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VARIANCE APPLICATIONFile #: Office Use Only Revised May 2016APPLICANT INFORMATION Property Owner: Contractor/Agent: Mailing Address: Mailing Address: Daytime Phone: () Daytime Phone: () Cell: () Cell:
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A pond private water system is a water system that is privately owned and supplies water from a pond or other natural water source.
Owners or operators of pond private water systems are required to file and report information about their water system.
To fill out a pond private water system report, owners or operators must provide information about the water source, treatment method, and water quality.
The purpose of pond private water system reporting is to ensure the safety and quality of water supplied to consumers.
Information such as water source location, treatment method used, water quality testing results, and contact information must be reported on pond private water systems.
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