Form LW902I "Request for Extension of Property Transfer Evaluation or Inspection Report Validity" - New Mexico

What Is Form LW902I?

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 July 1, 2020;
  • 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 Form LW902I by clicking the link below or browse more documents and templates provided by the New Mexico Environment Department.

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Download Form LW902I "Request for Extension of Property Transfer Evaluation or Inspection Report Validity" - New Mexico

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Request for Extension of Property Transfer
New Mexico Environment Department
Evaluation or Inspection Report Validity
Environmental Health Bureau
Liquid Waste Program
For use when an evaluation or inspection has been performed on a permitted liquid waste system within the last 180 days, and
the system has not been in use since the inspection or evaluation and an extension of an additional 180 days is requested.
GENERAL (To be completed by Owner or Authorized Representative):
Name (Property Legal owner, Inc., LLC, partnership, DBA, full legal name):
Field Office:
Application Date:
Permit No.:
Facility Name:
Phone:
E-mail address:
System Location: Physical Address
Mailing Address (Invoices, permits, official correspondence):
City:
State:
Zip Code:
City:
State:
Zip Code:
Uniform Property Code:
Date of Record:
Lot Size (0.01 acres):
Total No. LW Systems on Property:
Total Design Flow on Property:
Subdivision:
Unit/Phase:
Block
Lot/Tract
Township
Range
Section
Third Party Evaluator / Inspector Name:
Evaluator / Inspector Phone No.:
Evaluation / Inspection Date:
Company Name:
Company License No. or Approval Date:
Evaluation / Inspection Received Date:
Evaluation date must be within 15 days of the NMED received date.
Attach evaluation or final inspection report.
Reason the system has not been in use:
Applicant Name and Title
Applicant Signature
Date Signed
I the above signed individual hereby certify that I have provided the above listed information and that it is true and correct to
the best of my knowledge.
This waiver shall not be construed as a warranty that the system will function properly. Because of the numerous factors (usage, soil
characteristics, previous failures, etc.) which may affect the proper operation of a liquid waste system, NMED disclaims any warranty, either
expressed or implied, arising from the inspection and evaluation of the wastewater system or this extension. This extension is invalid if any
modifications have been made to the liquid waste system since the original inspection or evaluation, including changes in the design flow.
The NEW MEXICO STATE ENVIRONMENT DEPARTMENT may verify the above information and decide not to accept this extension request.
Not Accepted
Accepted
NMED Review Date:
Reason not accepted or comments:
NMED
STAMP
This extension is valid for one (1) year from the date of initial inspection or evaluation. Inspections and
evaluations are valid for 180 days from date of inspection, or evaluation.
Approval of this form waives the 180-day limit and adds an additional 180 days in which the evaluation or
Extension Expiration Date:
inspection can be used as a valid property transfer document. This is accepted by the department when
the system is not in use at any point after the inspection or evaluation but prior to transfer of property.
Expiration dates are always expressed as the last day of the anniversary month which the evaluation or
inspection were performed. This waiver is based department policy.
NMED Official Name and Title
Date Signed
LW 902I Request for Extension of Property Transfer Evaluation or Inspection Report Validity Form 200701
Request for Extension of Property Transfer
New Mexico Environment Department
Evaluation or Inspection Report Validity
Environmental Health Bureau
Liquid Waste Program
For use when an evaluation or inspection has been performed on a permitted liquid waste system within the last 180 days, and
the system has not been in use since the inspection or evaluation and an extension of an additional 180 days is requested.
GENERAL (To be completed by Owner or Authorized Representative):
Name (Property Legal owner, Inc., LLC, partnership, DBA, full legal name):
Field Office:
Application Date:
Permit No.:
Facility Name:
Phone:
E-mail address:
System Location: Physical Address
Mailing Address (Invoices, permits, official correspondence):
City:
State:
Zip Code:
City:
State:
Zip Code:
Uniform Property Code:
Date of Record:
Lot Size (0.01 acres):
Total No. LW Systems on Property:
Total Design Flow on Property:
Subdivision:
Unit/Phase:
Block
Lot/Tract
Township
Range
Section
Third Party Evaluator / Inspector Name:
Evaluator / Inspector Phone No.:
Evaluation / Inspection Date:
Company Name:
Company License No. or Approval Date:
Evaluation / Inspection Received Date:
Evaluation date must be within 15 days of the NMED received date.
Attach evaluation or final inspection report.
Reason the system has not been in use:
Applicant Name and Title
Applicant Signature
Date Signed
I the above signed individual hereby certify that I have provided the above listed information and that it is true and correct to
the best of my knowledge.
This waiver shall not be construed as a warranty that the system will function properly. Because of the numerous factors (usage, soil
characteristics, previous failures, etc.) which may affect the proper operation of a liquid waste system, NMED disclaims any warranty, either
expressed or implied, arising from the inspection and evaluation of the wastewater system or this extension. This extension is invalid if any
modifications have been made to the liquid waste system since the original inspection or evaluation, including changes in the design flow.
The NEW MEXICO STATE ENVIRONMENT DEPARTMENT may verify the above information and decide not to accept this extension request.
Not Accepted
Accepted
NMED Review Date:
Reason not accepted or comments:
NMED
STAMP
This extension is valid for one (1) year from the date of initial inspection or evaluation. Inspections and
evaluations are valid for 180 days from date of inspection, or evaluation.
Approval of this form waives the 180-day limit and adds an additional 180 days in which the evaluation or
Extension Expiration Date:
inspection can be used as a valid property transfer document. This is accepted by the department when
the system is not in use at any point after the inspection or evaluation but prior to transfer of property.
Expiration dates are always expressed as the last day of the anniversary month which the evaluation or
inspection were performed. This waiver is based department policy.
NMED Official Name and Title
Date Signed
LW 902I Request for Extension of Property Transfer Evaluation or Inspection Report Validity Form 200701