ࡱ> #` bjbjmm C .+:::8P::T <FR?R?R?R?-@,YCESSSSSSSbUhWhSG-@-@GGSR?R?fTLLLGR?R?SLGSLL:L,LR?< LD<;:HpL N$|T0TL 2X I2XL2XLFZ[F@LF4F,FFFSSKXFFFTGGGG d  State of Maine DEPARTMENT OF ENVIRONMENTAL PROTECTION Bureau of Land & Water Quality 17 State House Station, Augusta, ME 04333-0017 Telephone: (207)287-3901 E-mail: Erich.D.Kluck@Maine.gov CLASS V UNDERGROUND INJECTION CONTROL (UIC) WELL REGISTRATION Facility Name or Well Indentifying Information Facility Name or Well Indentifier: FORMTEXT      Town or City FORMTEXT      County FORMTEXT      Physical Location (street, road, etc. Please provide map, latitude/longitude or UTM coordinates, if available) FORMTEXT       Owner/Operator Information Owner/Operator Name FORMTEXT      Business/Agency FORMTEXT      Mailing Address FORMTEXT      Daytime Telephone Number FORMTEXT       Number and Type of Injection Well(s)  FORMCHECKBOX Motor Vehicle Waste Disposal WellBeneficial Use Well FORMCHECKBOX Industrial Well  FORMCHECKBOX Aquifer Remediation Well  FORMCHECKBOX Commercial Car Wash (engine and undercarriage washing)  FORMCHECKBOX Salt Water Intrusion Well FORMCHECKBOX Large-capacity Cesspool FORMCHECKBOX Fluid Return Well (Supplemental Data Required) FORMCHECKBOX Large-capacity Septic System FORMCHECKBOX Sewage Treatment Effluent Well FORMCHECKBOX Experimental Technology Well FORMCHECKBOX Drainage Well FORMCHECKBOX Mine Backfill and Drainage Well  FORMCHECKBOX Agriculture Drainage Well FORMCHECKBOX In-situ Recovery and Solution Mining Well  FORMCHECKBOX Stormwater Runoff Well FORMCHECKBOX Other Industrial Well  FORMCHECKBOX Manual Car Wash  FORMCHECKBOX Non-contact Cooling Water Well  FORMCHECKBOX Food Processing Wastewater Well Discharge Information Indicate the type/characteristics of the discharge, average flow (gallons/day) and well construction information (drywell, septic tank, drainfield/leachfield, etc.) for each injection well listed above. Attach additional sheets or supplemental material, as needed. Well IdentifierCharacteristics of DischargeAverage Flow (gallons/day)Well Construction Information FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT  Are the injection well(s) listed above located in a wellhead or source water protection area of a public water supply? FORMCHECKBOX Yes FORMCHECKBOX No If more than one injection well is listed, please indicate which wells are located in the wellhead or source water protection area. Distance to nearest water supply well FORMCHECKBOX feetType of well: FORMCHECKBOX Public FORMCHECKBOX Private Predominant soil type:  FORMCHECKBOX Sand and gravel soils FORMCHECKBOX Clay soils FORMCHECKBOX Shallow to bedrock soils FORMCHECKBOX Don t know FORMCHECKBOX Other (Please explain)  FORMTEXT   Name of Preparer: FORMTEXT      Date: FORMTEXT      Return form prior to well operation to Maine DEP at address above. Descriptions of Class V Underground Injection Control (UIC) Wells Motor vehicle waste disposal wells receive or have received fluids from vehicular repair or maintenance activities, such as an autobody repair shop, automotive repair shop, new and used car dealership, specialty repair shop (e.g., transmission and muffler repair shop), or any facility that does any vehicular repair work. Industrial wells are used to inject non-hazardous industrial or commercial waste and fluids other than those described for the other types of Class V wells. These include but are not limited to: Wastewater from petroleum refineries, chemical manufacturers, dry cleaners, electric component manufacturers, small machine manufacturers, die and tool manufacturers, commercial printers, asphalt manufacturers, and other industrial operations; or Spills from industrial or commercial process areas, storage areas, or loading docks, or drainage highly contaminated by large spills from such areas. Wastewater from carwashes specifically set up to perform engine or undercarriage washing. This does not include wastewater from manual carwashes where