ML061730289

From kanterella
Jump to navigation Jump to search
Permit to Operate Vermont Yankee Neob Water System
ML061730289
Person / Time
Site: Vermont Yankee Entergy icon.png
Issue date: 04/27/1999
From: Webb D
State of VT, Agency of Natural Resources
To: Williams B
Office of Nuclear Reactor Regulation, Vermont Yankee
References
%dam200611
Download: ML061730289 (55)
v • d • e


Text

State of Vermont AGENCY OF NATURAL RESOURCES Department oF Environmcntal Conservation s sd

)palxw'.t of F'rv.2 pi,.di.e-ezn WATER SUPPLY DIVISION' riprnent of Emir'cnmert Cone". The Old PantryBuilding Stat Geo: 2 is: 103 South Main Street RELAY SERM1CE FOR THE 1HEARVG it.PAInfED Waetruby, VT*0567i.0403 1.800253-0191 TDOoD>VoC f.s~oa-e1;-ol*S Vo-coCO TELEPHONE (802) 241-3400 FACSIMILE (802) 241.3284 April 27, 1999 Ms. Barbara Williams Vermont Yankee Nuclear Power Corporation

'P.O. Box 157 Vemon, VT 05354 APR 2 9 1999 Re: Permit to Operate Vermont Yankee NEOB Water System Byy

Dear Barbara:

Enclosed is the Permit to Operate for Vermont Yankee's New Engineering Ofice Building (NEOB) water system. Please read the permit carefuUy as you will be expected to be famriliar with all terms and conditions. Condition 5 under the Special Conditions section pertains to Microscopic Particulate Analysis (MPA) testing for the new well. The two other Vermont Yankee system's obtained exemptions from this testing last year. I have enclosed the exemption application for your use.

The adjusted gross alpha (gross alpha - uranium 234, 238) result from the sampling conducted on March 8, 1999 was below the MCL of 15 pCi/L. You should be aware that EPA may propose a MCL for uranium in the near future. I do not know what this level will be, but in the past they have considered 30 pCiIL.

If you have any questions regarding the permit, please call me at (802) 241-2599.

Sincerely, David H. Webb Assistant Regional Manager c: WSID 20738 Jean Nicolal, Compliance and Certification Thi Raymond, Regional Manager Regional Vi!ces - erreEs!ex J.kt.Pitzcrd1Ru~arid'N. Sptinglief~tSt JoIhnsburl

State of Vermont AGENCY OF NATURAL RESOURCES Department of Ensironmcntal Conseryation Depanmeo of Fit mvi Wdditc DeNw-uant 01rforests. Pafcs 3.1 Receatien WATER SUPPLY DIVISION Dopwunont of Em£ onrenUI Cowscrva;ion The Old Pantry Building S!a~e Geobtisz 103 South Main Street MELAYSEHvICE FOR TI-E H-ARING IMPAIRED Waterbury. Vr 05671-0403 1-80.253-,ogl TOOV; ce I-OOc-253-015 Volce>TDD TELEPHONE (802) 241-3400 FACSIMILE (802) 241-3284 April 26, 1999 Public Water System Pernit to Operate WATER SYSTEM IDENTIFICATION NUMBER: 20738 PIN #: NS95-0006.06 WATER SYSTEM: Vermont Yankee Nuclear Power Corporation New Engineering Office Building (NEOB) Water System TOWN: Vernon RESPONSIBLE PERSON: Barbara Williams ADDRESS: P.O. Box 157 APR 2 9 1999 Vernon, VT 05354 /2 .1 I I. Authority In accordance with 10 VSA, §1671 ed =q., the following findings and conclusions have been made for Vermont Yankee's NEOB Water System. The Department has determined that the operation of this public water system, subject to the following conditions, will not constitute a public health hazard or a significant public health risk; therefore, a permit is hereby issued.

II. Findings and Conclusions The following findings establish that this system is in compliance vWith the standards in accordance with 10 VSA, §1675(b), and will not constitute a public health hazard or a I significant public health risk:

I. Summary of sanitary survey physical conditions:

A. Date of most recent information: 4/23/99 I

B. Major Findings:

1. Facility Use: Office Building
2. Classification: 2 FR.9"cr.al Offc1es - Parn.E.sex Jct.;Pi.tsf.r.1 td and,/'lrigfie.diSL Johnmbury

F.xmit to Operate' Vermont Yaukft - New Engineering Office Building Page 2 April 26, 1999

3. Source: 500' deep bedrock well
4. Number of Connections: I
5. Population Served: 160 employees, maximum
2. Summary of most recent water qualty samplc results:

Contaminant(s) Date Results A. Bacteriological past twelve months met standards B. Inorganics (IOCs) . met standards C. VOCs met standards D). Radionuclides '318199 met standards E. SOCs met standards F. Cyanide" met standards G. Lead/Co per met standards.

H. Nitrate 3/30/99. met standards

1. Nitrite -________met sWAndards
3. Groundwater Under The Direct Influence D -termination:

MPA testing or exemption determination is required by this permit.

4. Isolation Zone:*

The zone of isolation is controlled by the Vermont Yankee Corporation. A well head protection afea has been delineated.

5. Operating Status:

This is a new Non-Transient, Non-Community water system serving an engineering office building. Water is pumped from a bedrock well to hydropneumatic storage and then into-the distribution system.

  • 9'h I Permt to opente Vermont Yankee - New Enginceig Office Building Page 3 April 26, 1999
6. Certified System Operator(s):

The Class 3 certified operators for this water system are Barbara Williams and Richard Gerdus. Their current certifications expire June 30, 2001.

7. The Department concludes that this water system is operated in compliance with the standards adopted under 10 VSA, §1671 cl scq. and does not constitute a public health hazard or a significant public health risk.

II1. General Conditions

1. The person to whom this permit is issued must comply in full with all applicable provisions of 10 VSA, §1671 et =q., the rules adopted thereunder and the Federal Safe Drinking Water Act and subsequent regulations.
2. This permit may be suspended or revoked in accordance with 10 VSA, §1675.
3. This permit is not transferable or assignable and shall automatically become invalid upon a change of ownership of the water system.

IV. Special Conditions

1. This permit is valid for five (5) years from the date of issuance.
2. Reapplication: The permittee shall submit a complete application for reissuance of this permit 90 days before this permit expires. The reapplication deadline is December 31, 2003.
3. The permittee shall comply with all of the Drinking Water Quality Monitoring Requirements pursuant to the Vermont Water Supply Rule, Chapter 21, Subchapter 21-6 ct t. To the extent that such requirements are not set forth in the aforesaid Rule or corresponding federal regulations, the Water Supply Division of the Vermont Agency of Natural Resources shall notify the permittee by mail of such requirements. Failure to monitor in accordance with the aforesaid requirements shall constitute a violation of this permit.
4. Reporting Requirements:

A. The water system shall submit the following monitoring results to the Water Supply Division:

'5I

Permit to Optrate Vermont Yankee *- New Engineering Office Building Page 4 April 26, 1999 (1) Bacteriological testing is required quarterly.

(2) Lead and Copper sampling is required for 2 consecutive 6 month periods yearly for 3 years, then every three years. The next required sampling period is July 31 -December 31, 1999.

(3) Sampling as required by the Phase II/V individualized monitoring schedule for this water system.

5. Groundwater Under the Direct Influence of Surface Water Determination A. Microscpopic Particulate Analysis (MPA) testing shall be conducted on the supply well to determine if the well is under the direct influence of surface water unless an exemption is grated by this Division. Two rounds of testing are required; one in the Spring (April 1 - June 30, 1999) and one in the Fall (September 1 -November 1, 1999), if an exemption is not obtained.

The State of Vermont Agency of Natural Resources Department of Environmental Conservation Canute E. Dalmassc, Commissioner by:__ __ __ __ _

Rodney I. Pingree, Cffief Water Systems Section Water Supply Division As of this 26" day of April, 1999 in Waterbury, Vermont.

cc: WSID #20738 Jean Nicolai, 'Compliance and Certification Chief Tim Raymond, Regional Manager

State of Vermont AGENCY OF NATURAL RESOURCES Department of Environmental Conservation Dopu:, nt of Fish and Widlifes WATER SUPPLY DIVISION tDepawnmom of Fo-aism PL.As and Rvereation The Old Pantry Building .

Depanmern DIEnv~onrncw,?l Ca'nservaLon 103 South Maia Stret Swe3 Gbob-;fst RELAY SERNICE FOWTHE HEARING IMPAIRED Waterby, VT 05671-0403 1-503-253-01191 TDDilhica 1-000-2530195 Voica3400 ThLEPHONE (802) 241r3400 FACSDMILX (802)'241-3284 September 10, 1996 I Public Water.System Permit to Operate WATER SYSTEM IDENTIFICATION NUMBER: 8332 PIN #: NS75-006 WATER SYSTEM: Vermont Yankee.Main Plant TOWN: Vernon RESPONSIBLE PERSON: Robert J. Wanczyk I ADDRESS: Vermont Yankee Nuclear Power Corp.

Governor Hunt Road Vernon, VT 05354 I. Authority In accordance witr 10 VSA, §1671 et seq., the following findings and conclusions have beefi made for the Vermont Yankee Main Plant Water System. The Department has determined that the' operation of this public water system, subject to the. following conditions, will not constitute a public health hazard or a.

significant public health risk; therefore, a permit is hereby issued.

II. Findings and Conclusions The following findings establish-that this system is in compliance with the standards in accordance with 10 VSA, 51675(b), and will not constitute a public health hazard or a significant public health risk:

1. summary of sanitary survey physical conditions:

A. Date of most recent survey: July 23, 1996 B. Major Findings:

(1) The July 23, 1996 sanitary survey identified the need to install a screened vent on the southwest well and to regrade around the west

'well for surface drainage as the only minor deficiencies.

Chlorina Free 100% Reqcled Paper Regionial Offices - SafreEssex Jct.1Pilzfcr&Rutand1N. SpringtiecVS1 Jocunsbui'y

.4

Permit to Operate Vermont Yankee Main.Plant Page 2 September 10, 1996 (2) Water system speCifics include:

A. Source.;*

The system has two rock wells for water sources. The west well is 555 feet' deep with a drillers estimated yield of 50 gpm, and the southwest well is 500 feet deep with an estimated yield of 6 gpm:

B. Treatment capacity:

Treatment consists of 25 micron cartr.idge filters.

C.' Storage:

The only storage is. a 1,000 gallon steel hydropneumatic tank.

D. Population served:

The system.serves -an estimated 200 employees.

E. System demand:

There is no information available on daily water use. Design flow is.3,000 gallons per day based on 15 gallons per person per day.

F. :System reserve:

" . The pump capacity of the west well is iestimated at 74 'gpn. .There is no, infornation availablle on the capacity of the pump iri the southwest well..

