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Maricopa County Approval Of Construction (AOC) Environmental Services (Maricopa County Telecommunications)

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REV
ISED AUGUST 2
01
9
DO NOT ALTER APPLICATION
Maricopa County
Environmental Services
Subdivision Infrastructure and Planning Program
Approval Of Construction (AOC)
Application Packet
501 N. 44
th
St., Suite 200
Phoenix, AZ 85008
C OVER P AGE
(
PLEASE PRINT CLEARLY
)
Project Name:
Contact Person:
Title
Email address of contact person
Company Name:
Phone Number:
Ext:
E-mail:
Address:
City:
State:
Zip Code:
On the AOC application ONLY, an Engineer can be the Project Owner.*
→
Application Check List for Approval of Construction
Cover Page for MCESD Projects (This page)
Approval of Construction application (Attached)
Full Size Set of Sealed and Signed Water/Sewer As-Built
Plans
(Sealed and signed by a Registered Land Surveyor or a Registered Engineer)
Full set must be available upon request in accordance with R18-4-507.2, R18-4-508 Record Drawings and Part E Type 4 General Permit R18-9-E301.E.
Test Results
OR
A Letter From The City Stating The Type Of Tests That Were Run And
That They Passed
• Potable water systems - test results including, but not limited to pressure and bacteriological test data.
• Sewage collection systems - test results including, but not limited to deflection, leakage and uniform slope test data.
• Reclaimed water distribution systems - test results including, but not limited to pressure test data.
• New Well Only - Unexpired New Source Approval
Operation and Maintenance Manual Verification for Private Sewer and/or Private Lift Station (Attached)
♦ Only for private sewer systems and/or private lift stations
--------------------------------------------------------------------------------------------------------------------------------------------------------
o The Approval of Construction (AOC) application will be signed by the MCESD Program Manager or
designee
and will become your AOC certificate.
o Only signing engineer will be e-mailed when issued unless otherwise noted.
An y q u e st i o n s c o n t a c t C i n d y Fu rze a t 6 0 2 - 5 0 6 - 1058 or at Cynthia.Fu rze@ma ri co p a .g o v
*** The Department reserves the right to request any other information ***
Visit our web page at esd.maricopa.gov
REV
ISED AUGUST 2
01
9
DO NOT ALTER APPLICATION
Maricopa County
Environmental Services
Subdivision Infrastructure and Planning Program
Approval Of Construction (AOC)
Application Packet
• Approval OF Constructions (AOCs) are applied for after the component is built and testing has been completed and
passed.
• MCESD issues AOCs only for MCESD issued Approvals To Construct (ATC).
• One (1) MCESD number per AOC application. Do not put multiple numbers on one application. ATCs are
issued with one MCESD number and AOCs are issued the same way.
• For the Engineer’s Certificate of Completion area on the application, the only items required are registered
engineer’s name, phone & e-mail and the wet seal and signature. Nothing else is to be added.
• The engineer sealing/signing must be comfortable with the information provided on the as-built plans.
• Please make sure that the application is completed legibly. MCESD signs the bottom of the application when
issued, which turns it into the issued certificate.
• ONLY Private Sewer Systems and Private Lift Stations need to have Operations and Maintenance Manuals.
Provide engineer verification of completed requirements on last page of AOC application.
AOC Application Instructions
PWS# - “Public Water Supply” number – last three digits needed. Needs to be the assigned number that is providing potable water, must be the
same on the ATC and the AOC.
MCESD# - located on the plans that were signed by MCESD and can be found on the Approval to Construct Certificate.
(One MCESD number per application)
Type of Component – write in the type of component the AOC application is for, water, sewer, etc.
DWR# - last six digits needed. FOR WELLS ONLY. Must have unexpired source approval before applying for AOC.
Project Name – as denoted on the Approval to Construct Certificate. Should be the same as on the plans.
Project Address – physical location of project.
Project Description – the description should be the same as the description on the Approval to Construct (ATC) Certificate, this will be different
for each component.
Project Owner – must be a person with fiduciary responsibilities associated with the Project.(Print Name) *
Job Title – examples: Owner, President or Vice President of Corporation/Home Owner Association, Manager.
Project Company Name – the name of Company who owns the Project.
Mailing Address, City, State, Zip Code – location of project owner.
Signature of Project Owner – No one other than named / listed project owner can sign the application unless there is a letter of authorization
attached.
Engineer’s Certificate of Completion – must be filled out, sealed and signed by a registered Engineer only, do NOT alter the application in any
way.
O & M Verification Page For Private Sewer Systems – Regarding Operations and Maintenance Manual verification. MUST be completed if
the AOC is for a private sewer and/or private lift station.
REV
ISED AUGUST 2
01
9
DO NOT ALTER APPLICATION
Environmental Services Department
501 N. 44
th
St., Suite 200
Phoenix, AZ 85008
Division of Water and Waste Management
Subdivision Infrastructure & Planning Program
Approval of Construction and/or
Verification of General Permit Conformance
**One (1) MCESD# and Component Per Application**
PLEASE PRINT CLEARLY
PWS#
04-07-
MCESD #
Type of Component
(WATER COMPONENTS ONLY)
(Specify water, gravity sewer, reuse, lift station, storage tank, etc.)
Wells Only: DWR#
55-
-
-
Must have unexpired source approval before applying for AOC
Project Name:
Project Address:
(Physical location of project)
Project Description:
Project Owner:
Job Title
Company Name
Mailing Address
City
State
Zip Code
Signature of Project Owner
Date
Engineer's Certificate of Completion
I,
, a Professional Engineer registered in the State of
Arizona; confirm that the project was completed in compliance with the plans and specifications approved by the Department,
except as noted on the "as-built" plans. Attached are applicable test results as required.
Seal & Signature
Engineer's Phone
Engineer's E-mail
Department Use Only
Approval of Construction and/or
Verification of General Permit Conformance
For the project as described above, the Project Owner is granted an Approval of Construction and/or Verification of General Permit Conformance
for operation and/or discharge under the terms of General Permit 4.01 in accordance with Title 18, Chapter 9, and Permit Article 2 (Wastewater);
And/Or Title 18, Chapters 4 and 5 and Chapters IV and V of The Maricopa County Environmental Health Code (Water).
By
Subdivision Infrastructure & Planning Program
Date
Page 1 of 1 (Note: Once MCESD Signs This Application, It Becomes THE AOC Certificate)
REV
ISED AUGUST 2019
DO NOT ALTER APPLICATION
Maricopa County
Environmental Services
Subdivision, Infrastructure & Planning Program
Approval Of Construction (AOC)
O & M Verification Page
For Private Sewer Systems
Per APP Rule R18-9-E301.E.3
1. Do
es an Operation and Maintenance (O&M) Manual exist for this private sewage system?
Yes No
If Yes, go to next question. If No, do not submit for AOC until there is a manual.
2. Does this Operation and Maintenance (O&M) Manual address the installed components?
Yes No
If Yes, proceed with rest of questions. If No, revise manual to address the installed components.
3. Provide the name and 24 hour emergency number of the owner or operator of the private sewage
collection system.
Owner Operator
Contact Person:
Phone Number:
4. Provide the address where the operation and maintenance manual is maintained.
Address:
City:
State:
Zip Code:
5. Will the manual be available for inspection at the above address by the Department on request?
Yes No If No, explain:
Signature of Engineer
Date
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Completed 6 August 2020

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