people use hand-held hoses to wash the exterior of their cars, trucks, or other vehicles. Large-capacity Cesspools are dry wells, which sometimes have an open bottom and/or perforated sides, used to dispose of untreated sanitary waste. They are typically located in areas not served by sanitary sewers. This subpart applies to you only if your cesspool has the capacity to dispose of sanitary waste from 20 persons or more per day (you are exempt from this subpart and from the federal Underground Injection Control program if it is smaller than that). However, if you use your cesspool to dispose of motor vehicle waste or industrial waste, either by themselves or together with sanitary waste, your well qualifies as a motor vehicle waste disposal well or an industrial well rather than a cesspool. Large-capacity Septic systems are septic tanks and fluid distribution systems, such as leach fields or wells, used to dispose of sanitary waste only .Like cesspools, this subpart applies to you only if your septic system has the capacity to dispose of sanitary waste from 20 persons or more per day. However, if you use your septic system to dispose of motor vehicle waste or industrial waste, either by themselves or together with sanitary waste, your well qualifies as a motor vehicle waste disposal well or an industrial well rather than a septic system. Sewage treatment effluent wells are used to inject treated effluent from publicly owned treatment works or treated effluent from privately owned treatment facilities receiving solely sanitary waste. If you inject effluent from a privately owned treatment facility that receives industrial waste, your well qualifies as an industrial well rather than a sewage treatment effluent well. Also, if you own or operate a well that injects sewage treatment effluent beneath the lowermost formation containing a USDW, it qualifies as a Class I well rather than a Class V well. Drainage wells consist of a variety of wells used to drain surface and subsurface fluids. These wells include agricultural drainage wells that receive irrigation or stormwater runoff. Drainage wells also include stormwater runoff wells in municipalities. A well at a commercial or industrial site also qualifies as a drainage well, not an industrial well, if it is intended for stormwater management, even if it may have the potential to receive insignificant amounts of waste due to unintentional small volume leaks, drips, or spills, as long as it cannot reasonably be separated from potential sources of contamination. This category does not include mine drainage wells. Beneficial use wells are used to improve either the quality or flow of aquifers or to provide some other ground water management benefit. They include aquifer recharge wells used to re-supply dwindling ground water resources; aquifer storage and recovery wells used to place excess water in the subsurface during periods of high flow and then withdraw the water later when it is needed; subsidence control wells used to inject fluids to prevent the land surface from sinking or settling; injection wells used to help clean up contaminated ground water, either by injecting solutions to neutralize contamination or to return previously contaminated ground water that has been treated; and wells that inject water to control the intrusion of saltwater in coastal areas into freshwater aquifers. Fluid return wells are used to inject fluids associated with the production of geothermal energy for space heating or electric power, the operation of a heat pump, aquaculture, or the extraction of minerals from produced fluids. In accordance with MEDEP Rule 06 096 Chapter 543, Rules to Control the Subsurface Discharge of Pollutants, anyone planning on installing and operating a geothermal well system must fill out and submit the required information requested on the Supplemental Geothermal Well Information Form prior to use. Additionally, please provide a brief description