(3) Summary of the most recent.monitoring results:

A. A sampling'plan for bacteriological monitoring has been submitted-and approved by the Water Supply Division.

B. B~cterio logical'results: (past 12. months) met standards.

Permit to Operate Vermont Yankee Main Plant Page 3 September 10, 1996 C. Nitrate testing results (05/95) ret standards.

D. Nitrite testing results (05/95) met standards.

E.. Inorganic testing results (08/95) met standards.

F. Volatile organic chemical compound-results (04/96) met-standards.

G. Synthetic organic chemical results (03/95) met standards.

H. Lead and copper sample results (1995) did not exceed action" levels. .

I. A determination has not-been made by the Secretary of the Agency. of Natural Resources as to whether the two groundwater'sources are under the direct influence of surface water.

(4) Isolation zone control/watershed control status:

A source protection plan has not been prepared for the witer'sources. Potential sources of contamination within 200 feet of the wells include septic systems, gas station, roads, and parking areas..

(5) Operator certification:

Richard Gerdus is the certified operator for this system.

(6) The Department concludes tlat'this water system is operated in compliance with the standards adopted. under 10 VSA, §1671 et seq.

and does not constitute a public health hazard or a significant- public health risk.

III. General Conditions

1. The person to whom this permit is issued must comply in ful-l with all applicable provisions of 10 VSA,.S1671 et

.22

~.

Permit to Operate Vermont Yankee Main Plant Page 4 September 10, 1996*

sea., the rules ad6pted thereunder and the Federal Safe Drinking Water Act and subsequent regulations.

2. This permit may-be suspended or revoked in accordance with 10 VSA, S1675.
3. This permit is not transferable or assignable and shall automatically become invalid upon a change of ownership of the, water system..

IV. special Conditions

1. This permit is valid for five (5) years'from the date of this issuance or.renewal.
2. The pernittee-shall comply with all of The Drinking ,

Water-Quality Monitoring Requirements pursuant to the Vermont Water Supply Rule, Chapter. 21, Subchapter 21-6' e t seg. To the extent that such requirements' are'not set forth in the' aforesaid Rule or corresponding federal' regulations, the Water-Supply Division of the Verm6nt

-Agency of Natural Resources shall notify the permittee by mail of such requirements.

  • Failure to monitor in" accordance with the aforesaid requirements shall constitute a violation'of this permit.
3. A determination'on whether the two groundwater'sources
  • are under the direct influence of surface water mrXst be obtained from the Secretary of the Agency of Natural.

Resources by June 29, i999.

The S~tate ot.Vermont*

. Agency of Natural Resources Departmdnt of Environmehtal Conservation William C. Brierley, Commissioner Rodney 1. ikingredAchief

  • Water Systems-Section
  • . Water Supply Division -

As of this 10th day of September, 1996 iii-"aterbury, Vermont.

RIP:TAB:ro cc: WSID. #8332 Jean Nicolai, Compliance and. Certification Chief' Tim Raymond, Regional Manager

State of Vermont I

AGENCY OF NATURAL RESOURCES Department of Environmental Conservatiun Cenaarnent orF;-' and Wtdipe WATER SUPPLY DIVISION Depaiflefll of FomstsZ.

P261s and Racte.ar-oi ~TT~fl~RflITho Old Pantry Buildng Depa~aenl IciEnkor-m'~lJ Consrvation

)L&W~UL~ ~103 South )42in Street RELAY SERVICE FCA DAE HEARING iMPFAiRSD Waterbur, VT 05671-0403 i-io)-25Ui09l TOD)Ndco 1.wa-2534iss9 Vcice>TDO SEP 2 0 1996 TELEPHONE (802) 241-3400 BFACSIMIME (8G2) 241-3284 September 10, 1996 Public Water System Permit to Operate WATER SYSTEM IDENTIFICATION NUMBER: 20559 PIN #: NS75-0006 WATER SYSTE4: Vermont Yankee, C.O.B. System TOWN: Vernon RESPONSIBLE PERSON: Robert J. Wanczyk ADDRESS: Vermont Yankee Nuclear Power Corp.

Governor Hunt Road Vernon, VT 05354 I. Authority In accordance with 10 VSA, §1671 e setq., the following findings and conclusions have been made for the Vermont Yankee C.O.B. Water System. The Department has determined that the operation of this public water system, subject to the following conditions, will not constitute a public health hazard or a significant public health risk; therefore, a permit is hereby issued.

I1. Findings and Conclusions I

The following findings establish that this system is in compliance with the standards in accordance with 10 VSA, 51675(b), and will not constitute a public health hazard or a significant public health. risk:

1. Summary of sanitary survey physical conditions:

A. Date of most recent survey: July 23,' 1996 B. Major Findings:

(1) The July 23, 1996 sanitary-survey did'not identify any deficiencies.

(2) Water system specifics include:

ag~ior.al I'

Chl'*io Free 101% R-Iy*od Pr3 Wr C:fxes - SarcEIzsox c1 Pl CgRil.land SPrrtn3ftiCI4S t. royr) dA

Permit to operate Vermont Yankee, C.O.B. System Page 2 September 10, 1996 A. Source:

The water source is a rock well 350 feet

-in'depth with a driller's estimated yield of 12 gpm.

B. Treatment Capacity:

Treatment consists of carbon filters and' cartridge, filters. The carbon filters were installed because of low levels of volatile organic compound contamination of the source.

C. Storage:

The only storage is four pressure tanks with a total capacity of 344 gallons (86 gallons each);'

D. Population Served:

The system serves one building -with approximately 100 employees.-

E. System Demand:'"

There is no information available on daily'water use' Design flow is 1,500 gallons per day based on 15 gallons per day per employee.

F. System Reserve:

Information on the well punp capacity is not 'available.

(3) Summary of most recent monitoring results:

A. A sampling plan-for bacteriological monitoring has been submitted and approved by the Water Supply Division.

B. Bacteriological results (past 12 nonths) met standards..

C. Nitrate testing'results (05/95) met standards.

Permit to Operate Vermont Yankee., C.O.B. System Page 3 September 10, 1996 D. Nitrite testing results (05/95) met standards.

E. Inorganic chemical testing results (08/95) met standards.

F. Volatile organic chemical compouand results (04/96) met standards.

G. synthetic organic compound chemical results (03/95) met standards..

H. lead and copper sample results (1995) did not exceed action levels.

I. A determination has not been made by the Secretary.of the Agency of Natural Resources as to whether the groundwater source is under the direct influence of surface water.

(4) Isolation zone control/watershed control status:

"A source protection plan has not been.

prepared for the water source. Potential sources of contamination within 200 feet of the well include roads, buildings, and the Connecticut River.

(5) Operator certification:

Richard Gerdus is the certified operator for this system.

(6) The Department concludes that this water system is operated in compliance with the standards adopted under 10 VSA, S1671 !t seq.

and does not constitute a public health.

hazard or a significant public health risk.

III. General Conditions I. The person to.whom this permit is issued must comply in full with all applicable provisions of. 10 VSA, S1671 et seat., the rules adopted thereunder and the. Federal Safe Drinking Water Act and subsequent regulations.

Permit to Operate Vermont Yankee, C.O.B. System Page 4 September 10, 1996

2. This permit may be suspended or revoked in accordance with 10 VSA, 51675.
3. This permit is not transferable or assignable and shall automatically become invalid upon a change of ownership of the water system.

IV. special Conditions

1. This permit is valid for five (5) years from the date of this issuance or renewal.
2. The permittee shall comply with all of the Drinking Water Quality Monitoring RequireMents pursuant to the
  • Vermont Water Supply Rule, Chapter 21, Subchapter 21-6 et s__eg. To the extent that such requirements are not set forth in the aforesaid Rule or corresponding federal regulations, the Water Supply Division of the Vermont
  • Agency of Natura'l Resources shall notify the permittee by mail of such requirements. Failure to monitor in accordance with the aforesaid requirements shall constitute a violation of this permit:
3. A determination on whether the groundwater source is

.under the direct influehce of surface water must be*

obtained from the Secretary of the Agency of Natural Resources by June 29, 1999.

The State of Vermont Agency of Natural Resources Department of Environmental Conservation William C. Brierley; Commissioner by:T'L Rodney I. PF.ngree, thiet Water Systems 'Section Water Supply Division As of this 10th day of September, 1996 in Waterbury, Vermont.

RIP:TAB:mo cc: WSID #20559 Jean Nicolai, Compliance and Certification Chief Tim Raymond, Regional Manager

VERMONT YANKEE NUCLEAR POWER CORPORATION Governor Hunt Road, Vernon, .VT 05354

)February 25, 2000 Mr. David Webb Assistant Regional Manager "

Agcncy of Natural Resources Dcpartment of Environmental Conservation The Old Pantry Building 103 South Main Street Waterbury, VT 05671-0403

Dear Mr. Webb:

Enclosed is the Exemption Application from MPA testing on Vermont Yankee's NEOB water supply system located in Vernon, VT. This letter and the attached materials include the supplemental infqrmation on the drilled bedrock water supply as outlined in the Exemption Application Guidance Document. Attached materials include a USGS map showing the water supply well locations, a detailed site map, soil survey map of Vernon with a table showing the flooding frequency, the Well Completion Report for the NEOB and West wells at Vermont Yankee and summarized coliform monitoring results for this system. The information provided is given with the Application question number and guidance response.

NEOB WELL:

  • 2 (1I. A.) See attached Well Completion Report showing that the source is drilled bedrock well.
  • 3 (111. B.) See attached Site Map showing the well located - 1000 feet from the Connecticut River.
  • 5 (i1. C.) See the attached Well Completion Report showing that the well has 38 feet of casing with drive shoe and cement grout used to seal the casing into bedrock.
  • 6 (11. D.) See the attached Well Completion Report showing that the well has a confining layer: the 0-27 feet lithology shows a layer of clay before bedrock was found, this layer was confirmed by telephone conversation with Green Mountain Well. The clay-confining layer with the drive shoe and cement grout sealing the casing to bedrock prevents the well from being under the direct influence of surface water. Due to stream and site elevation, groundwater flows down towards the river. The surface water elevation typically controlled by the downstream Vernon Dam is 220' above mean sea level. The plant buildings are at an elevation of 250' above mean sea level, which is above the 100-year flood elevation. The information, which supports this is included and is found in the map and table from the Soil Survey of Windham County. The NEOB Well is at an elevation slightly above the 250' and therefore not under direct influence of surface water of the Connecticut River. Additionally, the West Well at Vermont Yankee was approved for a MPA exemption, and the distance from the NEOB well is approximately 400'. The lithology of this well also aids in defining the clay-confining layer of the NEOB well. The results of the one-year of coliform data are summarized with no positive results found. This well appears not to be in a karst terrain.

IFyou have any questions concerning the information contain di call me at 802-258-5663.

