Onsite Sewage Management Approval to Operate Renewal Form

File Number:
Property Details
Property Name:
Address:
Occupant Name:
Contact
Number:
Onsite Sewage Management
Approval to Operate Renewal Form
Section 68 Local Government Act 1993
Owner / Agent Details
Name:
Address:
Contact
Number:
Onsite Sewage Management System Details
Type of System
Aerated Wastewater
Treatment System (AWTS)
Septic System – Transpiration
Area
Other System Type
Details -
Septic System – Absorption
Trenches
Collection Well – Pump Out
Capacity of System:
Approximate Date of Installation:
Litres
Site and Usage Details
Property Size (approximate): m 2
Number of System Users (average):
Connection to Town Water: Yes No
Connected Wastewater
Sources:
Toilet/s
Shower / Bath
Dishwasher
Kitchen
Laundry (inc. Washing Machine)
Hand basin/s
persons
1

System Location Details
Dispersal Area: Lawn Garden
Proximity of Sensitive
Receptors:
Field
Other (Specify)
Landscaped Area
Creek / River: m Dam: m
Pool: m Bore: m
Boundary: m Nearest
Dwelling:
Other sensitive
receptors:
m
Specify:
Soil Type: Sand Loam
Clay
Alluvial
Other soil type
Gravel
Sandy Loam
Specify:
m
Flooding Potential of Dispersal Area Yes No
Aerated Wastewater Treatment System Details (Where Applicable)
Dispersal Area Warning Sign: Yes No
Frequency of
Maintenance:
Maintenance Contractor -
Name:
Address:
Contact Number:
Yearly Quarterly Monthly Never
Septic System / Collection Well (Pump Out) Details (Where Applicable)
Last Desludged / Pumped Out:
Physical Condition -
Tank: Good Fair Failing
Plumbing: Good Fair Failing
Dispersal Area: Good Fair Failing
(Date)
Office Use Only
Date Received
Determined Risk Level High Medium Low
2