Fillable COVER SHEET (Alternative Features) Application Packet (Maricopa County Telecommunications)

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COVER SHEET (Alternative Features) Application Packet (Maricopa County Telecommunications)

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Revised October 2018 - Fillable
Maricopa County
Environmental Services
A312G
(Alternative Features)
Application Packet
ADDRESS:
Maricopa County Environmental Services Department 501 N. 44
th
St., Suite 200
Subdivision Infrastructure and Planning Program Phoenix, AZ 85008
COVER SHEET
Request for Approval of Alternative Feature of Technology,
Design, Setback, Installation, or Operation per
A.A.C. R18-9-A312(G) General Aquifer Protection Permits 4.01 through 4.23
Project Name:
(PLEASE PRINT CLEARLY)
Contact Person:
Title
E-mail address of contact person
Company Name:
Phone number: Ext: Fax Number:
City: State: Zip Code:
A312G Application Check-Off List
Brief explanation of need for this review. (Use Comment Section below)
A312G application (attached)
Supporting documentation and Fee (Fee is $75 per request)
Comment Section
The proposal must be sealed and signed by the engineer.
Any questions contact Cindy Furze at 602-506-1058 or CFurze@Maricopa.gov
*** The Department reserves the right to request any other information ***
Visit our web page at www.maricopa.gov/EnvSvc/WaterWaste/Subdivisions/Subdivisions.aspx
Revised October 2018 - Fillable
Application for A312G under
Arizona Administration Code
Title 18, Ch.9
G. Alternative design, installation, or operational features. When a person submits a Notice of
Intent to Discharge, the person may request that the Department review and approve a
feature of improved or alternative technology, design, setback, installation, or operation that
differs from a general permit requirement in this Article.
1. The person shall make the request for an alternative feature of technology, design,
installation, or operation on a form provided by the Department and include:
a. A description of the requested change;
b. A citation to the applicable design, installation, or operational requirement for which the
change is being requested; and
c. Justification for the requested change, including any necessary supporting
documentation.
2. The person shall submit the appropriate fee specified under 18 A.A.C. 14 for each
requested change. For calculating the fee, a requested change that is applied multiple
times in a similar manner throughout the facility is considered a single request if submitted
for concurrent review.
3. The person shall provide sufficient information for the Department to determine that the
change achieves equal or better performance compared with the general permit
requirement, or addresses site or system conditions more satisfactorily than the
requirements of this Article.
4. The Department shall review and may approve the request for change.
5. The Department shall deny the request for the change if the change adversely affects other
permittees or causes or contributes to a violation of an Aquifer Water Quality Standard.
6. The Department shall deny the request for the change if the change:
a. Fails to achieve equal or better performance compared to the general permit
requirement,
b. Fails to address site or system conditions more satisfactorily than the general permit
requirement,
c. Is insufficiently justified based on the information provided in the submittal,
d. Requires excessive review time, research, or specialized expertise by the Department to
act on the request, or
e. For any other justifiable cause.
Revised October 2018 - Fillable
Maricopa County
Environmental Services Department
Water and Waste Management Division
501 N
44
th
St., Suite 200
Phoenix, Arizona 85008
Phone: (602) 506-1058
www.maricopa.gov/envsvc
PERMIT APPLICATION PROCESS NOTICE
Subdivision Infrastructure and Planning Program
1) Steps required to obtain an Approval for Alternative Features (A312G) are as follows:
i) Submission of the complete application for Approval To Construct along with all relative items
in the application check list on the Cover/Transmittal Page of the application. When the review
is complete, an Approval To Construct certificate will be issued to allow construction of the
system to commence.
ii) Construction of the project.
2) T
he Department will approve or deny the application in the number of business days listed below or
less, excluding any days the application is returned to the applicant for additional information. This
overall licensing timeframe is set by the Arizona Department of Environmental Quality (ADEQ) as
required by A.R.S. §11-1605 and is part of the Delegation agreement between ADEQ and Maricop
a
c
ounty.
P
ermit
Overall Timeframe
(Business Days)
Alternative Features
Standard
95
3) Department contact information regarding your application
i) Telephone: 602-506-1058
ii) E-mail: subdivision@Maricopa.gov
iii) Website: www.maricopa.gov/EnvSvc/WaterWaste
4) You may request a clarification from the Department of its interpretation or application of a statute,
ordinance, regulation, delegation agreement or authorized substantive policy statement as provided
in A.R.S. §11-1609. Contact us by e-mail or telephone, or in person or mail at the address listed at
the top of the page, marked attention Subdivision Infrastructure & Planning Program.
Revised October 2018 - Fillable
Maricopa County Environmental Services Department
501 N. 44
th
St., Suite 200
Phoenix, AZ 85008
Division of Water and Waste Management
Subdivision Infrastructure & Planning
Phone (602) 506-1058
A312G
Request for Approval of Alternative Feature of Technology, Design, Setback, Installation, or Operation per
A.A.C. R18-9-A312(G) General Aquifer Protection Permits 4.01 through 4.23
PROJECT NAME:
Project Address
,
City
, AZ
Zip Code
Section
TWN
Range
Owner Information
Owner Name:
Mailing Address:
City: State: Zip Code:
Phone number: Ext: Fax Number:
Engineer Requesting Change
Engineer:
Must be Registered with the Arizona Board of Technical Registration Number
Phone Number
Ext
Fax Number
E-mail address
Name of Engineer's Firm as Registered With
The AZ Board of Technical Registration:
Mailing Address
City
State
Zip Code
1. Rule Citation of Requirement for which change is requested – enter the citation you are requesting:
2. Description of requested change (give clear explanation)
If not enough room, use additional page
:
3. Justification for requested change (give clear explanation)
If not enough room, use additional page
:
(Please attach any necessary calculations, drawings, or other supporting documentation)
Pursuant to A.R.S. § 41-1009, the Department may enter your establishment to conduct inspections. You have the right to receive a copy of the
Department’s inspection report at the time of the inspection, within thirty (30) days after the inspection, or as otherwise provided by federal law. By
initialing below, I agree that the Department may send me a copy of its inspection report by e-mail to the following email address:
or by facsimile transmission to the following fax number:
(Permit Owner/Holder initials)
**It is the responsibility of the permit holder to update the Department if there is a change in contact information. **
AGENCY USE ONLY
Request Denied Request Approved
Not equal or better performance
Equal or better performance
Does not address site/system conditions better
Site or system conditions addressed more satisfactorily
Excessive review/research time needed
Approved by:
Adverse impact to environmental/other permittees
Date Approved:
Request insufficiently justified
Other:
Denied by:
MCESD Number:
Date Denied:
Check Number:
Amount Paid:
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COVER SHEET (Alternative Features) Application Packet (Maricopa County Telecommunications)

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Completed 6 August 2020

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