Sincerely, Barbara Williams ) idTatch Environmental Program Lead Chemistry Manager 3

VERMONT YANKEE NUCLEAR POWER CORPORATION NEOB Well Coliform Monitoring Results SAMPLE Test/Method 1V Floor Cafeteria 2"d Floor 3rd Floor Kitchen DATE Kitchen 3/8/99 Total Coliform SM9223 Absent Absent Absent Ist Quarter E. coli SM9223 Absent Absent Absent 4/26/99 Total Coliform SM9223 N/S Absent N/S 2 nd Quarter E. coli SM9223 N/S Absent N/S 8/12/99 Total Coliform SM9223 Absent N/S N/S 3 Quarter rd E. coli SM9223 Absent N/S N/S 10/1/99 Total Coliform SM9223 N/S N/S Absent 4 th Quarter E. coli SM9223 N/S N/S Absent Where N/S means No sample was required.

State of Vermont AGENCY OF NATURAL RESOURCES Otoartm'ent of Fish and Wildlife Department of Environmental Conservation WATER SUPPLY DIVISION Oarx.m.,n of Forits. Parks and F.,creation

'The Old Pantry Building*

0eooryment of Environmentai Conservation State Geologist 103 South Main Street Nairal Resources Conservation Council Waterbur, VT 05671-0403 Telephone Relay Service for the Heaing Impaired TELEPHONE (802) 241-3400 1-800-253-0191 TDD>Voice FACSIMILE (802) 244-5141 1-800-253-0195 Voice>TDD VERMONT DEPARTMENT OF. EVMONMENTAV CONSERVATION WATER SUPPLY DIVISION GROUNDWATER UNDER THE DIRECT INFLUENCE OF SURFACE WATER EXEMPTION APPLICATION For The Determination Of Exemption From Microscopic Particulate Analysis (MPA) Testing The water "sysfem may use this form ,to request an exemption. from the requirement to test ..its groundwater source(s) by Microscopic Particulate Analysis testing. The MPA testing shall-,provide evidence to be used for the determination of the direct influence of surface water on a groundwater source.. If the groundwater source does not. qualify for an- exemption from 1PA testing, then those* sources will"be .tested "for the presence of surface water indicators and a corresponding Risk of Contamination level assigned to them.

Tm filing ou.t.:this Application please follow the numberedline-by-li-ne -instructions, progressing - to the indicated sections

  • as directed-.'in ;Bol&.Type... Please place an [X] in the appropriate..

boxes: and. supply- all'. supporting doc&umentation. Refer' to the.

Guidance. Document (Sections referenced) for further explanation of the required. documentation. When --

t he line-by-line instructions indicate that- the Application,. has been finished, ssend the Application along with all requested supporting docuiimentation to the Water Supply Division.

Town: .Ver=x Public Water System name; VentYkime NEB WM'-

Water System Z. D. 1 (WSID): 2738 (Please make additional copies of this application and complete one form for each groundwater 'source which is to be considered for an exemption.)-

Please be sure to complete and include the attached Inventory Of Water System Sources with your -ubmittal.

15 TDD: 14-(00-53-0191

i. Source Name: l'4arrri Office Bimdwg (tEMB) p-ll Source Identification Number or letter: 6642 (Include a USGS Topographic Map showing the location of each groundwater source which contributes to the water system.)

Source Type:

A. Drilled Bedrock Well.

[] B. Drilled Gravel Well,

[] C. Well Point, or Dug Well.

[] D. Infiltration Gallery, or Spring.

Current. Source Status:

n New Source.

V3 Permanent,

[] Seasonal Standby. (Planned use).

[] Emergency, or Back-up (Unplanned use).

Is this source currently filtered?--. --------. Yes

  • No []

If yes, describe 5QcL ca= dg ilemethod and type of filtration (Advance tor line 2.)

2.. rs the source a Spring'or Infiltratioh Gallery?--Yes [I No OT If No, Advance to line 3. See Guidance Doc.Section II, A.

rf"Yes,. Advance.to Line 11. See Guidance Doc. Section III-Vt.

  • j.. *.. , .
3. 15 the source. located-150 feet ormore from surface wate-r?----.

Yes INo N If Yes, Advance to line 4. See Guidance Doc. Section. I1, B.

If No, Advance to line 7. See Guidance Doc. Section. II, B.

4- 'Is the source a drilled bedrock well?--- .------- Yes F No (1 If Yes, Advance to line 5.

If No, Advance to Line 11.

5. Does the source have greater than 50 feet of watertight casin9 below grade? --.------------ ------------- Yes [] No (1 If Yes, Advance to line 11. See Guidance Doc. Section I1, C.

If No, Advance to line 6.

2

6. Is there a confining layer present between the surface water and the source aquifer? --------------------- Yes -No (J If Yes, Advance to line i1. See Guidance Doc. section Ii, D.

If No, Advance to line 11. See Guidance Doc. Section III-VI.

7. please complete all of the following:

A. Does the source have 'a historical 'association with water-borne disease outbreaks?----. ----

... Yes(] No (

.f No, See Guidance Doc.Section II, E.

B. Has the source, within the last -three year period, had one or more violations of . total coliform MCL, or repeatedly. failed .to* meet. coliform monitoring requirements?--- ------------------- Yes [J No []

If No, See Guidance Do.c. Section II, F.

C. Is the source subject td' surface water influence by annual flooding? ------------ ---------- Yes ]o N (J If No, See Guidance Doc.Section II, G.

D. Are there construction defects or deficiencies which could allow surface water to directly enter the source?--

Yes [. No (J If No; See- Guidance Doc. Section 11, H.

E. Does the source*have a tested capability to. yield more than 500 gallon per minute?. --- ----. Yes [] No ()

rTf I6;..See Guidance Doc.Section II, I.

F. Does th'e. source'have .any of..being Under

..the. direct influence of surface

  • rf`- Nd* "See:.Guidanceuboc. Section.'II, J. 'water?----Yes -No (1

'anof*th"above.

af items in line 7 were answered Yes,,

Advance -to line I1.. See Guidance Doc. Section -III-VI.

If all of the above items in line 7 were answered No, Advance to line 8.

8. Is the top of the well screen, bottom of the well casing, or the bedrock surface greater than 50 feet below ground surface?------ ------------ -------- Yes (] No (]

If Yes, Advance to line 11. See Guidance Doc. 'Section II, K.

If No, Advance to line 9.

I

9. Is there a confining layer present between the source aquifer and surface water?-------------------------------- Yes (] No (I If Yes, Advance to line 11. See Guidance Doc. Section II, D.

If No, Advance to line 10.

10. Is there a direct hydraulic connection between the source and surface water? ----------------------------------- Yes ] No (]

If Yes, Advance to line 11. See Guidance Doc. Section III-VI.

If No, Advance to line 11. See Guidance Doc. Section II, L.

11. If this Application was completed with the help of an

.environmental. consultant, engineer, or well driller, please have them sign below. (Then advance to line 12.)

Signature Profession*

Affiliation Phone # Date

12. I hereby certify that my answers to these questions are accurate and the attachments meet the requirements of the Guidance Document.
  • (802) 258-5663 2/25/=X Aignatu.e; Owner,. Responsible Person Phone. Date STOP. The. application procedure for this source is finished.

Please-.rea&:the following:

Please submit.' all 'completed Exemption -Application. forms AND SUPPORTING DOCUMENTATION, including the Inventory of Water SVstem Sources form, t.. the following address.

Water Supply Division The Old Pantry Building 103 South Main Street Waterbury, VT. 05671-0403 (802) 241-3400 Please contact this office if you have any questions regarding the completion of this Application. Please address your submittals or inquires to either the Regional Manager or Assistant Regional Manager for the region within which your water system is located.

(See enclosed map).

rip\7.19.93 4

INVENTORY 'OF WATER SYSTEM SOURCES Water System Name:Veo rtYam Ne3 -]B" WSID 2(738 Please list each source (permanent, seasonal, emergency,,or other) which provides water to your water system- in the spaces provided below. The source . ID. should correspond with the source identification used to locate the source on'the topographic map accompanying this Application. Also indicate which source construction type you have by using the designated letter below (A,.

B, C, D, or E).

Souirce TVpe A. Drilled Bedrock Well B. Drilled- Gravel Well C. Well Point,"or Dug Well.

D. Infiltration Gallery or- Spring E. Surface Water F. Purchased from another water system,'WSID

  • APPLYING FOR SOURCE ID. SOURCE NAME SOURCE CONST. EXEMPTION?'Y/N-6642 -SM We! -A y
-4,:

!V1:Y ~

  • Area Map for Vermont Yankee Nuclear Power Corporation in Vernon (from USGS 1984 Brattleboro VT-NH 1:25000, 7.5 x 15').

J?4 1 47.

"403

,03E

'270000 FEET 0NH 7040004" 72' 7013 2 , 3 0 4r10 BRATTLEBORO, VERMONT-NEW HAMPSHIRE PROVISIONAL EDITION 1984 tz~16 OW FEEr .%.,u f L.t,. I () 42072.GS-TM-025

Site Map for Vermont Yankee Nuclear Power Station In Vernon with the locations of the Potable Water Wells connecticut ve drver wv"' --.- -.-.* .

  • ?p * %Ca.IeG vl"-\. :.

p'""1 aS /

Ti

/3 C00OIN C OS (SOUTH; pFl"

\ *K*N * -.,, U C L E.\R ". " 1g, " 6203 "ic*".

-- 4 LiAi

.,_..,-LJ-- I" ....... \ °.*)

.Ii 00:R

..... ~~P 131 o Potable Water Well(S

" 3'* * ,., **'.

t? Indirect Discharge WVelI a.,.

i

SOIL SURVEY OF WINDHAM COUNTY. VERMONT

-c a

SCALE 1 20 000 S 0 I M ,I,',

5000 Feet 4000 3000 2000 100 0 I I MI" 0

600 400 200 0 1 Kilometer 1000 Meters 800 1 '-' ' -t fI N

A I . I.

WIrIIiIIAt ((IIN I yY VlIII.Mirlil r

TAtL.- *'.o--9(jUZ.l ANIJ W14I.-*1 k r--

"occasional", .apparent," and "perched" are explained in the text. The IFloodlnq" and "water table" and terms such as "brief," or that data Zymholnot( means less than: > means more than. Absence of an entry indicates that the feature .is not a concern Vwre. esttmated) 0 o

Finnlinfl wate 'learck tabe isKn &+/-corrosion Flnndlno 1111,0 _____.___ ___Z Potential SCIlI*.IhI and Hydrologic Floodin A J i 3

map 'ymbol group Duration IMonths Depth Kind IMonths I Depth Ifro action!Uncoated F'req~uency I I steel I 0 a q I -

>6.0 >60 High ---------ILO------- IModerate.

IA, IB, i(, D--- INone--------

II 60 ig .-.... I

'Lo I

-'-.. [oderate.

Ltadi hi, ... ..

II ir ---------------- INone-------- >6.0 I I Udorth,.'ils >60~ ~~'odrt

LW--- '~g Moderate.

