Attachment C "Variance Application - Liquid Waste Submittal Checklist" - New Mexico

What Is Attachment C?

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 C by clicking the link below or browse more documents and templates provided by the New Mexico Environment Department.

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Download Attachment C "Variance Application - Liquid Waste Submittal Checklist" - New Mexico

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Attachment C
Applicant:_____________________________________________
NMED Processing Number:____________________
You must submit this form with your application. The installer shall check next to each “YES” or “No” box to verify that
the necessary information has been submitted. Print and sign your name at the bottom.
New Mexico Environment Department
VARIANCE APPLICATION- LIQUID WASTE
Submittal Checklist
Liquid Waste Application
Installer
Verification
Complete LW Application
(See ”Liquid Waste Permit Application Submittal Checklist”)
Include all attachments and Site Plan Drawing in accordance with “Site Plan Drawing-Liquid Waste System
YES
NO
Submittal Checklist”
Variance Application
Appropriate “Application for Variance” Form is completely filled out
YES
NO
Section(s) of the regulations being varianced is stated and is accurate
YES
NO
The justification section is completely filled out
YES
NO
Application is signed and dated by the applicant
YES
NO
Attachments
Equal Protection Documentation is attached and presents evidence that the proposed
system will not cause a hazard to public health, nor degrade a body of water and will result in
YES
NO
environmental protection equal to or better than the minimum protection of varianced
regulation(s)
Notification Letter is attached and includes the following: (1) nature of the request w/ section
of regs stated and specifics of requirement; (2) address where application is submitted; (3) time
YES
NO
frames for NMED actions; and (4) proposed submittal date of application to NMED Field Office
Documentation of Notification* for the adjacent property owners. Acceptable documents
are the return receipts (original or copies) of the certified letters mailed to the property owners
YES
NO
or sheets signed by property owners that received hand delivered letters
Map or Drawing which indicates the owners of adjacent lots who have been notified
YES
NO
All Adjacent Landowners Notified who share a common boundary and within 100 feet when
YES
NO
sharing a common right of way; OR all parties sharing a private domestic well located on the lot
where the variance is proposed
N M ED Perm it Processing Com m ents:
Date Applicant Notified of Incompleteness: _____/_____/_____
What is needed for application to be “Complete”:
Date Application Determined to be Complete: _____/_____/_____ Date sent to LW Specialist: _____/_____/_____
10 W orking Days from “Com plete” Date:
_____/_____/_____
20 W orking Days from “Com plete” Date:
_____/_____/_____
Other Comments:
________________________________ _____________________________ ________________
Installer Name Printed
Installer Signature
Date
________________________________ _____________________________ ________________
NMED Staff Name Printed
NMED Staff Signature
Date
Revised 8/1/10
Attachment C
Applicant:_____________________________________________
NMED Processing Number:____________________
You must submit this form with your application. The installer shall check next to each “YES” or “No” box to verify that
the necessary information has been submitted. Print and sign your name at the bottom.
New Mexico Environment Department
VARIANCE APPLICATION- LIQUID WASTE
Submittal Checklist
Liquid Waste Application
Installer
Verification
Complete LW Application
(See ”Liquid Waste Permit Application Submittal Checklist”)
Include all attachments and Site Plan Drawing in accordance with “Site Plan Drawing-Liquid Waste System
YES
NO
Submittal Checklist”
Variance Application
Appropriate “Application for Variance” Form is completely filled out
YES
NO
Section(s) of the regulations being varianced is stated and is accurate
YES
NO
The justification section is completely filled out
YES
NO
Application is signed and dated by the applicant
YES
NO
Attachments
Equal Protection Documentation is attached and presents evidence that the proposed
system will not cause a hazard to public health, nor degrade a body of water and will result in
YES
NO
environmental protection equal to or better than the minimum protection of varianced
regulation(s)
Notification Letter is attached and includes the following: (1) nature of the request w/ section
of regs stated and specifics of requirement; (2) address where application is submitted; (3) time
YES
NO
frames for NMED actions; and (4) proposed submittal date of application to NMED Field Office
Documentation of Notification* for the adjacent property owners. Acceptable documents
are the return receipts (original or copies) of the certified letters mailed to the property owners
YES
NO
or sheets signed by property owners that received hand delivered letters
Map or Drawing which indicates the owners of adjacent lots who have been notified
YES
NO
All Adjacent Landowners Notified who share a common boundary and within 100 feet when
YES
NO
sharing a common right of way; OR all parties sharing a private domestic well located on the lot
where the variance is proposed
N M ED Perm it Processing Com m ents:
Date Applicant Notified of Incompleteness: _____/_____/_____
What is needed for application to be “Complete”:
Date Application Determined to be Complete: _____/_____/_____ Date sent to LW Specialist: _____/_____/_____
10 W orking Days from “Com plete” Date:
_____/_____/_____
20 W orking Days from “Com plete” Date:
_____/_____/_____
Other Comments:
________________________________ _____________________________ ________________
Installer Name Printed
Installer Signature
Date
________________________________ _____________________________ ________________
NMED Staff Name Printed
NMED Staff Signature
Date
Revised 8/1/10