The applicant shall provide the following pursuant to Env-Dw 302.05(a)(2):

1. (a) A general description of the current use and 50 year history of the property where the well is or is proposed to be located;
2. (b) A description of all existing and proposed land use activities within the sanitary protective area;
3. (c) Documentation to demonstrate that the sanitary protective area is or will be under the direct legal control of the applicant and will be maintained as required by Env-Dw 302.10;

4. (d) The following maps and diagrams, to demonstrate that the location and sanitary protective area of each existing or proposed well meets the requirements of Env-Dw 302.09 and Env-Dw 302.10:

   1. (1) A USGS map on which the following are clearly marked:

      1. a. The location of each well for which approval is being sought;
      2. b. The location of each known contamination source, each potential contamination source, and each water resource and use inventoried as required by (g), below;
      3. c. The estimated wellhead protection area determined as specified in Env-Dw 302.11;
      4. d. The limits of the delineated potential impact area; and
      5. e. The title, scale, and date of the quadrangle;

   2. (2) One or more copies of a municipal tax map or a survey map that identifies the following for each well for which approval is being sought:

      1. a. The tax map and lot number of the property on which the well is or is proposed to be located;
      2. b. The property lines and the owner of each lot into which the sanitary protective area extends, and all easements on or over such lots;
      3. c. The location of the well and the sanitary protective area of the well;
      4. d. All public and private water supply wells located within 1,000 feet of the well;
      5. e. The 100-year flood elevation, the flood plain, and all surface waters and wetlands within 100 feet of the well;
      6. f. All land uses, including any paths, trails, structures, storage, landscaping, or other alteration of the natural terrain; and
      7. g. All stormwater discharge areas and drainage structures; and
   3. (3) A copy of the Flood Insurance Rate Map on which the location of each well for which approval is being sought is clearly marked;
5. (e) A conceptual hydrogeologic model of the withdrawal and potential impact area that has been prepared in accordance with Env-Wq 403.07;
6. (f) A preliminary estimate of the wellhead protection area and a proposed method for refining the estimate in accordance with Env-Dw 302.11;
7. (g) A preliminary contamination source inventory and water resource and user inventory in accordance with Env-Dw 302.12;
8. (h) Identification and evaluation of any known contamination source in accordance with Env-Dw 302.13;
9. (i) A proposal for a pumping test in accordance with Env-Dw 302.14; and
10. (j) A proposal for a water quality sampling program in accordance with Env-Dw 302.15.

Source. (See Revision Notes #1 and #2 at part heading for Env-Dw 302) #11061, eff 4-1-16