2A ----------------.I I 1.5-3.5 Apparent Nov-Apri >60 'High -------- IModerate IModerate" Belgr.ihi. I 3B*, 3('*, 3D*,

3r*: II I o - ih

>6.0 -- -- 6 II Io -----

1 None I --------

Warwit...--------

INone -------

>6.0

... ..I

-- >60

>o I~ov.......Lo -- -------High.

High.

5B, SC, m), SE----

I I>6.0 I

>60 ILo- .....

II Lo---- . - High.

Windsur 'None --------

I I 9B ---------------- 1.5-3.0 Deerf It.h! 'None .......

>6.0 I~parnt ~e-ApI 60 'Moderate-...Low.. - 'High.

IOA, lol ---------- I IIModerate ---ILaI---- I Iih Agavam I~prnIeAr >60

>60-----OW---------ILo ----- 'High. A I1B*, I1U'*, llD*: I'None....

Berksh I r.----------- None-------- >6.0 II I I Monado,Ck ........ >6.0 I - I--- >6 L.--------- HLo-" High.

12C*, il',12E*: 1. 1 Stratit .---------

I---e-------- II >6.0 I. 102 I1 1 ... 20-..0 MHegh -------- High -- -IH-h.

.1I I >6.0 Glebe ------------ I I I-I Se,* tootnote at end of table. ,KX I

-4 to

-4

02t23t00 WED 16:15 FAX 802 241 3284 WATER SUPPLY DIVISION Waxer Supply Division Well Report Printed: 2/23/00 Well Statistics Well Tag Number 8198 Data Report ReCciived S124,9 Well ReportNumbex 6.642 Map Cell: 39D9 Owners Name: Vt Yankee Unique Location Name For GIS: V?466 :42 Purhase/s Name:

E-911 Address:

Town Nzme: Vernon Sub Division: Lot Nvmber:

Date Well Wa3 Completed. 7/14198 Purposed Use of Well: Industral Reason for Drilling Well: New Supply WWcU Type:

Drilling EquilpmentIatiry CAP) [] Well HaSSerce Total Depth of Well (in feet)- 500.00 Casing Finish:Abovc ground, unfunished Totn Casinglcnth(in feet): 33.00 Casing Length below Land Surface (in fct): 36.00 Ca.eg LengthExpo,3C: 0.00 Casing Diamcter (in inmhes): 6.00 CasingMatralStrel Casing Wdeghr (In l/foot): 19.00 Len~th of Liner Used rinfeer): 0.00 LinerfDfamerr(In inchet): 0.00 Liner Materfal Liner Weight rn lb/lfooQ: 0.00 Depth To Liner Top: 0.00 Method of Sealing Casing: Grout bottom only (] Not Steel Casin Grout Type:

DiameterDrilledIn Bedrock (in Inches): 0.00 Depth Drilledin Bedrock. 0.00 Screen Make and Type: cremn Material:

Screen Length (infect): 0.00 Screen Dimnaisr(DI Inches): 0.00 Screen Slot Sire Cin inches):. 0.000 Depth to top ofseren below land suwface (In feer): 0.00 GravelSire or Type:

Yield Test Mthod: Compressed air Yield Tested At (Gallons per lMnutc): 30.00 n] Hydro Fracture Resulting Flow f HydrcFncturAl 0.00 Static Water Level (in fct: 4.00 E] Wceisll r~oi E] Has Water been Analyze Commcnts: water at 260,330,380.410 Reason for Well Development:

Well Driller.Richard Stromberg Tax Map:

Depth To Bedrock (in feet): 27 [] Grvel WC Items inITALUCS are re n=t additions to the computer databases. Information for these fields MAY exist in the paper files that is not entered hero.

H'

02/23/00 WED 16:15 FAX 802 241 3284 WATER SUPPLY DIVISION Q3o00 Water Supply Division Well Report Printed: 2123/00 W, rtlLihology Town: Vernon . Nell ReportNu ll~cr6,642 Statingl)Depth Ending Depth, GPM L ithology Driller's Description 0 27 27 240 240 320 kish ray Rocl. b &dr1,cdie. etc.

320 353 Pu 352 500 gn Rock. be~ock. IcdM ctc.

Itens in'TAUC, ar recent additions to the conputer databases. Informatilon for these.ields MAY evdst in the paper files that is not entered hem 15

..  :".... . 0-.-,. GREEN MT. WELL Oi. P-i3E 02 UP-itliLMIME N1 Ult, ON*LY WELL No./TAG HO. S1414 of Vtimaent A

91 tkl.t 1. sl

  • l[vimtomlg awtt Mai C4mufratlies ittilt (ION) EX

- - U. SL.Q. T

,,,t~, ., . .Vatirbutl,V1. Cot, 05676 dLtkInOA cr,.____

Legtl,* ""to" ______._

.WLL COMPUTION RIPOIXT q4 13.U,000.0, 4.....

i **Ii *"w 4! .o .*',"..q. JA.,.l 1-1 I -- -- -- , -- -- J " - - "i i i W 0LLOWN"EA Tf. P r 4 r,,7 on WELL, PUACHASSER 4.

LOCAl lUtN 01 WELL. LCT no. 11C

3. OATE WELL. WAS COMPLEME 1
4. PROPOSEO USE OF WILL 0 a-. C .

, , T. ." I,,,,,, 4.

10. REASON FOR DRILLING WELL:1-. I.s,-.,.O a-..'*,4....( s .. ,.

0 0.-"1Itw *"rf....0-m,13a.

41.

12. ORILLINQ EOUIPMdENT: o0 . ,.

1" PE OF"WELL.:*o,..-., . I~-. .. . , .*e ,.-.O i.,,-.,*. I ,,,, wet 7

8 "TOTAL QEPTX OFWdLL - ._-_.__.-__.... .

CASLING FIN13H: o ... -,--..C3.p.....0L.& ' C3 at.C3~~.4n CASING OETAILS: 3 o46L hdL_ loll I I. LINEA CR INNER CASING EAL:~..........~,. 4 12.

0o-.,

, ,1.. ._

14. CREE-N oE3TAILS:,,., ..._. ....._ _ _ _;_. .,
  • , I 04,1 ,e,,*lll4 JN *, N I'1
  • Set . 'e41..e o ..'e se - ___________________

1 .l.*eett N '..,, ic lk"*14. 03 ý. 0 w.6. 0c ..

1., STATIC WT*TE LEVEL: too,""0*t .L. S,-... *.. Go

16. WATER ANALYIS:,

17 3PECIAL hOTES:

18. WELL LOG 1I'. 5ITE MAP

.- p- - -- v- b0--"% -. to~*

Ci ,=

T, 7-A 13534 &RAI I . ... . ¶ScE t 3ejO 35do, 0 TES-.En r'ELD "ItLL OAIL'_ZO *II.7x*

I. . -- - ----

-d 4 I 5Y'.et...

- ~ ~ 7/t4 4s2 ~ *3 IU

I

  • VIATER WELLS
  • GRAVEL DEVELOPED WELLS .-- j.

GREEN MOUNTAIN W E LL 'C*O -!--I N ..

EDWARD J. STROMBERG, Pfes.

-. 802.387-6529 '

'BOX 13 *PUTNEY, VERMONT . : .. , -

05346 S'July 15,1" 998 =

Vermont Yankee Corp

?tti Theresa Derting * -. 3. ~..:'..4:*..

Govenor Hunt Road Vernon, Vt.' 05345 P.O. 97-57901-02 1% --f-3 --

cr.-Zl.

  • J* io 500 Feet -Drillng $8.25 $ 4125 00 38 ,Feet 6" caning, 19# $8.00 304. 00 Contamination prevention package 95 00

$10.00 300 00-30 Feet Benseal Grout $18.00 5 90 00

1 Bags Beneeal (picked up)

Drilling Mud 15 O00

$ 4929, 00 5% V.t. Sales Tax 20

$ 4969 20 Rlecovery Rate: 30 OPM

'SATISFIED CUSTOMERS ARE OUR RECOMMENDATION-LJI)

. - CýA ` 20 -t43' 11

WELL NO. /TAG NO. Sia te of Vermont DEPARTMENT USE ONLY Dept. of Ewr irIm=nentai CovaserVOtion E.C. ;a. : U.S.G.S.

103 Soul h Main Street (ION) FieldLocation3Mon 0 Map _

Wallrrburl,Vt. 05676 Lafltude ' , Etev._ _

WELL COiPAPLETION REPORT Loi-tude "Topo.

  • l .~..i . -4 - *e.-" *"S  : 62,500 0,25,00Q0, 24,000 C Locatio moo ofloched to '- 'ita DaR In Town FilIes 0 WELL OWNER y1 '/cir*\ c o. ai cf' W -ý e,- -\-i &V' A V rIc, OR WELL PURCHASER
2. LOCAl UN O0 WEL: TOWN er r\ SUBDIVISION C_ -IJ  ;-
3. DATE WELL WAS COMPLETED 7D3X
4. PROPOSED USE OF WELL: 1Io,estla. . 0om,
5. REASON FOR DRILLING WELL:
  • 13sp,, ts.... . s.-I o0 ... "

s-...u, (.;t.1 ", 0 me.'cavilotIe.

0 P'._,4. A44IM1 .I r. 0 Oask

6. DRILLING EQUIPMENT: 0 co.,e Too.., .t.

7, lD A-P, 0 O,,-_

7. TYPE OF WELL: loo-. ,v- i, ,,,.4,. 0 o0.- c.4 c,-.,. 0 1,,. s0,1,,,:

."4 0 co:,r S. TOTAL DEPTH OF WELL: _ _ _______ ,., ... ,..f

9. CASING FINISH: C3 A"- A,£,. .. .. =,l9.,. 0Q to-p*i. , .t. {3 ,.-........ 3 cr9.....
10. CASING DETAILS: Tows-,," .5 0 it. 1.0.1 ,.1 lo,-.*'.f. i ll . - "- .

It. LINER OR INNER CASING DETAILS: L...4-..___ i,. Wo-,,,,- La. Mot __,_,__ ,__VA, iL/t,.

12. METHOD OF SEALING CASING TO BEDROCX.7ci,. sit... ,o,,-,,-, ' . " , ,, _.. ;.,N, I...t_

s-

13. SCREEN DETAILS: U.9.=-, 1,9. ,,_,_,_ _ .,--r9 Ii.. q..... ___

YIELD TEST: r38,,a,...0,. e.. C,,-... .,- V _,. ... 44.,P ,-0 ,

14.

03 0.4'. pip*0 .. . 'o 03&fCP,-..... Aid.-

STATIC WATERLVE:.. 04..T..d*,9f9t1.P.

WATER AN ALYS IS: ,te- b--- o-oo, 0 Too 9f lo. It 1%4*W99e SPECIAL NOTES:

.WE" LOG .19. SITE MAP

__________________________________________________3A_ - I af-tr soc ".C lo"Idlole, twe % 0d.'

pro I.4 F-

-ioo .* 0 S_

mm b-lkof wo l.. ohmomibo ot-4 loot'4 .

fee& foom-e _ / Sc~ .

