Attachment A "Application Checklist - Liquid Waste System" - New Mexico

What Is Attachment A?

This is a legal form that was released by the New Mexico Environment Department - a government authority operating within New Mexico. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2010;
  • The latest edition provided by the New Mexico Environment Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Attachment A by clicking the link below or browse more documents and templates provided by the New Mexico Environment Department.

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Download Attachment A "Application Checklist - Liquid Waste System" - New Mexico

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Attachment A
NMED Use Only
Permit Processing No.__________________________
Applicant Name
_______________________________
You must submit this form with your application. The applicant shall check the box next to Yes or No or N/A (Not Applicable) for each
box to verify that the necessary information has been submitted. Print and sign your name at the bottom.
New Mexico Environment Department
Application Checklist - LIQUID WASTE SYSTEM
For All Liquid Waste Permit Applications
Applicant
Verification
Application is filled out completely with minimal cross-outs and no whiteout, no blanks
Yes
No
Detailed site plan is attached and includes all requirements and meets all setbacks (and Liquid
Yes
No
Waste Site Plan Submittal Checklist is attached)
Warranty deed, tax bill or other form of ownership verification is attached (requires county clerk
Yes
No
stamp)
Copy of plat or recorded survey is attached
(requires county clerk stamp)
Yes
No
(if these documents are not available other documents showing property size and easements must be provided)
Floor plan for all dwellings or structures is attached
(All rooms are clearly labeled, identifying
Yes
No
bedrooms and rooms that might reasonably be used as bedrooms)
For Liquid Waste Permit Applications Proposing Advanced Treatment
Applicant
Verification
A fully-labeled treatment and disposal system diagram is attached. The location and diagram of
Yes
No
the sampling port is clearly shown. Disinfection unit is shown(If applicable)
The system being proposed is on the “Advanced Wastewater Treatment Systems Approved by
Yes
No
NMED” list
A detailed design statement is attached which includes all of the following: Explains why an
Yes
No
ATU is required on this site, discussion of site conditions & operational details
A maintenance contract for the duration of the permit with a factory certified MSP (signed by
Yes
No
both homeowner and MSP) is attached
If Voluntary System, Disclosure Statement is included
(disclosure statement- indicates ATS is not
Yes
No
N/A
required, maintenance contract for duration of the permit, signed by homeowner)
A sampling contract for the duration of the permit with an approved sampling provider (signed
Yes
No
N/A
by both the homeowner and sampling provider) is attached
For Liquid Waste Permit Applications Proposing Alternative Disposal
Applicant
Verification
A detailed design statement is attached: Explains why an ADS is required on this site, it meets a
Yes
No
proven design criteria, statement of site conditions & operational details
A diagram & design specifications of the disposal system including manufacturer’s specifications
Yes
No
(or proven design specs) are attached
Detailed site drawings showing plan, profile and cross-section views are attached
Yes
No
Detailed design calculation sheets or worksheets are attached
Yes
No
N/A
Pump specifications and sizing information are attached
Yes
No
N/A
________________________________ _____________________________ ________________
Applicant Name Printed
Applicant Signature
Date
________________________________ _____________________________ ________________
NMED Staff Name Printed
NMED Staff Signature
Date
Revised 8/1/10
Attachment A
NMED Use Only
Permit Processing No.__________________________
Applicant Name
_______________________________
You must submit this form with your application. The applicant shall check the box next to Yes or No or N/A (Not Applicable) for each
box to verify that the necessary information has been submitted. Print and sign your name at the bottom.
New Mexico Environment Department
Application Checklist - LIQUID WASTE SYSTEM
For All Liquid Waste Permit Applications
Applicant
Verification
Application is filled out completely with minimal cross-outs and no whiteout, no blanks
Yes
No
Detailed site plan is attached and includes all requirements and meets all setbacks (and Liquid
Yes
No
Waste Site Plan Submittal Checklist is attached)
Warranty deed, tax bill or other form of ownership verification is attached (requires county clerk
Yes
No
stamp)
Copy of plat or recorded survey is attached
(requires county clerk stamp)
Yes
No
(if these documents are not available other documents showing property size and easements must be provided)
Floor plan for all dwellings or structures is attached
(All rooms are clearly labeled, identifying
Yes
No
bedrooms and rooms that might reasonably be used as bedrooms)
For Liquid Waste Permit Applications Proposing Advanced Treatment
Applicant
Verification
A fully-labeled treatment and disposal system diagram is attached. The location and diagram of
Yes
No
the sampling port is clearly shown. Disinfection unit is shown(If applicable)
The system being proposed is on the “Advanced Wastewater Treatment Systems Approved by
Yes
No
NMED” list
A detailed design statement is attached which includes all of the following: Explains why an
Yes
No
ATU is required on this site, discussion of site conditions & operational details
A maintenance contract for the duration of the permit with a factory certified MSP (signed by
Yes
No
both homeowner and MSP) is attached
If Voluntary System, Disclosure Statement is included
(disclosure statement- indicates ATS is not
Yes
No
N/A
required, maintenance contract for duration of the permit, signed by homeowner)
A sampling contract for the duration of the permit with an approved sampling provider (signed
Yes
No
N/A
by both the homeowner and sampling provider) is attached
For Liquid Waste Permit Applications Proposing Alternative Disposal
Applicant
Verification
A detailed design statement is attached: Explains why an ADS is required on this site, it meets a
Yes
No
proven design criteria, statement of site conditions & operational details
A diagram & design specifications of the disposal system including manufacturer’s specifications
Yes
No
(or proven design specs) are attached
Detailed site drawings showing plan, profile and cross-section views are attached
Yes
No
Detailed design calculation sheets or worksheets are attached
Yes
No
N/A
Pump specifications and sizing information are attached
Yes
No
N/A
________________________________ _____________________________ ________________
Applicant Name Printed
Applicant Signature
Date
________________________________ _____________________________ ________________
NMED Staff Name Printed
NMED Staff Signature
Date
Revised 8/1/10