of the geothermal system design and operation. Experimental technology wells include any well that is an integral part of an unproven subsurface injection technology other than waste disposal, such as in situ coal liquification, in situ oil shale retorting, tracer studies, and secondary water recovery (e.g., using air to force underground water bound in the unsaturated zone into the saturated zone where it can be recovered). Mine backfill and drainage wells are used to place mine drainage or slurries of sand, gravel, cement, mill tailings/refuse, fly ash, or other solids into underground mines, whether what is injected is a radioactive waste or not. Mine backfill and drainage wells may serve a variety of purposes, including subsidence prevention, filling dangerous mine openings, disposing of wastes from mine operations, and fire control. In-situ recovery and solution mining wells are used to inject fluids for the purpose of producing energy or minerals. 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$IfgdV(kdmP$$Iflr *11 t0644 layt 89:`rw $IfgdV(gdV(jkd"Q$$Ifl*+ t0644 layt  24PRTǯǗm_Gm/jVhb}hh=CJOJQJU^JaJhb}CJOJQJ^JaJ#jhb}CJOJQJU^JaJ/j Uh4h@:CJOJQJU^JaJ/jSh4h@:CJOJQJU^JaJ/jkRh4h@:CJOJQJU^JaJh4CJOJQJ^JaJ#jh4CJOJQJU^JaJ/jQh4h@:CJOJQJU^JaJ6111gdV(kdR$$Iflִt:}!#^*PC1 t6    44 layt 02V?VkdU$$Ifl01^*-( t644 layt eVkdsT$$Ifl01^*-( t644 layt e $IfgdV( $Ifgd4VHVkdW$$Ifl01^*-( t644 layt eVkdV$$Ifl01^*-( t644 layt e $IfgdV(024ǵs]L=/h@:CJOJQJ^JaJh@:hVOJQJ^JaJ!hVOJQJ^JaJmHnHu+jXhVh dOJQJU^JaJhVOJQJ^JaJjhVOJQJU^JaJ/j5Xh4hVCJOJQJU^JaJhVCJOJQJ^JaJ#jhVCJOJQJU^JaJh4CJOJQJ^JaJ#jh4CJOJQJU^JaJ/j'Whb}hh=CJOJQJU^JaJ $IfgdV(kkdY$$Ifl4F1N ^* ` t6    44 layt e @ $IfgdV(gdV(kkdQZ$$Ifl4F1N ^*  t6    44 layt e .02<>BPR̾̎̀̾h̎̀ZQI9hMWh@:>*CJOJQJaJh@:OJQJh@:5OJQJh@:CJOJQJ^JaJ/j}[hVh dCJOJQJU^JaJh CJOJQJ^JaJ.jhVCJOJQJU^JaJmHnHu/j[hVh dCJOJQJU^JaJhVCJOJQJ^JaJ#jhVCJOJQJU^JaJ#h@:h 5CJOJQJ^JaJh 5CJOJQJ^JaJ@BPR !YQGG@@xgd@: $<a$gd@:$a$gd@:kd[$$Ifl\F }^* 7. t0644 layt  !"1$I$&'()G)a+o+..101"262m253333555667AWܤ}~Ʒskgkgkh djh dU h@3h4CJOJQJ^JaJUh@:CJOJQJ^JaJ#hznh@:6CJOJQJ^JaJ h6h@:CJOJQJ^JaJh6h@:CJOJQJaJh6h@:>*CJOJQJaJhMWh@:CJaJhMWh@:>*CJOJQJaJhMWh@:CJOJQJaJ(!"@#1$&()a+.1356Aܤ & F hh<^h`gd@: & F hh^h`gd@: Vx^Vgd@: ZVx^Vgd@: & F 8hh<^h`gd@: & F 8hh<^h`gd@:s) into subsurface target formations to liberate the desired products that can be brought to the surface via recovery wells. Solution mining wells use injection and recovery techniques to bring minerals from underground deposits to the surface. Solution mining of conventional mines such as stopes leaching is included in Class V. However, in-situ production of uranium or other metals from ore bodies that have not been conventionally mined is included in Class III (see Sec. 144.6(c)).Similarly, mining of sulfur by the Frasch process is included in Class III, not Class V. Other industrial wells inject industrial and commercial wastes, which either contain lower concentrations of contaminants or are more like sanitary waste than wastes injected into Class V industrial wells described in paragraph (b) of this section. The category of other industrial wells was created to exclude these wells from the additional requirements in Sec. 144.85 that apply to industrial wells. There are four types of other industrial wells: Wells used to inject fluids from wash bays that are not specifically set up to perform engine or undercarriage washing; All self-service commercial car washes discharging to a Class V well are currently prohibited. Wells used to inject non contact cooling water that contains no additives and has not been chemically altered, meaning that it has not been mixed with or come into contact with a contaminated waste stream; Wells used to inject fluids from laundromats where no onsite dry cleaning is performed or where no organic solvents are used for laundering; and Wells used to inject wastewater from food processing operations.     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