20. TESTED YIELD WELL DRILLED BY: .. .. . .. i -- i

" REmDOT FSIESS ABS: ('-- '-e q r-,

I ......... n -ýr.\. u" ' ý' ýi C.,

I m* ),57 ::dREPCT FILED BY:-

I 1,- 1. 1 - I .'_ I

-S

ý. .9

.r -left W.* .. V.P A" J _, . C.p

.. )

State of Vermont AGENCY OF NATURAL RESOURCES Department of Environmental Conservation Department of Fish and Wildlife Department of Forests. Parkis and Recreation WATER SUPPLY DIVISION Department of Environmental Conservation The Old Pantry Building State Geologist 103 South Main Street RELAY SERVICE FOR THE HEARING IMPAIRED 1-800-253-0191 TOO>Voice Waterbury, VT 05671-0403 1.B0.2s3.0195 V~co>rTDo TELEPHONE (802) 241-3400 FACSIMILE (802) 241-3284 March 2,2000 Ms. Barbara Williams Vermont Yankee Nuclear Power Corporation Environmental Program Lead P.O. Box 157 Vernon, VT 05354 Re: Exemption Application, Microscopic Particulate Analysis (MPA) testing, NEOB Bedrock Well

Dear Barbara:

As a requirement of the Vermont Water Supply Rule, Chapter 21, all non-transient non-community water systems using a groundwater source and any new proposed groundwater source(s) must obtain a determination by the Secretary of the Agency of Natural Resources as to whether the groundwater source is under the direct influence of surface water.

Based on a review of the MPA exemption application dated February 25, 2000 and the attached supporting documentation, we find that the Bedrock Well that serves Vermont Yankee's NEOB Water System (WSID 20738) is not under the direct influence of surface water and is exempt from testing.

The State of Vermont Agency of Natural Resources Department of Environmental Conservation Canute E. Dalmasse, Commissioner by:, RodlyI. Pigree~D E~

Water Systems Chief Water Supply Division tMAR C 2000 as of this 2 "nday of March, 2000 in Waterbury, Vermont cc: Jean Nicolai, Chief, Certification and Compliance Section Tim Raymond, Region 4 Manager WSID #20738 100% Procossed Chlorine Froe Regional Offices - Barre/Essex Jct Pittsford,:Rutland SpnngfieldSt. Johnsbury

'Aquaterra 39 Pinnacle Drive South Burlington, Vermont 05403 Tel/fax: (802) 860-5016 10 August 1998 Mr. Tim Raymond ANR DEC Water Supply Division 103 South Main Street The Old Pantry

.Waterbury, Vermont 05671-0403 Re: MPA exemption application for Vermont Yankee's WSID 8332 and 20559 Dear Mr. Raymond On behalf of Vermont Yankee, enclosed are Exemption Applications from MIPA testing of Vernon Yankee's two (2) potable water supply systeins in .Vernon. This letter and attached materials includes supplemental information on drilled bedrock water supply wells for the above referenced systems as outlined in the Eemption Application Guidance Document. Attached materials include a USGS map showing the water supply wells, a Site Map showing more detail, a Well Driller Rep0ots for'each well, and coliform monitoring data for one of the systems. The information provided below is given with the Application question number and the Guidance.response number.

WSID 8332 Vermont Yankee Main Plant Southwest Well:

2 (II.A.) See attached Well Driller Repori showing that the source is a drilled bedrock well.

3 (lH.B.) See attached Site Map showing that the well is 660 feet from Connecticut River.

5 (II.C.) See attached Well Driller Report showing that well has 66 feet of casing, with drive shoe used to seal casing to bedrock.

West Well:

2 (II.A.) See attached Well Driller Report showing that the source is a drilled bedrock well.

3 (II.B.) See'attached Site Map showing that the well is - 1000 feet from Connecticut River.

5 (II.C.) See attached Well Driller Report showing that well has 51 feet of casing, with drive shoe and cement grout used to seal casing 10' into bedrock. Ground copY surface has been brought up to provide 50 feet of casing below ground surface.

WSID 20559 Vermont Yankee, C.O.B. System 2 (II.A.) See attached Well Driller Report showing that the source is a drilled bedrock well.

3 (I.B.) See attached Site Map showing that the source is 142 feet from Connecticut River.

7.A. (II.E.) Review of ANR files and conversations with chief operator indicate that the source does not have an historical association with waterborne disease outbreaks.

7.B. (II.F.) See attached tabulation of coliform monitoring. The only times when coliform bacteria were detected in monitoring (1993 to date) were in June 1994 (no fecal coliform present and follow-up sampling showed no presence of coliform bacteria),

and April 1996 (samples from COB and Main Plant system believed to be contaminated in laboratory during analysis with wastewater samples; follow-up sampling showed no presence of coliform bacteria in either system).

C. (II.G.) Surface water elevation typically controlled by downstream dam at 220', compared to typical site elevation of 250'. Site is located above 100 year flood elevation.

D. (II.H.) Well casing extends above impermeable asphalt, with local drainage away from casing.

E. (11.1.) Associated wastewater disposal system is permitted for 4607 gallons per day (gpd). Review of 1996 through July 1998 daily water meter readings show that this limit was exceeded less than three percent of the time during this period, typically during outage conditions, when many contractors are present on site. The maximum daily water use during this period was 5800 gpd. This well contains a I horsepower

- submersible pump.

F. (II.J.) No evidence of surface water influence has been observed. The consistent presence of 1,1-Dichoroethene and 1,1-Dichloroethane in this well (each at about 5 micrograms per liter) indicates that this well is drawing water from a limited radius in the surrounding bedrock, as opposed to infiltrating surface water, which would not contain any of these contaminants.

Please contact me or Richard Gerdus (system operator) at Vermont Yankee (258-5501) if you have any questions regarding the information contained in this submittal.

Sincerely Roland Luxenberg, P.E.

cc: Mr. Richard Gerdus, Vermont Yankee (Vernon, VT)

....*...:...c o py

") *.- ):!?.3

State of V errn ont AGENCY OF NATURAL RESOURCES

. Oeoartrnenx of Fish and Wildlife

Department or Environmental Conservation WATER SUPPLY DIVISION Oevartment of Forests. Parks and Recreation The Old Pantry Building ODeartment of Environmental Conservation 103 South Main Street State Geologist Natural Resources Conservation Council Waterbury, VT 05671-0403 Telephone Relay Service for the Hearing Impaired TELEPHONE (802) 241-3400 1-800-253-0191 TDD > Voice ... FACSIMILE (802) 244-5141 1-800-253-0195 Voice>TDD i

VERMONT C DEPARTMENT OF ENVIRONMENTAI" CONSERVATION WATER SUPPLY DIVISION'~.

GROUNDWATER UNDER THE DIRECT INFLUENCE OF SURFACE WATER EXEMPTION APPLICATION.

For The Determination of Exemption From Microscopic Particulate Analysis (HPA) Testing The water 'system may use -this-form.to request an -exemption from the

-requirement to'"test its groundwater source(s) by Microscopic Particulate Analysis testing. The MPA testing shall provide evidence to be used for the determination ofthe direct influence of surface water on a groundwater source. If the groundwater source does not. qualify for an* exemption.from. MPA-:testing, then those sources will be tested for the'presence of surface water indicators and a corresponding Risk of Contamination level assigned to them.

  • in filling out this Application please follow the numbered line-by-line instructions, progressing to the indicated/ sections as directed in.-Bold Type.- Please place an (X] in the appropriate.

boxes and supply all. supporting documentation. Refer to the Guidance Document (Sections referenced) for further explanation of the required documentation. When the line-by-line instructions indicate:, that . the :Application 'has been *finished, send the.

Application along with all requested supporting documentation to the Water Supply Division.

Town: t r t n Public Water System name; ViCNv-. AIiic r 1 Water System I. D. # (WSID)': 33* 2_-

(Please make additional copies of this application and complete one form for each groundwater source which is to0be considered for an exemption.)-

Please be sure to complete and include the attached Inventory Of Water System Sources with your submittal.

1". Source Name: -  ; AJLL.

Source Identification Number or letter: _311 (Include a USGS Topographic hap showing the location of groundwater source which contributes to the water systt Source Type:

[4 A. Drilled Bedrock Well.

(] B. Drilled Gravel Well,

[] C. Well Point, or Dug Well.

(1 D. Infiltration Gallery, or Spring.

Current Source Status:

[ New Source.

[4 Permanent,

[ Seasonal Standby. (Planned use).

(] Emergency, or Back-up (Unplanned use).

Is this source currently filtered? -------------- Yess.1 N" If yes, describe method and type of filtration (Advance to line 2.)

2. Is the source a Spring'or Infiltration Gallery?--Yes [ No If No, Advance to line 3. See Guidance Doc.Section II, A If Yes, Advance to Line 11. See Guidance Doc. Section III-\-
3. Is the source located 150 feet or more from surface water?--

--------------------------------------------- Yes W No If Yes, Advance to line 4. See Guidance Doc. Section. II, B If No, Advance to line 7. See Guidance Doc. Section. II, B.

4. Is the source a drilled bedrock well? ------------ Yes N No i If Yes, Advance to line 5.

If No, Advance to Line 11.

  • 5. Does the source have greater than 50 feet of watertight casin below grade? -------- ----------------------------- Yes (4 No (

If Yes, Advance to line 11. See Guidance Doc.Section II, C If No, Advance to line 6.

2r%

6. Is there a confining layer present 'between the surface water and the source aquifer? --------------------------- Yes [] No (]

If Yes, Advance to line 11. See Guidance Doc.Section II, D.

If No, Advance to line ii. See Guidance Doc. Section III-VI.

7. Please complete all of the following:

A. Does the source have a hist6rical association with water-borne disease outbreaks?---------- --------- Yes (J No [J If No, See Guidance Doc. Section II, E.

B. Has the source, within the last.three year period,' had one or more. violations of total" coliform MCL, or repeatedly 'failed to' meet" coliform monitoring requirements? -------------- ------------------- Yes (] No ()

If No, See Guidance Do.c.Section II, F.

C. Is the source subject to surface water influence by annual flooding? -------------------------"---Yes (3 No ()

If No, See Guidance Doc. Section* II, 'G.

D. Are there construction defects or deficiencies which could allow surface water to directly enter the source?--

Yes(J No([

If No, See Guidance Doc.Section II, H.

E. Does the -s6urie have a tested capability, to yield more than 500 gallons per minute?-------- ------ Yes [) No (J If No, See Guidance Doc. Section II, I.

F. Does the source .have any other evidence of being under the direct influence of surface-water? -------Yes [] No []

If Noo See Guidance Doc.Section II, J.

If any of the above items in line 7 were answered Yes, Advance to line 11. See Guidance Doc. Section III-VI.

