Water Well Records_ATT Short Hill

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WWDH 2013-0015





Form OW-2 ,

SANDONL-

7

CQMMQNWE6LTH

OF

VIRGINIA

State Water

Control Board

P.

O. E 3ox 11143

W A T E R W E L L

C O M P L E T I O N

R E POR T

2111

North

Hamilton

Street

Certification of

Co mpletion /

County

Permi t

Richmond, Virginia

23230

Coun ty /

city_-

G 17U

Virginia

Piano Crxrrdinates

N

t,atltude

R

Longitude

N

w

Topo . Map

No.

Elevation

Formation

River Basin

Province

Type

logs

Cuttln%

Water Analysis

Aquifer

Test

O wner . r t-

j '

a ag

t24

Well

Designation or

Number

Address

iTe-. &

r 1'

2

Phone

D r I l l i n g C o n t r a c t o r :

Nor thern V irg in ia Dr il li ng ,

Inc.

Address

11356

Industrial Road

Manassas.

VA 20109

Phone: (703) 361 -

6859

T M _

BWCM No.

SWCB Perm*

C o u n ty P e rm i t

Gertification

of inspecting official:

w—

This well doee

does

not

meet codellowrequirements.

S.

Date

For

Offic9 use

T ax

Map

I. D.

No.

Subdivision

Section

Block

Lot

f,.

ass.

Well

i

IIA

11 8 MIA

1 1 1 8

IIIC

MID __

IIIP_

WELL LOCATION: (

feet/

miles _.

direction)

of

and____

feetlmiles ( direction)

of

It

po s sib le p le as e Inc lu d e map

showing

locat ion marked)

Date startec •

Date

completed

WELL DATA: New

Reworked

Deepened

Total

depth

ft,

Depth

to bedrock

ft.

Sole

size (

Also Include

reamed

zones)

inches from _

to

ft,

inches

from

to

ft,

inches from

to

ft.

Cas t ing s i ze ( D.)

an d

material

inches from _

to

ft,

Material

Wt per toot

or

wall thickness

In.

inches from

to

ft,

Material

Wt

per

foot

or wail thickness

in,

inches

from

io

ft.

Material

Wt per foot

or wall thickness

in.

Screen s ize and mesh

fo r

each zone ( where appl icable)

inches from

to

ft.

Mesh size

Type

inches

from

to

ft,

Mesh size

Type

inches from

to

ft.

Mesh size .,..

Type

inches

from

to

ft.

Mesh size.

Type

Gravel

Pack

From

to

ft,

From

to

Grout

From _

to

ft., Type

From

to

ti.,

Type

L e

T y pe rig

1 G < -0yr-744—

WATER DATA • Water Temperature

Stalk:

water level (

unpu rnped l eve l-measured

StablGzed

measured pump ing water level

Stabilized yield

gpmater

hours

Natural Flow: Yes No

flow rate:

gpm

Comment o n

quality

3.

WATER

ZONES: From

To

From

To

From

To

From To

From

To

USE DATA:

Type o f use : D r ink ing

L i ves tock W ater ing

Irrigation

F o o d process ing

Household

Manufacturing

Fre Safety

Cleaning

Recreation

Aesthetic

C o o lin g o r h ea tin g

Injection

Other

Type

of f aci li ty Dom es t ic

Public water supply

Public

InsiltutionlFarm

Indust ry

Commercial

Other

5. PUMP DATA:

Type •

Rated W .

P.

Intake depth •

Capacity

at

head

S. WELLHEAD: Type well seat

Pressure

Tank gal.

Loc

Sample ta p

Measurement port

Well

vent

Pressure relief valve

Gate valve

Check valve (when

required)

Electrical disconnect switch

o n po we r s upply

7. DISINFECTION:

Well

disinfected _

Yes

No

Date /

t used

-

Disinfectant

ems-

UV o

A m o u n t 22

Hours used—,

2 f

8. ABANDONMENT (where applicable) + Yes ''~

No

Casing

pulled

Ye s

No —`

Not Applicable

Plugging grout From / QD•

to

Q

material

6e-47?9Mr r

OVER

WWDH 2013-0016



County

OfLoudoun

Division

of Environmental

Health

Leesburg, Virginia 20177

Office (

703)

777 -0234 Fax (703)

771 -

5023

Inspection Request ( 703) 771 -5808

WELL /WATER Permit #

T20361450002

Owner Name:

AMERICAN

TEL &

TELEGRAPH CO OF

Owner NameZ:

ATTN: J

DIFERDINANDO,

TAX DIR

Owner Address:

