Excluding the Domestic Use Aquifer Pathway

Learn more about the application process and requirements associated with seeking an exclusion of the domestic use aquifer pathway in Edmonton.

The City of Edmonton will review referral submissions as per Alberta Environment and Protected Areas’ Guide to excluding the domestic use aquifer based on municipal bylaws (the Guide).

Upon form submission, the City of Edmonton will review the referral submission and provide either:

Confirmation that the municipal requirements of the Guide are met, or
A rejection of the referral submission, or
An objection to the exclusion of the domestic use aquifer contaminant pathway for the site.

The City of Edmonton will endeavour to respond to a referral submission within 60 days after receiving the submission.

Applicant Instructions

Please complete the form below.

All fields in the form must be completed, and all technical documents must be authenticated in line with the requirements of the Professional Responsibilities in Completion and Assurance of Reclamation and Remediation Work in Alberta Joint Practice Standard, as replaced or amended from time to time.

Information to be Submitted When Completing the Form Online

Written summary of current site conditions
A site figure showing:
- Current contaminant delineation and sample locations
- Delineation of areas of heavily impacted media
- An areal extent of non-aqueous phase liquids (if present)
- A summary of the understanding of the conceptual site model
- A summary of the current understanding of the contamination extent
- Location of existing domestic or municipal supply water wells and surface water bodies being used for domestic or municipal supply
A summary table of a regional water well record search, extending a minimum of 300 metres beyond the property boundaries of the site, and including, at a minimum, a search of the most recent version of the Alberta Water Well Information Database.
All lines of evidence proving that the requirements of the Guide related to any existing water wells have been met.
A current and complete record of site condition form

Incomplete referral submissions or referral submissions with inaccurate information will be rejected.

Address(es) and Legal Land Description(s) of the Subject Site or Sites

What can you provide for the location of the subject site(s)?

Street Address and Postal CodeLegal Land Description (Plan, Block, Lot)Both

Street Address

Postal Code

Plan Number

Block

Lot

Site Owner(s) Shown on the Certificate of Title Under the Alberta Land Titles Act, RSA 2000, c L-4

Site Owner First Name

Site Owner Last Name

Site Representative (if different from Site Owner)

Site Representative First Name

Site Representative Last Name

Name and Contact Information of the Authenticating Professional

Authorizing Professional First Name

Authorizing Professional Last Name

Name of the Environmental Consulting Company

Does contamination extend into the City right-of-ways?

YesNo

City Right of Ways

Please enter your current Roadway Construction & Access Agreement (RCAA) number:

Please enter your Utility Line Assignment permit numbers for infrastructure within the ROW:

Please upload your GPS locations, borehole logs and design drawings for infrastructure in the ROW.

Document Submission

Please upload a document or zipped file containing the Information to be Submitted When Completing the Form Online outlined above.

Applicant Acknowledgment

I acknowledge that

1. The City of Edmonton relies on the accuracy of the information contained in this Referral Submission form;

2. Any false statements in my Referral Submission form may result in my Referral Submission being rejected; and

3. If The City of Edmonton discovers that any information provided in the Referral Submission is untrue, inaccurate, or misleading, or the facts of this matter change, The City of Edmonton may change how it responds to the Referral Submission; and

4. A completed Referral Submission form does not absolve any person responsible for a substance or a thing containing a substance, or any person responsible for a contaminated site, from any duties to take remedial measures under applicable statutes, regulations, bylaws, codes of practice, standards, policies, directives and procedures, including but not limited to the Environmental Protection and Enhancement Act, RSA 2000, c E-12 and its regulations, as amended from time to time, or any other measures required for the site.

Applicant Certification

I certify that:

1. All information in the Referral Submission is true, complete, and accurate, and

2. I am authorized to provide the application on behalf of the owner(s) of the site, named above.

Limitations

This Referral Submission form is submitted to The City of Edmonton pursuant to the Guide.
No person shall rely on this Referral Submission form, the information submitted within the Referral Submission form, or The City of Edmonton’s response for anything other than a potential exclusion of the domestic use aquifer pathway for a site in Edmonton.
Nothing in this Referral Submission form or process shall constitute the granting by The City of Edmonton of any approval or permit, as may be required pursuant to the Municipal Government Act, RSA 2000, c M-26.
Nothing in this Referral Submission form or process restricts The City of Edmonton, its municipal council, its officers, servants or agents in the full exercise of any and all powers and duties vested in them in their respective capacities as a municipal government, as a municipal council and as the officers, servants and agents of a municipal government.
By receiving your Referral Submission and responding to your Referral Submission, The City of Edmonton:
1. DOES NOT acknowledge any other aspects of the site, including but not limited to:
  1. The condition of the site; or
  2. If the site complies with any applicable laws, including but not limited to municipal, provincial or federal laws, code of practice, guideline, or directive, including but not limited to any bylaws, the Environmental Protection and Enhancement Act, RSA 2000, c E-12 and its regulations; or
  3. If the site meets any conditions noted in clauses (iv) through (vii) of the Guide to Excluding the DUA based on Municipal Bylaws, or any other requirements for the Tier 2 Pathway Exclusion under the latest edition of the Alberta Tier 1 or 2 Soil and Groundwater Quality Guidelines, as amended from time to time.
2. DOES NOT accept any responsibility, charge, management, or control of any substance, thing containing a substance, or any contaminated site;
3. DOES NOT approve of or assume any responsibility for the investigation, assessment or remediation of any substance or thing containing a substance, any contaminant release, or any contaminated site;
4. IS NOT waiving or releasing any rights or remedies The City of Edmonton may have in law or in equity, including but not limited to, seeking indemnity, contribution or reimbursement for any liabilities, costs, damages, or expenses which The City of Edmonton may incur or sustain as a result of any substance or contaminant release.

Protection of Privacy Act (POPA) Statement

Personal and professional information is collected for the purpose of the City of Edmonton’s Contaminated Sites Management Program and will be used to assess the accuracy and validity of the applicant’s Domestic Use Aquifer Pathway Exclusion proposal. Collection is authorized under section 4(c) of the Protection of Privacy Act (POPA) and is managed and protected in accordance with the Act. The City intends to input the information into an automated system to generate content or make decisions, recommendations or predictions in accordance with the City of Edmonton Generative AI Standard (see Council Policies, Standards section). If you have questions about the collection, please email the City Contaminated Sites Management Program at csmp@edmonton.ca.