If all of the above items in line 7 were answered No, Advance to line 8.

8. Is the top of the well screen, bottom of the well casing, or the* bedrock- surface greater than 50 feet Zbelow ground surface? ---------------------------------  :-------- -- Yes [H No H

!If Yes, Advance to line 11. See Guidance Doc. Section II, K.

If No, Advance to line 9.

3P N1. # ,

9. Is there a confining layer present between the source aauiff and surface water? ------------------------------- Yes [] No L If Yes, Advance to line 11. See Guidance Doc.Section II, r If No, Advance to line 10.
10. Is there a direct hydraulic connection between the source ar surface water? ----------------------------------- Yes [ No [

If Yes, Advance to line 11. See Guidance Doc. Section III-V:

If No, Advance to line 11. See Guidance Doc.Section II, L.

  • 11. If this Application was completed with the help of L.

.environmental consultant, engineer, or well driller, pleas,

" have them sign below. (Then advance to line 12.)

Signature . Profession Affiliation Phone # Date

12. I hereby certify that my answers to these questions ar*

accurate and the attachments meet the requirements of ti Guidance Document.

Signature; Owner, Responsible Person Phone ' Date STOP. The application procedure for this source is finishe, Please read the following:

Please submit all completed Exemption Anplication forms A;

. "SUPPORTING DOCUMENTATION, including the Inventory of Water Svst-Sources form, to.the following address.

Water Supply Division The Old Pantry Building 103 South Main Street Waterbury, VT. 05671-0403 (802) 241-3400 Please contact this office if you have any questions regarding t.

completion of this Application. Please address your submittals inquires to either the Regional Manager or Assistant Regiona Manager for the region within which your water system is locate" (See enclosed map).

rip\7.19.9 4

-. .:"-..2

Stale of Vermont WATER R1S0RCF.. USE ONLY WELL*N.uACI

./.,, - _L3 -'Cj DEPARTMENT OFWATER RESOURCES W.R. -I"5) U.S.G.S.

S..... ... AND ENVIRONMENTAL ENGINEERING Field Locatlioni Map area**-n

1. .'.*

°el .itg bvtl eOo fl.I.4o *tblg.*

.... °.... ....... of... '. W ELL COMPLETION REPORT Lonitude. " ". oo.

" ,.L 0. ,.. v.,,'.*.

........ o 9,,n,,...1 J -. 2 7- 7 Scale: 62,500 0,25,000 C-1,24,000 0 Loearion

- -~ atul,:e(IowCR...o.

anq Dat In Town F1ies I I ._____"

1. WELL OWNER a,, -' , '-..z:". _6-, ( /*.q AE°,! C7 OR *,q WELL PURCHASER Sz-VTflN . LOT NO.

-L'*t... __.__

2. LOCATION OF WELL: TOWN
3. DATE WELL WAS COMPLETED " ".
  • -( I (N1,.., b - (-., vd.--. UM -
4. PROPOSED USE OF WELL':0o.,,,,,. t
5. REASON FOR DRILLING WELL: ....c ...

E-<'..;,,." i.. 0 ast. "s., Cao,...,at 0 "

0* P',.o.4 £4dho,*o.l S*,0oI 9 . i"1 -1*.

6. DRILLING EQUIPMENT:Q C..a.v li Ai -14 Z-.

7 TYPE OF WELL: ,, 4-4?,

  • .., . C.. ci.,-.  !. S...... ,led. 0 cok.

lose "

8. TOTAL DEPTH OF WELL: Q . .,,.. .... . ,.9eg.
9. CASING FINISH: 0 ao,... w

.'... .... ... ." 8.,.,. L0,. (I f*,

. ... .. "God. o. Or...,

10. CASING DETAILS: . .. , .6 7 , t o,,.. ., . S f.,,6 6.. .0...... W.,_.L....,,,

c - __it.- M.,,. w.., - ,,.die II. LINER OR INNER CASING DETAILS: Lo.,a... __--

_.o-, .- ., - ,

12. METHOD OF SEALING CASING TO BEDROCK:Gco,.<..,-i-,,,,

yjo. .- ..-. *,,. _ _ao,,, " to,. ... I.e,,

13. SCREEN DETAILS:xo000 .

. 3, 9 ...

to .. 0.9 4129 .0 .O rs. g.4 Slat 3.86 .'Joel% to log ofscee 14O*0 149..' 1*4.14JS94gcq __________

14. YIELD TEST: Ges.,.o. 0, ... ,.. Y .- 0.

go J*L~. .......... -!.It U.... "'

.. .. L. w. C me ,,,-.,.,

,. r ,,,,.. ,A,,W.,,,

m"",, 5, . -

....- .o...-:. _ _ -

- 15. STATIC WATER LEVEL: 1.9 a.0. . 6-.4 s.... C. as., 1.-.@. _

16. WATER ANALYSIS: th.. .. ,SI. ,M U a.pe Too(3 1* t v,.*..,

.a.

17 SPECIACNOTE.

18. WELL 18.W ELL, .LO.' LOG S..,s W. . ..... ... . " I 19.
s. *., .'0..MAP'. ,'.*I, SITE .... .;,.I,,,,,,,,u,Io.*,i /i fool foo o

~ ......

wairtI*,io. ~ 9' .ct ~m99.9. .04i@** -

-7 ,vzn

20. TESTED YIELD WELL DRILLED BY:

DOING BUSINES Lie~

iP _ _ _ _ _

1REPORT FILED BY: ~ ~

WELL DRILLERS LIC. -NO. - *5Z O_____________

,'Uý/,195-6./

Q5-5-3 3* 6' L-6~2~

-b -L73 C-:r 7,- -,-473 f-ýk5r'

,-ICA tA-I

  • .' ~

~. -

I -~. a, 4'

~pILti

State of Vermont AGENCY OF NATURAL RESOURCES DeparumenL of Environmental Conservation Deoskrtnent of Fish and Wildlife WATER SUPPLY DIVISION Oeoertment of Forests. Parks and Recreation The Old Pantry Building Deoartment of Environmental Conservation State Geologist

."103 South Main Street Naural Resources Conservation Council Waterbury, VT 05671-=43 Telephone Relay Service for the Hearing Impaired
  • TELEPHONE (802) 241-3400 140I-.253-0191 TDD> Voice
  • lFACSIMILE (802) 244-5141 1400-253-0195 Voi= >TDD DEPARTMENT OPF EIWRONENTAL CONSERVATI0" WATER SUPPLY DIVISION --

GROUNDWATER UNDER THE DICT INFLUENCE OF SURFACE WATER EXE-MPTIrON 'APPLICATION ""

For The Determination Of' Exemption From, 3icroscopic Particulate Analysis (MPA)..Testing. -

The' wte-r system may use this*form to request an exemption.from the requirement to .test its. groundwater-'-source (s) .by ..Xicroscopic Particulate Ana-lysis 'testing. . .The MPA , testing shall-" provide' evidence* to be used -'for the determination of" the . direct influence.

of surface water on a groundwater- source.. If' the- groundwater.

source does not qualify .for an. exemption from *EPA testing, ..then those. sources will be tested for the presence of surface. water indicators and a corresponding Risk of Contamination level assigned to them.. " 7 ," "  :.-:.".:'..

In filling out this Application please follow the numbered* line-b"-

line instructions, progressing- to the. indicated *sections as directed in. Bold. Type.. Please.'place an iX] in the appropriate boxes and supply all supporting documentation. Refer -to, the Guidance. Document :(Sections referenced) for, further. expl'anation.of.

the' required documentation.. when the line-by-line instructions

'indicate that the Application

  • has
  • been- finished,
  • send "-the

-..Application along" with 'all' requested supporting documentation to

.the Water, Supply Division.

Town: EI MOMt Public Water' System name: VE-'ACN. I/ANJY*CE PL.*A":.'

"A4^JA Water System I. D..4 (WSID): 3 3 2_

(Please make additional. copies of this application and complete one form for each grotindwater source which is to 'be, considered -for an exemption.)'

Please be sure to complete and include the attached Inventory Of Water System Sourices'with your submittal.

1 /d:

Tnn.f: 1400-253-0191

i1. Source Name: bJJcr A L Source Identification Number or letter: Z ,3 (Include a USGS Topographic Map showing the location of e

-groundwater source- which contributes to the water system.,

Source Type:

. N A. Drilled'Bedrock Well.

[.]:EB. Drilled Gravel Well,

[] C.-.Well Point; or Dug Well.

"[ D. Infiltration Gallery, or Spring..

Current. Source Status:

2 [] New'Source..

.Permanenit,

[ Seasonal Standby. (Planned use).

[] Emergency, or Back-up-(Unplanned use:).

Is this source currently filtered?- -- .Yes 54 No If yes," describe method and .type of filtration_

  • ". (Advance.
  • to line- 2.)*

-2. Is the source"a Spring or Infiltration Gallery? -Yes [H No If No, Advance.to'line 3. See. Guidance Doc.Section II, A.

- . If Yes., Advance-to LinelII. See Guidance-Doc. Section ITI-V:

  • C"
3. Is-the source locate'd 150 feet or more from* surface water?----
  • _ _ _ _-Yes *Nc; If Yes, Advance to line 4. See Guidance. Doc. Section. .IT, B

. *If No, Advance to line 7. See- Guidance Doc. Section. II, P.

- 4. Is the source a drilled bedrock well? -----.-- Yes No

" - - - If Yes, Advance to line 5. -

  • If No,; Advance to Line i.- - -
5. Does the source have greater than'Sa feet of watertight cas:

- below grade?-.- ---------- Yes C4 No if Yes, Advance to line 11. See Guidance Doc. Section Ii, If No, Advance to line 6.

2

- .... -:: -. . :"- All6

6. Is there a confining layer present between the surface water and the source aquifer?-------------------------- Yes J No.(]

If Yes, Advance to line II. See Guidance Doc. Section'II, D.

If No, Advance to line 11. See Guidance Doc.* Section III-VI.

7. Please complete all of.the following:

A. Does the source have a historical with water-nassociatio

" borne disease outbreaks? -----]..No Yes []

If No, See Guidance -Doc.Section II, E.

B. Has the source, within the last three year period,'.had oonene or. more violations of total: coliform MCL," or repeatedly failed to meet coliform " monitoring requirements?- ----. Yes.*[. No C]

C.. ..Is-- the source subject to .surface water influence -by

" " annua floodingf------. es U- No* H.

Sf N,: See-GuidancSection .G..

D.. A tr. constction. defects . or deficiencies :.hich could allo* surface water:to*directly 'enter the :source?--

-- -------------------------- Yes [].No[]

- .fo.See:Guidande-Doc...sectio"II,".-."

E... Does the source have'a tested capability to. yield "moke than500 a-----Yes. No

  • " "" -. '.If -No,-" See Guidance Doc.'"Section 11
  • . . *~~~- .

i, .. 1.

v -.'.'-.-..:-...'"*-

th

.- rf5. *. o . a.ospe .- .> .< m.