PO BOX 7207

D E S I G N

BEDMINSTER

N307921 -7207

Applicant

Name:

AMERICAN TEL &

TELEGRAPH CO OF

Applicant

Name2:

ATTN:

J DIFERDINANDO,TAX

DIR

Applicant

Address:

P O BOX 7207

S a n i t a r i a n

D a t e

BEDMINSTER

Home

Phone:

Subdivision:

Work Phone:

Ext

Lot:

Permit Active

Date:

Pn #:

Tax Map #:

Construction Purpose:

Permit Purp:

Structure

Type:

System Type :

2012 -

07 -

11

477387669000

7//////// 59/

WELL ABANDONMENT

WATER WAB

STRUCTURE TYPE

Page 1 of

5

Directions to

property :

12355 White Rock Road, Purcellville,

VA -

Rt. 7

W

to

Rt.

9 toward

Charlestown,

R @

Harpers

Ferry

Rd . R @

White R o c k

R d . -

A

LOCATIONAL

CLEARANCE IS

REQUIRED BY B & D

New _ Repair _

Abandonment

X

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: AMERICAN TEL &

TELEGRAPH

CO

OF

D E S I G N NOTE:

INSPECTION RESULTS

Water

supply, exist' ng: (

describe)

DRY HOLE

Water

supply

location:

Satisfactory

yes El

no

Report (G.

W.2) Received

yes

no

El

To be-

+

eleHed: classo

Cased and Grouted

to Bedrock plus

10'

or a minimum

Well Construction Approval

yes no

cased N /

A Grouted

N/

A whichever

is greater

S a n i t a r i a n

D a t e

Well Location.

See

Page

Well

Driller

Lic #

Pump Installer

Lic #

If well yield

as determined by

3 0 minute airlift test

is less

Chemical Quality

Data

Received

yes no

NIA

th

5 gallons per minute, a pumping test must b e performed

Pumping

Data

Received

yes

no

N/ A

as

fo ws

As built sketch on page

Bacteriological Sample Received yes

no

. Pum

nd related

equipment shall

be

installed

and the static

water

le I measured.

Water System Approved

yes

no

B.

Pumping

s

II begin at a rate of wthdrawal greater than 5

Sanitarian

Date

GPM until

wat

level drops to a

point close

to

bottom of

the

1 1 .

Criteria for approval of

well and well

yield are

as follows:

wel.

The well

must produce

a:

C. At

this

point, the p

p

rate

shall

be

adjusted

so the

water

level remains constant.

A. Minimum

of

1

gallon

per minute for

6 continuous

D. Measure

and record

the

olume of water discharge and

pumping hours

after the

well

has been

pumped out

water

level ( electric tape) at 5 minute intervals

throughout

accorc}

4tg

to

Part

1 ,

Sec.

B of this permit.

the

test.

B.

The

puritp test

can be

terminated

early and

well yield

E . Discharge

water

at

least

50 feet m

the

well and sewage

considered adequate

if:

disposal area.

1.

The

well+sannot be

pumped out

as

stated

in Part 1,

F . Interruption of pumping

longer

than

1 5

m utes shall require

Sec.

B of

airs

permit.

extending

the

pumping time that amount of

e.

2. The well yiel 'ds 2. 5 GPM

or

greater

for

3

hours of

continuous puhiping after

Part

1 , Sec. B of

this

ar cs

The

well /water system

is

to

be

Ewpctfuct"

as

specified

by the

permt

are

comp0ed.

permit X and attached

plans /

specifications. _

C. Sufficient storage

an

yield may be considered

for

approva.

This water system eerrstrv

ctienn permit

is null and void if ( a)

D. Person conducting the

pu

test shall collect a sample

conditions are

changed from those shown

on the application

to be analyzed for constitugrtts

described

in Codified

b)

conditions

are

changed

from those shown on

the

Ordinances

of

Loudoun County Title

4,

Chapter

1040,

comsrucionpermt.

Appendix III.

E. Replacement wells are exempt from

is requirement.

Date:

012 -07 -11

Issued By:

This

Construction

Date:

U

Reviewed By:

Permit Valid

Until

2013 -

07 -11



tJ

Form GW -

2

1976-

10,ouo

State

Water

Control Board

P.O.

Box

11143

2111 North

Hamilton

Street

Richmond. Virginia

23230

Virginia

Plane Coordinates

N

Latitude

3

Longitude

N

W

T opo ,

Map No.

