Get Application-extension-sampling-tier3-beach. Application For Extension Of Sampling Variance For A

This guide provides users with clear and concise instructions on how to fill out the Application for Extension of Sampling Variance for a Massachusetts Tier 3 Beach. By following these steps, you can ensure that the application is completed accurately and submitted properly.

Follow the steps to accurately complete the application form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the section labeled 'City/Town', enter the name of the city or town where the beach is located.
3. In the 'Beach Name' section, provide the official name of the beach.
4. Fill in the date when the original variance was granted in the space for 'Original Variance Granted on'.
5. Enter the expiration date of the original variance in the 'Expires on' section.
6. For 'Water Quality Over the Past Four Years', input the respective years, number of samples collected, average sample result, and highest sample result for each year.
7. Respond to the query regarding any changes to the beach or surrounding area that could impact water quality in the provided space.
8. Sign and date where indicated to affirm that a reduced testing frequency does not pose a greater public health risk.
9. Enter the name and department of the individual granting the extension.
10. Indicate the recommended sampling frequency in the appropriate section.
11. Document the date the variance extension was granted by the Board of Health and its expiration date.
12. If applicable, include the approval from the Massachusetts Department of Public Health in the designated area.
13. Review all entered information for accuracy before deciding to save, download, print, or share the completed form.

Take action today by completing your application online.