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Well /Water System Construction Permit Page 1 Of 4 <br />Loudoun County, Virginia b •,, e� Health Department 434FW91 <br />Division of Environmental Health Identification Number <br />777 -0234 Metro 478 -8408 [T M M n F1 D FT D n <br />Map Reference <br />General Information <br />New C3� Repair ❑ Well ID. ��� �I - 0- <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 6Iay Corp. Telephone 703 -641 -9000 <br />Addresg /O Kettler & Scott, 8081 F7olftrap Rd., Suite 300, Vienna, VA 22180 <br />For a well /water system which is to be constructed on /at Rt. 7 East into Fairfax County, L on Rt. 19 <br />first L on Rt. 602 (Seneca Rd.) follow to end. <br />Subdivision Section /Block Lot <br />DESIGN <br />NOTE: INSPECTION RESULTS <br />Water supply, existing: (describe) <br />Water supply location: Satisfactory yes El no ❑ <br />Drillers Report (G.W.2) Received yes [�K n El <br />To be installed: class D1 <br />Cased and Grouted to Bedrock plus 10' or a minimum <br />Well Constructio pproval y s no 11 <br />cased 5p Grouted So whichever is greater <br />Sanitarian (` Date <br />Well Location See Page 3 <br />Well Driller Lic # <br />Pump Installer Lic # <br />I. If well yield as determined by 30 minute airlift test is less <br />Chemical Quality Data eceived yes ❑ no ❑ N/A ❑ <br />than 5 gallons per minute, a pumping test must be performed <br />Pumping Data Received yes ❑ no ❑ N/A ❑ <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 />II. Criteria for approval of well and well yield are as <br />than 5 GPM until water level drops to a point close <br />to bottom of the well. <br />follows: <br />C. At this point, the pump rate shall be adjusted so <br />The well must produce a: <br />the water level remains constant. <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 permito or attached plans and specifications ❑. <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 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. i <br />C� <br />Date: 9/Q191 Issued by: � <br />This Construction <br />�,- s nI is <br />Permit Valid until <br />Date: % Reviewed by: <br />9/9/92 <br />perviso Sanitar <br />Original / Health Department Copi// ilding Departmeflt Copy / Applicants Copy <br />