Elevation

Formation

Li tho logy

River

Basin

i

Province

Type logs

Cuttings

Water Analysis

Aquifer

Test

A

5

AND0N "

l E N T

COMMONWEALTH OF

VIRGINIA

W AT E R W E L L C O M P L E T IO N R E P O R T

Certification o f Co mpletion /County

Permit

I- , , ei *;<-

3

Owner _

met-

G '

r4 7ei- 2 - 71 CQ ,16 :1 2ho.

W 8 1 1 Designation or Number

Address .

Q

315'

5

LL , ,

7 7 7 - ? ',

Phone

D r i l l i n g

Contractor. Nor thern Virg in ia Dr il li ng , Inc.

Address

11356 Industrial Road

Manassas, VA

20109

Phone: ( 703) 3 6 1 -6859

BWCM No,

SWCH PemNt

County

Permit

Certification at inspecting official:

This well does

does

not

Meet cudalow requirements.

S.

Date

For Office Use

T ax

M ap I.

D.

No .

Subdivision

Section

Block

Lot

Class Well

I

IIA

1 1 8

IIIA

IIIB

VIC

ti

D _

1 1 1 E

m - =

NELL LOCATION: (

feet/miles

direction) of

and

feevmiles (

direction) of

it p o s s ib le p le a s e in c lu d e map s h o w i n g location m a r k e d ) + +

Date

started •

Date completed

Type ng

L

tY7LJr

i

1 _.

1 . WELL DATA: New

Reworked—

Deepened

Total

depth

ft

Depth

to

bedrock

ft

Ho le s iz e ( A is o incl ud e r eam ed

zones)

h o u r s

inches from

to

tt,

Inches

from _

to

ft,

itches from

to

tt

Cast ing

s ize (

I.

D.)

an d material

Inches from ,_,_„•

to

ft

Material

Wt.

per

foot

or wall thickness

Inches from

to

R .

Material

Wt. per

foot

or wall thickness

in

Inches

from —

to

it

Material

Wt.

per

toot

or wall thickness

in.

Screen

size

and

mesh fo r

each zone ( where applicable)

inches from _

to

g,

Mesh size

Type

h e a d

Inches from —

to

h.

Mesh

size.^,,,,,__

Type

Inches from

to

ft,

Mesh

size

Type Y_ .

inches

from

to

ft.

Mash sizes _ _ _ _

Type

Gravel

Pack

No

From

to

ft,

Frorn

to

ft.

Grout

From

to

ft.. Type

From

tc

ft., Type

W A T ER D A T A • W a t er T e m p e ra tu re . . .

Static water

level ( unpumped level -measured )

Stabilized

measured pumping water level

Stabilized yield

gpm

after

h o u r s

Natural

Flow:

Yes

No

flow

raja:

Un

Comment

on quali ty

3.

WATER ZONES:

From

To

From

To

From

To

From

To From To

USE

DATA:

Type

o f use:

Drinking

L ivestock

W atering

Irrigation

Fo o d p ro ces s in g

Household

Manufactur ing

Fire

Satety

Cleaning

Recreation

Aesthetic

Cool ing o r heating

infection

Other

T y p e

o r 1 a C +lty Domest ic

Public water supply

Public insti tution_

Farm

Indust ry

Commercial

Other

5. PUMP DATA: Type -

Rated

H . P.

Intake depth _••,,,,

r• •

apac i ty - - _. -

at

h e a d

6. WELLHEAD: Type well seat"

Pressure

Tank

gal. Loc

Sample tap

Measurement port

Well vent —

Pressure relief valve

Gate valve

C h e ck v a lv e (when required)

E l e c t ric a l d is c o n n e ct s w it ch o n

p o w e r s u p p ly

7. D I S I N F E C T I O N : W e ll disinfected

e

No

es

Date /

1 ?

9 - /

Disinfectant used S.

I •

Amount 3-

Hours

used

121E

8. ABANDONMENT (

where appricable) •

Y •

rNo

Casing p u ll ed Ye a

No - J—

ro

Applicable

i

P lu g g in g g r ou t F r o m l00, o - 0—

aena

Z ,

Yq

i7"

OVER

WWDH 2013-0017



County

Of

Loudoun

Division

of

Environmental Health

Leesburg, Virginia 20177

Office (703) 777 -

0234

Fax (703) 771 -

5023

Inspection

Request ( 703)

771 -

5808

WELL/WATER Permit # T20371350001

Owner Name: AMERICAN TEL &

TELEGRAPH CO OF

Pennit Active Date:

Owner Name2:

ATTN: J DIFERDINANDO,TAX DIR

Pn #:

Owner Address:

