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HomeMy Public PortalAbout100_073_2015.03.02_DRAFT Wellhead Protection Application (2) WELLHEAD PROTECTION: NEW WELL/SPRING APPLICATION SHEET Georgia Department of Natural Resources Environmental Protection Division/Drinking Water Program FOR COMMUNITY-MUNICIPAL DRINKING WATER SYSTEMS ONLY This is a preliminary data check to expedite permitting of new drinking water sources for municipal-community systems.A separate application must be filed for each new well. System Name: Tybee Island Cretaceous Aquifer Well County: Chatham System ID. No. GA 0510005 System Permit No. TBD Proposed Well/Spring No. _104 Owner: City of Tybee Island Applicant: City of Tybee Island Address: P.O.Box 2749 Address: P.O.Box 2749 City/State/Zip: Tybee Island,Georgia 31328-2749 City/State/Zip: Tybee Island,Georgia 31328-2749 Phone No.: ( ) Phone No.: ( ) Well/Spring Address if applicable: Submit a map-mark the well location on a USGS 7 'h minute topographic map,a copy of a portion of a map is acceptable. Is the well site located within a 100 year flood plain zone as defined by FEMA? X yes no Ground Elevation 15 ft.MSL, Longitude: W 80°5'7.54"W Latitude: N 32°1'24.44"N PROPOSED WELL DESCRIPTION Provide a well construction diagram Proposed Drill Date: August 2015 Proposed Total Depth: 3,800 Proposed Pump Rate: 650 to 1,000 gpm During temporary aquifer Name and Georgia License#of proposed driller: To be determined based on bids pump test PROPOSED DRILLING METHOD(Indicate) PROPOSED WELL SCREEN/OPEN HOLE INTERVAL Rotary: X Percussion: Other: From: See Attached ft. To: ft. From: Figure 1 ft. To: ft. PROPOSED CASING INTERVAL PROPOSED GROUTING MATERL4L & INTERVAL From: See Attached ft. To: ft. Material: See Attached Figure 1 From•Figure 1 ft. To: ft. From: ft. To: ft. PROPOSED BACKFILL MATERIAL&INTERVAL Material: See Attached Figure 1 Please submit drillers logs from nearby wells if they From: ft. To: ft. are available. First Cretaceous aquifer well in Georgia PROPOSED WELLHEAD PROTECTION AREA CONTROL ZONE X 15 ft. radius from wellhead PROPOSED INNER-MANAGEMENT ZONE: (indicate one) Aquifer Type Wellhead Protection Area Key to Map Karst 500 ft. radius from the wellhead K Piedmont Fractured Crystalline Rock 250 ft. radius from the wellhead P Coastal Plain Unconfined 250 ft. radius from the wellhead C X Coastal Plain Confined(attach documentation) 100 ft. radius from the wellhead C All wells in the Coastal Plain will be considered unconfined unless shown to be otherwise. PROPOSED OUTER-MANAGEMENT ZONE: For the purpose of this application a proposed outer-management zone radius of one mile will be considered when identifying the potential pollution sources listed on the back side of this application. The final outer-management zone will be dependent upon well construction and the geology of the wellhead protection area.The final radius may range from 100 feet to several miles. DNR/EPD/DWP New Well Application Rev 10/2013 Page 1 of 2 POTENTIAL POLLUTION SOURCE INVENTORY WITHIN THE PROPOSED WELLHEAD PROTECTION AREA Indicate whether any of the following potential pollution sources are present. EPD will not permit the well/spring if any of the following are present within the inner management zone. yes no X commercial animal enclosures poultry enclosures or animal feedlots X underground storage tanks X non-domestic septic systems Further investigation will be necessary if any of the following lie within one mile of the proposed site. yes no yes no X domestic septic systems _ X commercial animal enclosures X municipal solid waste landfill _ X animal feedlots X industrial waste landfill _ X quarries/underground mines _ X construction waste landfill X underground storage tanks(unmonitored) X hazardous waste disposal — waste water treatment basins X facilities handling hazardous waste _ X non-domestic septic systems X agricultural waste impoundments _ X underground injection wells X land application of waste water/sludge PROPOSED ALTERNATE WATER SUPPLY Please provide a brief description of the alternative water supply to be used in the event this well must be shut down. This well not be used for water supply as it is intended to explore the technical,environmental and cost implications of installing and operating a deep well in the Cretaceous aquifer. The