water well records_att short hill
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8/15/2019 Water Well Records_ATT Short Hill
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WWDH 2013-0015
8/15/2019 Water Well Records_ATT Short Hill
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8/15/2019 Water Well Records_ATT Short Hill
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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
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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
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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
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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
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