Form ENLS-651-035 "On-Site Wastewater Treatment Systems Designer Experience Verification" - Washington

What Is Form ENLS-651-035?

This is a legal form that was released by the Washington State Department of Licensing - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Washington State Department of Licensing;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ENLS-651-035 by clicking the link below or browse more documents and templates provided by the Washington State Department of Licensing.

ADVERTISEMENT
ADVERTISEMENT

Download Form ENLS-651-035 "On-Site Wastewater Treatment Systems Designer Experience Verification" - Washington

Download PDF

Fill PDF online

Rate (4.4 / 5) 16 votes
Page background image
Click here to START or CLEAR, then hit the TAB button
On-Site Wastewater Treatment
Systems Designer
Experience Verification
Experience is gained under the direct supervision of an on-site wastewater
treatment system designer or professional engineer.
Four years of broad based, progressive field and office experience in the
design of on-site wastewater treatment systems is required. The approval
of the experience is based on the verifications provided by you, the level of
independent judgments and decisions, and demonstration of the ability to
work within the regulatory structure.
For questions or language help call: 360-664-1575
Applicant: complete sections 1 and 2
Verifier: complete section 3
Applicant instructions
• Complete sections 1 and 2
• Send a copy (with section 1 and 2 done) to each of your verifiers
• Your verifiers should complete section 3 and send it back to you in a sealed envelope (don’t open).
Or they can email it to:
engineers@dol.wa.gov
• When you have all your forms back from your verifiers, mail the sealed envelopes to:
Board of Registration for Professional Engineers and Land Surveyors
Department of Licensing
PO Box 9025
Olympia WA 98507-9025
1. Work experience information
–Applicant complete this section
TYPE or PRINT Applicant name (First, Middle initial, Last)
Employed by
Dates of employment (From, To)
Average hours per week
Supervisor name and title
2. Work experience descriptions
–Applicant complete this section
When describing your experience, be specific about your contribution to wastewater treatment systems. Avoid terms
like “participated in,” “involved with,” or similar generalities. State your exact duties.
Describe your experience
A. Site soil assessment
B. Hydraulics
ENLS-651-035 (R/10/19)WA Page 1 of 3
Click here to START or CLEAR, then hit the TAB button
On-Site Wastewater Treatment
Systems Designer
Experience Verification
Experience is gained under the direct supervision of an on-site wastewater
treatment system designer or professional engineer.
Four years of broad based, progressive field and office experience in the
design of on-site wastewater treatment systems is required. The approval
of the experience is based on the verifications provided by you, the level of
independent judgments and decisions, and demonstration of the ability to
work within the regulatory structure.
For questions or language help call: 360-664-1575
Applicant: complete sections 1 and 2
Verifier: complete section 3
Applicant instructions
• Complete sections 1 and 2
• Send a copy (with section 1 and 2 done) to each of your verifiers
• Your verifiers should complete section 3 and send it back to you in a sealed envelope (don’t open).
Or they can email it to:
engineers@dol.wa.gov
• When you have all your forms back from your verifiers, mail the sealed envelopes to:
Board of Registration for Professional Engineers and Land Surveyors
Department of Licensing
PO Box 9025
Olympia WA 98507-9025
1. Work experience information
–Applicant complete this section
TYPE or PRINT Applicant name (First, Middle initial, Last)
Employed by
Dates of employment (From, To)
Average hours per week
Supervisor name and title
2. Work experience descriptions
–Applicant complete this section
When describing your experience, be specific about your contribution to wastewater treatment systems. Avoid terms
like “participated in,” “involved with,” or similar generalities. State your exact duties.
Describe your experience
A. Site soil assessment
B. Hydraulics
ENLS-651-035 (R/10/19)WA Page 1 of 3
Applicant name
2. Work experience descriptions
–continued
C. Topographic delineations
D. Use of specialized treatment processes and devices
E. Microbiology
F. Construction practices
G. Applying state and local health regulations
H. Field identification and evaluation of site conditions
I. Conducting related research
J. Interacting with clients and the public
K. Demonstrating an understanding and concern for environmental considerations and public health
ENLS-651-035 (R/10/19)WA Page 2 of 3
Applicant name
Verifier instructions
• Refer to applicant’s information in sections 1 and 2 to answer the questions below.
• When you are done:
• Put the form in an envelope
• Seal the envelope and sign across the flap
• Return the sealed envelope to the applicant
• Or you can scan and email it directly (not to the applicant) to:
engineers@dol.wa.gov
3. Work experience verification
–Supervisor/ Verifier complete this section
Name of person completing this verification
Verifier information (Choose all that apply)
Please choose from the following selections and provide the information requested.
Local health department official . . . . . . . . . . . . . . . . Affiliation with applicant
Your title
Name of health department/district
Professional engineer . . . . . . . . . . . . . . . . . . . . . . . Affiliation with applicant
License number
Expiration date
State licensed on-site system designer . . . . . . . . . Affiliation with applicant
License number
Expiration date
Answer the following
1. Do you feel qualified and prepared to verify the experience in categories A through K from the
attached Work Experience section? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If no, please explain:
2. Do you agree with the applicant’s employment time and hours worked? . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If no, please explain:
3. Do you agree with the applicant’s description of work, duties, and responsibilities? . . . . . . . . . . . . . . .
Yes
No
If no, please explain:
4. During this time of employment, how long has the applicant been in a position of making independent judgments and
decisions?
years/ months
5. Please check the work experience categories in which you believe the applicant is competent and prepared to be
examined for admission to the profession:
A. Site soil assessment
G. Applying state and local health regulations
B. Hydraulics
H. Field identification and evaluation of site conditions
C. Topographical delineations
I. Conducting related research
D. Use of specialized treatment processes and devices
J. Interacting with clients and the public
E. Microbiology
K. Demonstrating an understanding and concern for
F. Construction practices
environmental considerations and public health
6. Would you recommend this applicant for licensure if requirements are met? . . . . . . . . . . . . . . . . . . . . .
Yes
No
If you believe this applicant does not satisfy the requirements for licensure, please explain:
TYPE or PRINT Name
X
SEAL
When you have completed this form, please print it out and sign and date here.
Supervisor/ Verifier signature
Date
Please affix your stamp or seal in the space provided. If no seal or
stamp is available, attach a copy of your current license. If the stamp
or license cannot be provided, provide a detailed explanation.
ENLS-651-035 (R/10/19)WA Page 3 of 3
Page of 3