.. e~ ..-. ~..., - -. El',..,No-.*E.-

..F. Does: the source .havy anyi other evidence of being under the'direct influence'.of surface water.?---'--Yes  :. o] [].

If No, See. Guidance Doc.' section II,:J." .: 1"

. If any of. the'above' items in- line 7 were. answered :Yes,.

'Advance to " line I1.:' See Guidance Doc. Section .

III-VI.

.,. . . .. . "'7 If all of-theaove

.- items in line 7 were answered No, Advance"to line '8. . . ,

8. Is the top of the well screen, .bottom of the well: casing, or
the bedrock -surface greater than 50 feet below.. ground surfa.. - . ..--  :-YesEJ No6[]

If Yes, Advance to line 1i. See Guidance Doc. Section II,: K.

Tf.No, Advance to line 9.

" '3 .

9. Is there a confining layer present between the source aqui and surface water? ------------------------ Yes (] No If Yes, Advance to line 11. See Guidance* Doc. Section ii, If No, Advance to line 10.
10. Is there a direct hydraulic connection between the source surface water? ---.--------- -Yes-I] No
If Yes, Advance to line 11. See Guidance Doc- Section III-If No, Advance to line 11. See Guidance Doc.- Section II, L

'i.. If this - Application was completed 'with the help of environmental. consultant, engineer, or well driller, ple-have them sign. below.' (Then advance to line 12.)

Signature.- .Profession

....  :; *Z._e. "( tc iJ0iA t.-v ,

Affi'liation. - . Phone. Date

.. . . .. .o-. . .......... .. -. "-..; - . . -.. . . *.,::.' ,

2. . hereby -certify: that. my. aners to.. these questions accurate an& the attachments meet the requirements of-

"" .Guidance Document- . . . . "" '.'.

- * * ... .. . ... . .. . . .v Signatare; Owner,. Responsible Person Phone #t.-. Date STOCP.. The appic6ation procedure for.this source is finish Please read .the following... ."

Please submit all completed Exemntion ApDlication form.s

. SUPPORTING DOCUMENTATION, including .the Inventory of Water SVs,

-Sources form, to. the following address..

T Supply Division d.iWater *

"The old Pantry. Building

" .. Waterbury,. Main 103 "South 05671-0403 '

VT.. Street Plea.e conta"t "hs .(802). 241-3400a . . -

Please contact this office if-you have any questions regarding

. completion of this Application. Please address your submittals

  • inquires to either the Regional Manager or Assistant Region Manager for the region within which your water system is locat (See enclosed,
  • map)p" "rip\7.19.

4 C/

/13.

WELL NO. /TAG NO. Stale of Vermont DEPARTMENT USE ONLY Dept. of Ervimmentai Conservation E. C. a"Z 5 U.S.G. S.

103 South Main Street (ION) Field Location 0 Map ce Waterbury,Vt. 05676 Latitude ° ' "Elev.

WELL COMPLETION REPORT Longitude 0 ' "Topo.

Us .-.

bA 0 So:*le: 62,500 0,25,000 0,24,000 C Location moo cttoched to WCR - - ' SData In Town File% 0 _ _ _ .

WELL OWNER ' 'I v*t* *, AItM h,""de"I V~~rVgriZ Výcy?~

OR WELL PURCHASER Names ~pw o,*. w~I4lbeAo.aaes-

2. LOCAI uN OF WELL:TOWN " *9'i

."t(.o, SUBDIVISION ( .'o.

3. DATE WELL WAS COMPLETED 7 b:3 1 A-7
4. PROPOSED USE OF WELL: To come.... 00ines
5. REASON FOR DRILLING WELL: me.. s 0 11'°4, Car.l,-, Ssooy. CI 0 .o. CoI.t E,,g W.el. 0 Teel or t,'lf,,lo°,

0I Pflrvid. A£d4tl@l S.Pol@7 0 0ther

6. DRILLING EQUIPMENT: 0 c,.ol o°.0 °,,, t .4% A-P, 0 oth._
7. TYPE OF WELL:Vo'o.,,H.,oi. =md,. 10 o. toe cos.° . 0 sr,..,,or si,= ;0 ,a..,
8. TOTAL DEPTH OF WELL: "f."., ,.*. ,no..
9. CASING FINISH: 0 At," wo ~eel,.-*." V. d,.t.- 4,. Q ,s .d, i-0 . pit. 0 pRes. .* Cm," wo*d. [Ot,-o

[]

10. CASING DETAILS: Total,..,..., 1. 1.0-,1 be.lw LS. - 4 7 It Did.. ... o..,t , ,,./,,. tb...

II. LINER OR INNER CASING DETAILS: LO.W, used - ft. 0..,,l, - i. MWat" _

,,__ to.Ift.

12. METHOD OF SEALING CASING TO BEDROCK.oriv, Shot.... ( .,-,- li p " , . o .J.Q... I I,*m*,.

0" 0O.. o,, _________________________________

  • 1 - -oftf _, , -A.__
13. SCREEN DETAILS:u. ey,..Type M  ;*d Is-

"Did Slot *O@ t to. of AI*

IsoR ter" Iow~toce lased ft.. 0#4.04 poex it Boost G10,41 51*,.. Ty14 114. YIELD TEST: 0 ea-.e.0 E3 P~me# esse ..Z .........

toe.. .~r U*to U..,..4 b, 11-alet 03 orifes pipe. 03 vie. 03 water 0CI .o. ,c.. ,tl*

STATIC WATER LEVEL: lo.,keb.e.,, * .,* C., o,te . .orTi.,m I,.P aoI*. U WATER ANALYSIS: o Iýn.,We.

SPECIAL NOTES:

Is. . WELL. LOG 19. SITE MAP . bU9~e~~tO.~~

,.., 7om*;iýocer is 041114`111 frosts, I 1ft- I a Fe a Dossscrl~ zbwte.j 39 16..-S £re.4 P;7~ ri IfV=

,46 rLf-n M~
.-
20. TESTED YIELD WELL DRILLED BY: ?rd -- , ,- x --<ý ý r 0 r--, )zy--r 0 It 1%47"E4 - whte or dltto.I ameree Ort droe.t b.W DOinG BUSINESS AS: rljf\. G,'ý'Pd C&._ _

. -- /

feet4Ir I 45ls ON REPORT FILED BY:. JF q iW - -rf v

  • i*m I g Ig mln J

- L..~vo.d ~S~ 0 I...S ('

1-  ! . A /- . / /,) 477-11

pA<IAQ 1.-.-...

- ~..1- ~ r .. ra~.*-..

COpy,

INVENTORY OF WATER SYSTEM SOURCES Water System Name: Vr.ZC, AA

  1. A, k r WSID
  • Please list each source (permahent, seasonal, emergency, or other) which provides water to your water system. in the spaces provided below. The source ID. should correspond with the source identification used to locate the source on the topographic map accompanying this Application. Also indicate which source construction type you have by using the designated letter below (A, B,.C, D, or E).

t' Sou'rce Type A. Drilled Bedrock Well B. Drilled Gravel Well C. Well Point, or Dug Well D. Infiltration Gallery or Spring E. Surface Water F. Purchased from another water dystem, WSID #

APPLYING FOR SOURCE ID. SOURCE NAME SOURCE CONST. EXEMPTION? Y/N 28_ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _

253.

.14,

State of Vermont AGENCY OF NATURAL RESOURC=-S Department or Environmental Conservation Deoarrne'nt of Fish and Wildlife WATER SUPPLY DIVISION Deoarment of Forests. Pjrk$ and Recreation Otoarnment of Environmental Conservation The Old Pantry Building State Geologist ZA 0, 103 South Main Street Natural Resources Conservation Council Waterbury, VT 05671-0403 Telephone Relay Service for the Hearing Impaired TELEPHONE (802) 241-3400 1-800-253-0191 TDD >Voice FACSIMILE (802) 244-5141 1-800-253-0195 Voice>TDD VERMONT DEPARTMENT OF ENVIRONMENTAL" CONSERVATION WATER SUPPLY DIVISION

ý0, GROUNDWATER UNDER THE DIRECT INFLUENCE OF SURFACE WATER EXEMPTION APPLICATION For The Determination Of Exemption From Microscopic Particulate Analysis (MPA) Testing The water *systemmay use'this form.to request an exemption from the requirement to test its groundwater- source(s) by Microscopic Particulate Analysis testing. The XMPA testing shall provide evidence to be used for the determination of the direct influence of surface water on a groundwater source. If the groundwater source does: not. qualify- for an" exemption fromrMPA testing, then those sources will be tested for the presence 'of surface water indicators and a corresponding Risk of Contamination level assigned to them.

In filling out this Application please follow the numbered line-bv_

line instructions, Iprogressing to . the indicated sections ' as directed in Bold Type. -Please place_..an. [X) . in -the appropriate.

boxes and supply all. supporting documentation. Refer to the Guidance Document (Sections .referenced) ,:for further- explanation of the' required documentation., ,When, the line-by-line instructions indicate that the Application has been' finished, send the Application along with all requested supporting documentation to the Water Supply Division.-. .

Town: ",\i NJC.j Public Water System name: '/,AI-, A/ýs.',..A,C  ?

Water SystemI.-1. #D-(WSID): 20 5sr (Please make additional copies of this application and complete one form for each groundwater source which is to be considered for an exemption.)-

Please be sure to complete and include the attached InventorY Of Water System Sources with your 'submittal.

- A.la - -  %, e

1. Source Name: 6C1\ *~..

Source Identification Number or letter: 2I-1/

(Include a USGS Topographic Map showing the location of groundwater source which contributes to. the water system.

Source Type:

(4 A. Drilled Bedrock Well.

(I B. Drilled Gravel Well,

[I C. Well Point, or .Dug Well.

(I D. Infiltration Gallery, or Spring.

Current Source Status:

[] New Source.

[4 Permanent,

[] Seasonal Standby. (*lanned use).

[] Emergency, or Back-up (Unplanned use).

Is this source currently filtered? -------------- Yes [ NC If yes, describe method and type of filtration (Advance to line 2.)

2.. Is the source a Spring'or Infiltration Gallery?--Yes [H No if No, Advance to line 3. See Guidance Doc.Section II, A.

If Yes, Advance to Line 11. See Guidance Doc. Section III-1"

3. Is the source located 150 feet or more from surface water?--

Yes Nc If Yes, Advance to line 4. See Guidance Doc. Section. II, B If No, Advance to line. 7. See Guidance Doc. Section. II, I

.4. Is the source a drilled bedrock well? ------------ Yes (3 No If Yes, Advance to line 5.

If No, Advance to Line 11.

5. Does the source have nreater than 50 feet of watertight casi; below grade?- -------------------------- Yes (3 No If Yes, Advance to lin9 11. See Guidance Doc. Section II, If No, Advance to line-6.

