Site Screening Questionnaire for Non-Potable Groundwater Requests

  • Current Applicant Details
  • Subject Property Information
  • Contaminants on the Property
  • Required Documents
  • Certification
  • Review
  • Payment
  • Complete

The personal information submitted in this form is collected under the authority of the Environmental Protection Act, R.S.O. 1990, c. E.19. Ontario Regulation 153/04, section 35 for the purposes of evaluating non-potable groundwater requests and Source Water Protection program administration.

This form must be completed for all non-potable groundwater standard requests submitted to York Region and is part of the Applicant/Owner’s submission. York Region may request additional information not outlined on this form at its discretion in connection with evaluating a non-potable groundwater standard request submission. 

The Applicant/Owner can access York Region’s online mapping tool at york.ca/SPMap to indicate whether the Subject Property is within an environmentally sensitive area.

If you have any questions regarding the non-potable request procedure or the completion of this questionnaire, please call Access York at 1-877-464-9675 or @email

Applicant Details
Applicant Contact Information
Legal Owner & Municipal Address of the Subject Property