PO BOX

7207

Tax Map #:

W a t e r

s u p p l y , e x i s t i n g :

d e s c r i b e ) D R I L L E D W L

BEDMINSTER

NJ07921 -

7207

Construction Purpose:

Applicant

Name:

AMERICAN

TEL &

TELEGRAPH CO OF

Permit Purp :

Applicant

Name2: ATTN: J DIFERDINANDO,TAX

DIR

Structure Type:

Applicant Address:

PO

BOX 7207

System Type

t h a n

5 g a l l o n s

p e r

m i n u t e ,

a

p u m p i n g t t m u s t

b e p e r f o r m e d

BEDMINSTER

as f o l l o w s :

2012 -07 -31

477387669000

7////////

59/

WELL

ABANDONMENT

WATER WAB

STRUCTURE TYPE

Page 1 of

4

Home Phone:

Work Phone:

Ext

Subdivision:

Lot: , /

J 9Yl

H

dQ 3 1770007—

Directions to property :

Rt.

7 W

to Rt .

9W R o n H a r p er s F e rr y Rd.

to

R o n

White

R o ck R o ad

to

the top # 1 2 3 5 5 - A

L O C A T I O N A L C L E AR A NC E IS

R E Q U I R E D BY

B &

D

New _ Repair _

Abandonment X

Upgrade _ Hydrofrack —

Well ID #

Bas ed o n the

application for a

well /water

supply

system

construction

permit

filed in

accordance

with

Chapter 1040. Codified

Ordinances,

a

construction

permit

is issued to:

AMERICAN TEL &

TELEGRAPH CO OF

DESIGN

NOTE: INSPECTION

RESULTS

W a t e r

s u p p l y , e x i s t i n g :

d e s c r i b e ) D R I L L E D W L

Water

supply

location:

Satisfactory

yes

no

Drillers Report (G.W.2) Received yes

no

To

be installed: Blass

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,

Well Driller

Lic #

Pump

Installer

Lic #

I.

If well yield as determined

by

3 0 minute airlift test

is

less

Chemical Quality Data Received

yes El no NIA

t h a n

5 g a l l o n s

p e r

m i n u t e ,

a

p u m p i n g t t m u s t

b e p e r f o r m e d

pumping

Data

Received

yes

E l

no

E l

N/ A

E l

as f o l l o w s :

As

built sketch on

page

Bacteriological

Sample Received

yes

no

A.

Pu

and related equipment shall

be

installed and

the

static

waerleve measued.

Water System

Approved

yes

no

B.

Pumping

shall begin at a rate of withdrawal

greater

than 5

Sanitarian

Date

GPM

until water level drops to

a

point close to bottom of the

II.

Criteria for approval

of

well

and

well yield

are

as

follows:

wel.

The well must produce a:

C .

At

this point,

t4R

pump rate shall b e adjusted so

the

water

level remains

con

tant.

A. Minimum

of 1

gallon per m inute for 6 continuous

D.

Measure

and recor

the volume of water discharge and

pumping

ours after the

well

has been

pumped

out

water level (

electric tape) at 15

minute

intervals throughout

according

t

art 1 , Sec. B of

this permit.

the test.

B.

The pump tes

an

be terminated

early

and

well yield

E . Discharge

water

at least

50

feet from the well and

sewage

consderedadequ

if:

disposal area.

1 .

The

well

cannot

be

umped out as stated in Part 1 ,

F . Interruption of pumping longer than

1 5

minutes

shall

require

Sec.

B of this permit.

extending

the

pumping

time

that amount of

time.

2.

The

well yields 2. 5

GP

r greater for 3 hours

of

continuous pumping

after

art 1,

Sec.6

of this

T he

well /water

system

is

to

be

constructed

as

specified

by th e

permt

are

compeed.

permit

X

and attached plans /specifications. _

C. Sufficient storage an d yield m ay

a

considered for

approval.

This

water

system

construction permit

is

null

and

void

if (

a)

D .

Person

conducting

the

pump test shall c lest a

sample

conditions are changed

from those shown on

the application

to

be

analyzed for constituents describe

in Codified

b)

conditions are changed from those shown on the

Ordinances

of Loudoun County Title 4,

Ch

ter 1040,

comsrucionpermt.

Appendix III.

E . Replacement wells are exempt

from

this requirement.

Date:

2012 -07 -

31

Issued By:

This Construction

Date:

6

Reviewed

By:

Permit

Valid

Until

2013 -07 -

31

abandonment



WWDH 2012-0134

















Documents

Water Well Records_ATT Short Hill