REQUEST FOR DEVIATION TO INSTALL

A REPLACEMENT ON-SITE SEWAGE DISPOSAL SYSTEM

Monroe County Health Department

Environmental Health Division

2353 South Custer Road, Monroe, Michigan 48161

Telephone (734) 240-7900

I (We) ______

ADDRESS (STREET AND NUMBER):______

TOWNSHIP:______PropertyI.D______

I (We) have submitted an application to construct a replacement onsite sewage disposal system to service an existing single or two-family residential dwelling located on the above-referenced parcel. An evaluation was conducted by a representative of the Environmental Health Division on ______for the purpose of designing a sewage disposal system in accordance with Chapter V of the Monroe County Sanitary Code. The evaluation has disclosed that a sewage disposal system cannot be installed, in accordance with that Code, due to the following condition(s) found on the parcel:

insufficient area is available to construct a sewage disposal system,

the parcel lacks sufficient isolation distances from property lines, surface waters, water supply systems or

the parcel is subject to flooding by inclusion within the 100-year floodway,

slopes are greater than 12%,

unsuitable soil conditions,

a seasonal high water table is present within 24 inches of the bottom of the bed,

I (We) have been advised by the health officer to construct:

I (We) are requesting the following deviation (s):

By copy of this request, I (We) are requesting a deviation to install a replacement sewage disposal system which does not meet the minimum construction standards set forth in Chapter V of the Monroe County Sanitary Code. I (We) have been advised by the Monroe County Health Department of the problems that may occur when a sewage disposal system is installed in any of the above-mentioned conditions. Should the variance be granted and the permit issued, I (We) agree to the following:

  1. The owner agrees that the sewage disposal system will be operated and maintained so as not to create a nuisance or health hazard.
  2. The owner understands and acknowledges that the County of Monroe and the Monroe County Health Department assumes no responsibility or liability in granting a deviation to construct an on-site sewage disposal system and, therefore, the owner agrees to hold harmless the County of Monroe as well as the Monroe County Health Department and its employees and agents from any and all liability, loss, and/or damages arising from the potential failure of said system.
  3. The owner agrees to advise all prospective buyers of this affidavit by including it as part of any sales agreement for the above-described property.
  4. If this system malfunctions the only alternative for sewage disposal may be a pump and haul method.
  5. I (We) are fully aware of the conditions on this parcel that are not conducive to the proper operation of a conventional on-site sewage disposal system.

The owner understands that failure to comply with the above may result in the condemnation of the dwelling as unfit for human habitation and legal action as provided for in the Monroe County Sanitary Code.

Signature of Owner______Date______

REQUEST REVIEWED BY: ______DATE:______

DENIED OR GRANTED: ______

G: Forms/Deviations/2011 Deviations/Deviation-Replacement Sewage New 8/11