decision to use it for water supply will not be made until all the test data is collect and then only if Tybee Island decides to lease it from the State. Until then Tybee Island will continue to use its three Floridan wells to meet its water supply demands. Does this permit application affect or require another environmental permit or license or certification issued by the Georgia Environmental Protection Division? ❑No ©Yes(if Yes,please indicate below) ❑Air Quality ❑Asbestos n Dam Safety ©Drinking Water © Erosion/Sediment ❑Hazardous Waste ❑ Lead-based Paint ❑ Radioactive Material ❑ Scrap Tires ❑ Solid Waste ❑ Storm Water [' Underground ❑Underground © Wastewater © Water Withdrawal Injection Control Storage Tanks 1=Perhaps in the future Tybee Island may request a Drinking Water ▪ Well Drilling ❑ Other(specify): permit 2=A temporary NPDES permit is needed for the aquifer pump test I understand the Director of EPD is relying upon the accuracy of the information provided herein and in accordance with Section 9 of the Georgia Safe Drinking Water Act of 1977. I shall upon request of the Director or his representative,provide such additional information as may be necessary to complete final disposition of the application. I further understand it is unlawful for any person to own or operate a public water system, except in such a manner as to conform and comply with all rules, regulations, orders, and permits established under the provisions of the Georgia Safe Drinking Water Act of 1977 and applicable to the waters involved. Name of Owner of the Water System as it will appear on the permit(Individual,City,County,Company, etc.)Please Print Owner's or Authorized Agent's Signature: Title: For governmentally owned water systems(Cities,Counties,Authorities): To the best of my knowledge,the water system is in compliance with the Service Delivery Strategy(House Bill 489, 1997)for all counties in which its boundaries lie. Owner's or Authorized Agent's Signature: Date: SEND FORM TO: Don Shellenberger,Georgia Environmental Protection Division,Drinking Water Program,2 Martin Luther King Jr.Dr. SE,Suite 1362 East Tower,Atlanta,Georgia 30334. (404)463-3948. DNR/EPD/DWP New Well Application Rev 10/2013 Page 2 of 2 Modified From Pollard and Vorhis, 1980 Casing Diameter(inches) �_ y_ I 40 N N�to 0 , I 28-34 to Co 0 C rn GENERAL NOTES: w w o- • s e Geologic Aquifer } W C C co fn Formation System 1. THE INFORMATION PROVIDED HEREIN IS INTENDED TO AID DISCUSSION 110 2 I y WITH THE STATE ON THE WELL HEAD PROTECTION PERMIT REQUIREMENTS fn 1 i FOR THIS PROJECT. (ft bls) Cl,ti l CO w m 2. THE CRETACEOUS AQUIFER DEEP WELL IS CURRENTLY UNDER DESIGN SO 12 16 0_ ti WELL SCREEN INTERVALS,CASING INTERVALS,GROUTING MATERIAL,AND Pit Casing, Steel PM Undifferentiated Surfidal Aquifer BACKFILL MATERIAL INTERVALS WILL BE PROVIDED/UPDATED AS THE 40' DESIGN PROCEEDS. Miocene Hawthorn Formation Upper Confining Surface Casing, F� I U'd 3. THE NAME AND GEORGIA LICENSE NUMBER OF THE COMPANY AWARDED 170'—L Suwannee Limestone THE CONTRACT WILL BE PROVIDED ONCE THE BIDS HAVE BEEN RECEIVED \ \ Steel AND THE NOTICE-TO-PROCEED HAS BEEN ISSUED. \ Upper 4. DTHIS FIGURE IS INTENDED FOR EPD WELL HEAD ISCUSSIONS/PERMITTING PURPOSES ONLY,AND SHALL NOT BE USED TO Ocala Limestone Floridan Aquifer SUPPORT ANY OTHER PURPOSE. Lyj i 500 Middle S ",.. -a Confining Unit '\ s Grout LL Avon Park Formation Lower 1,000 Floridan Aquifer \� Intermediate Casing, s 1 200' — Steel '� Oldsmar Formation Lower Cedar Keys Formation Confining Unit \ 1,500 v Final Casing, Stainless Steel or Fiberglass \ Reinforced Plastic 2,000 Providence Sand \ hJ/varroan A Ripley Formation A2,C2&A3 Cusseta Sand Grout 1 a0,I.il I R Bluffton Formation C3,A4&C4 2,500 A5 y r \3 ,000 9, Austinian Eutaw Palmation 5 C - - 3,00V- i 2 Screen, Stainless Steel A6 •[ Eaglefordian D Gravel Pack w • Tuscaloosa Formation Woodinian E Cry____- . 3,500 ; Blank Casing, Stainless Steel Washita ? , A7 Fredrid<shurgian 4,000_ :'.. ft bls=feet below land surface 4,000'— FIGURE 1 GEOPHYSICAL LOGS - CRETACEOUS AQUIFER DEEP WELL PROPOSED DEEP WELL CONSTRUCTION DIAGRAM CRETACEOUS AQUIFER DEEP WELL NTS NTS CH2MH I LL® 496604 FILENAME:Figure-1_496604.dgn PLOT DATE:2/20/2015 PLOT TIME: 6:38:46 AM / , / /. s eief . ‘. ;,., •■ r • vies. 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