Virginia Law

A. When a Class IV well is proposed for property that does not have an onsite sewage disposal system, either active or inactive, an application may be made for an express Class IV construction permit. An application for an express Class IV construction permit shall be made on a form provided by the district or local health department and approved by the commissioner.

B. An application shall be deemed completed upon receipt by the district or local health department of a signed and dated application, together with the appropriate fee, containing the following information:

1. The property owner's name, address, telephone number, and personal signature. The owner's signature will acknowledge that the permit will be issued without the benefit of a site visit by the local health department prior to the issuance of the construction permit; that the permit is being issued based upon the information provided on the accompanying site plan; that the property owner also acknowledges that if the well is found not to comply with the minimum separation distances or other provision of this chapter, the well must be abandoned at the direction of the local or district health director; and that a variance will not be considered if the improper location of the well is a result of the failure by the owner, the owner's agent, or the water well systems provider to provide complete or accurate information on the site plan submitted with the application or to install the well in accordance with the permit;

2. Address and directions to the property;

3. The proposed use of the well;

4. The name, address, telephone number, license number, and signature of the water well systems provider who is to construct the well;

5. A statement signed by the property owner (and not the owner's agent) granting the department access to the site for the purposes of inspecting the property and the well during and after its installation until the well is approved by the department or a required abandonment is completed; and

6. A site plan showing the proposed well site, property boundaries, recorded easements, and accurate locations of actual or proposed sources of contamination (including those listed in Table 1 of 12VAC5-630-380) within 100 feet of the proposed well site, and at the option of the applicant a proposed well design. If the proposed well site is located on or at the base of sloping topography, the minimum separation distances shown on the site plan for sources of contamination within a 60 degree arc slope of the proposed well site must be increased 25 feet for every 5.0% slope.