2 Q, D*

6. Is there a confining layer present between the surface water and the source aqu.ifer?-------------------------- -Yes [] No [J If Yes, Advance to line ii. See Guidance Doc.Section II, D.

If No, Advance to line il. See Guidance Doc. Section IlI-VI.

7.. Please complete all of the following:

A. Does the.source have *a historical assbciation with water-borne disease outbreaks? -------------------- -Yes [ No

.If No, See Guidance Doc.Section II, E.

B. Has the source, within the last three .year period, had one or --more violations, of total coliform MCL, or repeatedly -*failed to meet*. coliform monitoring

.requirements?-----------------------------Yes [] No [x If No, See Guidance Do.c. Secti6n' II, F.

C. Is the source subject to" surface water influence by annual' flooding?-------------- - - -Yes [] No [

If No, See Guidance Doc.Section II, G.

D. Are there- construction defects or deficiencies which could allow surface water to directly enter the source?--

S----Yes [ No 6J If No, See Guidance Doc.-Section 1I, H.

E. Does the source have a-tested capability to yield more than 500 gallons per minute?------------- -Yes No If No, See Guidance Doc.Section II, I.

F. Does the source have any other evidence of being undler the direct influence of surface water? ------ Yes [ ] No W

..If No, See -Guidance -Doc.Section II, J. ..

If any of the above items in line 7.owere answered Yes, Advance to line ii. See Guidance Doc. Section III-VI.

If all of *the' above items, inline 7 were answered No, Advance to 'line 8.

8. Is the top of the well screen, bottom of the well casing, or the ".bedrock, surface greater than 50. feet -below ground surface?-, ---------------- Yes D No []

If:Yes, Advance to line II. See Guidance Doc. Section II, K.

If No, Advance to line 9.

-3

9. Is there a confining layer present between the source aqi and surface water? ------------------------------- Yes [ ] .

If Yes, Advance to line 11. See Guidance Doc. Section I]

If No, Advance to line 10.

10. Is there a direct hydraulic connection between the sourcE surface water? ----------------------------------- Yes N(

If Yes, Advance to line 11. See Guidance Doc.Section III If No, Advance to line 1i. See Guidance Doc.Section I,

11. If this Application was completed with the - help ot

.environmental consultant, engineer, or well driller, ple have them sign below. (Then advance to line 12.)

Signature Profession Affiliation Phone # Date

12. I hereby certify that my answers to these questions accurate and the attachments meet the requirements of Guidance Document.

Signature; Owner, Responsible Person Phone # Date STOP. The application procedure for this source is finis Please read the following:

Please submit all completed Exemption ApDlication forms SUPPORTING DOCUMENTATION, including the inventory of Water SV Sources.form, to..the following address.

Water Supply Division The Old Pantry Building 103 South Main Street Waterbury, VT. 05671-0403 (802) 241-3400 Please contact this office if you have any questions regardinc completion of this Application. Please address your submittal=

inquires to either the Regional Manager or Assistant Regic Manager for the region within which your water system is loca (See enclosed map).

rip\7.l-

  • "L..:.-..-"o.:

INVENTORY OF WATER SYSTEM SOURCES Water System Name: V.f.!rc.vr . ".:. . WSID 4 Please list each -source- (permanent, seasonal, emergency, or other) which provides water to your water system. inthe spaces provided.

below. " The source ID. should correspond with the source identification used to locate the source 'on.-the topographic 'map accompanying -this- Application. Also indicate. which source, construction type you have by using B, C, D, or E).

-. ." COpy the designa-ted let~ter below (A, S o u 'rc e T yp 'e A. Drilled Bedrock Well B. Drilled .Gravel Well . ' .. -.

C. Well Point, or Dug Well D. Infiltration. Gallery or 'Spring E. Surface Water F. P.urchased from'another water system, WSID #

r APPLYING 'FOR SOURCE ID. SOURCE NAME SOURCE CONST. EXEMPTION? Y/N-LZ. . C'JL'CL~. A_..___

  • CLL NuhaOCR State of Vermont WATER RESCOURCE USE ONL(

DEPARTMENT OF WATER RESOURCES W.R. -De H U.S.G.S.

AND ENVIRONMENTAL ENGINEERING Field LocatIon 0 Map area -'_2ýd 1) lot.ft.Dt eof wate OO..cwf,. 4 .6 Latitude 'Elea.

WELL COMPLETION REPORT Longitude ' Topo.

neePo.4.e.vor,_e# 05602.0016lot.

M~~Q S

so 4o *I I f 4-0.l.Fon 09 1.. .. If.

FEB 2 9 L985 Scale: 62,500 G, 25,000 0, 24,000 c LocctlIon moa ottceried to WCR Data In Town Files U 1 WELL OWNER No"

" ,a ____

P~r,,*At U0I11.9 Address OR WELL PURCHASER 71v121.i/

NMe.

-/¶a. <A-P Z/'7

/ _ý7 Per.o4e4o MWoldlr Address

2. LOCATION OF WELL: TOWN SUBDIVISION LOT NO.
3. DATE WELL WAS COMPLETED /2-" 4 "
4. PROPOSED USE OF WELL: 07oea.,tc. 0 o,p., .. _ ___'_ _'__,_"_"_ _
5. REASON FOR DRILLING WELL: gN,. s-poy,, 0 Relc ct,, I-.i 5.eoI,. 0 ....- enle.Iq s .,i*]0 Te.s of Epl',tlo..

C0 Frlld. AddilonCll S.pply 0 01%.f

6. DRILLING EQUIPMENT: Q1 cabl. ToolI, *cor? .11, A-p, 0 otn.,

7:. TYPE OF WELL"3 o,.toiei t Bedrock,. 0 O.PO Ed C*Iq.. .

Sieeeof , $lott.d [ Ot,0r

8. TOTAL DEPTH OF WELL: .,lo-,d feel 1" 0,...
9. CASING FINISH: X Abe,. ,r ,.. . Abe,. ,diE,,u,0 d,UtIeIht.. Q] ed. ]0 t, pit. ] *.*"-.d. 0 Me-.....,0 0 C her,_._
10. CASING DETAILS: ra.ttoootenien ...... t.

i_ t.00211%b.el"L.S. ..-7E.....F t cat. _____t.ooetetmwe 6 W ... /*%L.2 i...th.I II. LINER OR INNER CASING DETAILS: -. ,,t .. od,, - ft. Dl°,_.,., __ In. hOtf,,l .... , - ,./,,.

12. METHOD OF SEALING CASING TO BEDROCK.'Mo,.. so.. 0 coo.-o,,°. . 0,,ie, i,,.,,l, I it. w,,, c, 0 Other
13. SCREEN DETAILS: ,.i aTryp. __ 4ftr.ct ...- ,gft - ,i
  • 0e.t*f I~.

slo St.

31* Door'%t@o9140 atscreent tnoop bet..aostod "face ý to. Gre,.oG~toecsle.d Gravel Stze of T794

14. YIELD TEST: 0*'3iled, 0 (d P* ,] C,...e.. ed Air, for  :'! Q r"P *Hin ,. at$ ,4,2 Gallotn per

.. to uMesed by So Bucket. 03 Crifco plo*, 0 w,,,. [0 sister 0 Pee,,e.eoO AtrIse. ,@etOII

15. STATIC WATER LEVEL: .test bo , ..

kal... . ,fte.

  • .d D.o. a, TI- e

-,o..,f ... . ,, C.P-

16. WATER ANALYSIS: iwt. -t=-be.o ,,, t.*d? 0 ye. a Me, Ifte, W.,.r_ -S I'.

17 SPECIAL NOTES'

18. WELrLOG. " 19. SITE MAP -S Shoesy .r-o. Ate t ," ftffg other Iand -%Sa," idl:V nodtt bessth. ?-e 4EOO0Cftt0 004 -'I-.

to'dalco local ,tttet OO, 000 9.Mb.,ileo lot ..

  • o. .o k ~It L17 I

F-i i-i vJ

20. TESTED YIELD ofto- .e y.ebd t "tfed of EItfte-t doeb&. *o11WI .tll.ebek4t.. 1/

feet Gaellont Per mh..Io DOING BUSINESS AS: ,' (cel , N.-.

c_.o' o o 9-r .

RFPORT FILFO By~ ,~

f7r.au ~ ~7L4 -

DATE OF REPORT: - WELL DRILLERS LIC. NO. '9 / -

,cL3

Coliform monitoring data for Vermont Yankee's C.O.B. System WSID 20559 in Vernon, VT Presence (P) Absence (A)

Sample Total Fecal

-Date Coliform Coliform Notes 09-Feb-93 A A 19-Jun-93 A 08-Oct-93 A A

  • 29-Dec-=*3 A A A A 17-Jun-94 P A 22-Jun-94 A A 3 samrples 23-Jun-94 A 4 samples 28-Jul-94 A A S13-Oct-94 A A 07-Mar-95 A A 17-May-95 A A 12-Oct-95 A A 11-Apr-96 P also present in Main System*

15-Apr-96 A A 13-May-96 .A A S10-Jun-96 A A 14-Aug-96 A A

  • 13-Nov-96 A A 13-Feb-97 A A-A A 13-May-97 03-Jul-97 A A 13-Nov-97 A 'A.

20-Feb-98 A, A A'

04-Jun-98 A Notes: .

Believed to becontaminated in laboratory during concurrent analys!

with wastewater Samples

.9<,.

' " A:

.~*:~I'

< ~

s>"

Area Map for Vermont Yankee Nuclear Power Corporation in Vernon (from USGS 1984 Brattleboro VT-NH 1:25000, 7.5 x 15').

,7, H.)

4737 2700C0 FEET (N.H. 04H") 72°

'00 2 ,C O~ 132' 30' 102 4000 5cxMMETERS BRATTLEBOtRO, VERMONT-NEW HAMPSHIRE PROVISIONAL EDITION 1984 12000 14 cC 16 000 FET . WijeLL.

-- L 42072-G5-TNIM025

TYPIC-AL AIVEJ-1Z o~~su 1= ~VATlONI 7ZO' 00PWl WW Wi4SE LEACHF1ELIDS IEA oGCOS SEPTIC T 1,0 &-i Coa (SOUTH) LEA,

- Ty PIC-A L &,fno UNJ *  ;

~1 Qe~jLEvkTj0V '" S. 42 LYC~20 g L.'\R V.. 5 KV SLSTArC)--ýP. IL 4

ItI 7--

5 PLJ!0

,sTRLCTION 40~ .2;q yji~ ')

5I 5It SUPCi P-BsCDNLLj-b.1

'0 .V42 S445" 04.OIT

,IIVN Ib L MElYSC SieMpfrVrotYneoula O1 Poe Coprto nIennwt loain of potable water wells.

  • IJO4F~ OS~t.'~69
Retrieved from "https://kanterella.com/w/index.php?title=ML061730289&oldid=2584234"