficient storage and yield may be considered for <br />approval. <br />D. Person conducting the pump test shall collect a <br />sample to be analyzed for constituents described <br />in Codified Ordinances of Loudoun County Title <br />4, Chapter 1040, Appendix III. <br />E. Replacement wells are exempt from this <br />requirernent i <br />ates <br />This Construction <br />Permit Valid until <br />9/9/92 <br />Original / Health Department Ccl y /Lduilding Department Copy / Applicants Copy <br />