EPA Region 4 Sole Source Aquifer Project Review Form - Section B: Determination of Potential Project Impacts to the Sole Source Aquifer

Welcome to the Environmental Protection Agency (EPA) Region 4’s Sole Source Aquifer (SSA) project review form. The EPA SSA Protection Program is authorized by section 1424(e) of the Safe Drinking Water Act of 1974 (42 U.S.C. 201, 300 et. Seq., and 21 U.S.C. 349). Under the SSA Protection Program, EPA reviews proposed projects that will both: 1) be located within the SSA project review area and; 2) receive federal financial assistance. The review area may include the area overlying the SSA, its recharge zone, and source areas of streams that flow into the SSA's recharge zone. The EPA's review is intended to determine any possible contamination to the SSA from submitted projects. Your accurate submission of information will help us determine any possible contamination.

Please complete this form in its entirety and as well as the two-part submission process. Keep the email received at the end of submission process for your records. This email will serve as the official record of the decision and may be required by the federal agency funding your project. Thank you.

Section B: Determination of Potential Project Impacts to the Sole Source Aquifer

By providing the information below, I certify under penalty of law that this questionnaire was completed under my direction or supervision and the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for known violations.

Please contact the EPA Region 4 Sole Source Aquifer team at R4_SSA@epa.gov if you encounter problems with this form or have any questions.

Contact Information
Please enter the name of the applicant requesting a Sole Source Aquifer (SSA) Review.
Please select the Sole Source Aquifer in which your project is located. *
Use the Interactive map of SSAs to verify. (Please note projects located entirely outside of a SSA area or a SSA’s recharge zone do not require a SSA review by USEPA. The link for the map will open in a new window or tab - depending on your browser.).
Section B:
The following questions will help the EPA determine whether an in-depth SSA review by is required. Please select YES or NO for each of the below questions:
2. Is the project new construction, acquisition, or rehabilitation of residential housing that involves no more than four dwelling units? *
3. Is the project construction of (or addition to) residential, commercial, industrial projects, public facilities or land developments that will be served by a municipally or publicly owned and operated sewage treatment plant which is operating within the capacity for which it was designed and is not subject to any local, state or federally imposed moratorium? *
If the project is not a new construction, answer “No”. If the project is a new construction, and if a municipally or publicly owned and operated sewage treatment plant will be serving the project and it has capacity to handle the additional sewage and waste generated by the proposed development then answer “Yes”. Else, answer “No”. If there is a moratorium on the sewage treatment plant then the question should be answered “No”. Please contact R4_SSA@epa.gov in that scenario. The applicant should contact the sewage treatment plant and get confirmation prior to answering this question. An official statement may be required from the treatment plant if the project is selected for a review.
4. Is the project rehabilitation or modernization of a residential structure or of commercial, industrial, or publicly owned buildings that are served by a municipally or publicly owned sanitary sewer system operating in compliance with its authorized permits? *
If the project is a new construction answer No. If the project involves rehabilitation or modernization of an existing structure, then answer yes or no whether it is currently being served by a municipally or publicly owned sanitary sewer system operating in compliance with its authorized permit(s).
5. Is the project funding for public services, planning activities, technical assistance, training, or payment, repayment, or reimbursement of either loans or interest? *
6. Is the project repairing and/or modernizing existing Public Water Supply infrastructure, except for the installation of new infrastructure? *
7. Is the project repair or reconstruction of streets, sidewalks, or curbs? *
8. Does the project involve domestic waste not connected to a public sanitary sewer system? *
9. Does the project include the construction or rehabilitation of residential, commercial, or industrial projects, public facilities, or land developments whose sanitation facilities will consist of individual sewage disposal systems such as cesspools, septic tanks with leach fields or seepage areas, pit toilets, or privately-owned sewerage systems, including those owned by a homeowners’ association? *
10. Does the project include any project or activity for an existing or proposed facility that manufactures, stores, transports, spreads, or disposes of toxic, noxious, or hazardous chemicals, or radioactive materials, including pesticides, petroleum, and/or fertilizers? *
11. Does the project include the acquisition, disposition, rehabilitation, or new construction of any facility or operation which disposes of its wastewater into dry wells or retention ponds, or through any method other than conveyance to a treatment plant? *
12. Does the project include the acquisition, disposition, rehabilitation, or new construction of storm water drainage facilities modifications to existing wetlands, or modifications or new construction of shallow injection wells (i.e., dry wells, French drains, sumps, and drain fields)? *
13. Does the project include the acquisition, disposition, rehabilitation or new construction of a site intended for or used as a landfill or other waste storage, transfer, disposal, or treatment facility? *
14. Are there any deep pilings or foundations (e.g., greater than 10 feet below land surface) that will be installed, modified, or disturbed during the project? *
15. Will any construction activity penetrate into the Sole Source Aquifer? *
16. Does the project involve agricultural activities or related operations employed in the production, raising, processing, and/or marketing of crops or livestock? *
17. Does the project involve storage or handling of hazardous or toxic materials or petroleum products, including, but not limited to, aboveground or underground storage tanks, and oil and gas pipelines (other than service lateral extensions for 4 or fewer residential units, or service lateral extensions where trenching and excavation is no deeper than 10 feet below ground surface)? *
18. Is a National Environmental Policy Act (NEPA) Environmental Impact Statement (EIS) required for the project? *
https://www.epa.gov/nepa
19. Has any federal, state, or local authority determined that the project could be a potential source of contamination to a SSA and/or a SSA’s recharge zone? *
20. Has a review conducted by a federal, state, or local authority, or a private entity, identified any potential environmental impacts related to this project? *

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Last updated on April 7, 2025