APPLICATION FOR SEPTIC TANK SYSTEM PERMIT TO INSTALL ...

PUBLIC HEALTH UNITAPPLICATION FOR SEPTIC TANKSYSTEM PERMIT TO INSTALL/ALTERI hereby apply for permission to installor alter a septic tank system and supplythe following information.OFFICE USE ONLYL 24200 1081FEE $………… DATE ……/……./…..RECEIPT NUMBER:……………………APPLICANTName: ……………………………………………………………………………………………………..Postal Address: ……………………………………………………………………………………………..Postcode: ……………………………….. Phone: ……………………………………………..ADDRESS OF PROPOSED/EXISTING SEPTIC SYSTEMStreet No.: ………………………..…………….. Lot No.: ……………………………………..Street: ………………………………………………. Suburb: ……………………………………..OWNER (where applicant is not the owner)Name: ……………………………………………………………………………………………………..Address: ……………………………………………………………………………………………………..Postcode: ……………………………………….. Phone: …………………………………………….BUILDERName: ……………………………………………………………………………………………………..Address: ……………………………………………………………………………………………………..Postcode: ………………………………………… Phone: ……………………………………………..DRAINAGE CONTRACTORName: ………………………………………..…………………………………………………………Address: ……………………………………………………………………………………………………..Postcode: …………………………………………. Phone: ……………………………………………..Drainer’s Licence Number: ……………………………………………………………………………………..PLUMBING CONTRACTORName: ………………………………………..…………………………………………………………….Address: ……………………………………………………………………………………………………..Postcode: …………………………………………. Phone: ……………………………………………..Plumber’s Licence Number: ……………………………………………………………………………………..1

SYSTEM SPECIFICATIONSCapacity of Septic TankPTO…………………………………………………………. LitresType of Treatment PlantType of Effluent DisposalType: ………………………………………………………….EPA Approval No.:……………………………………………q Irrigation Systemq Absorption Trenchesq Transpirationq Dome DrainAG DrainsLength: ……………………………………………. MetresWidth: ……………………………………………..MillimetresSand FilterDimensions: …………………………………………………IrrigationArea: ………………………………………………. Sq.metresType of Buildingq Houseq Officeq Shopq Factoryq Other: ……………………………….……………….NUMBER OF FIXTURES TO BE CONNECTEDBaths Basins Dish Washers Spa BathsToilets Sinks Food Waste DisposalUnitOtherShowersTroughsNOTE: FOOD WASTE DISPOSAL UNITS ARE NOT RECOMMENDED FOR SEPTIC SYSTEMS.2

SIZE OF BUILDINGNumber of BedroomsMaximum number of persons expected to use system daily.PLANS: Attach two copies of a layout plan of the proposed septic tank system (scale of1:200) showing the location and dimensions of all proposed or existing:-• Water, gas & electrical trenches • Buildings • Bores or wells for water supply• Septic tanks and sullage systems • Dams, ponds • Tennis courts• Water tanks & storm water drains • Driveways • Parking areas• Excavations and/or fill • Swimming pools • Rivers, creeks, gullies etc.• Septic tank system components (including disposal drains) and their locations in relation to the building/s connected.• Property boundaries and easements.Results of a Soil Test must be submitted with the Application and Plans. The soil test must be carried outby an approved consultant.MINIMUM INSPECTIONS REQUIREDEffluent Disposal Trenches:1. Site inspection (prior to any works commencing)2. When the trenches have been cut at the correct levels (Dumpy Level Test required)3. When the effluent drains have been laid but not covered4. When the system is ready for use. (Water Test required on inlet)Sand Filter Systems1. Site inspection (prior to any works commencing)2. When sand filter hole has been excavated, outlet pipe and inspection chamber installed.3. When sand and pipes have been laid prior to aggregate being placed.4. When the system is ready for use. (Water Test required on inlet)Sewerage Treatment Plants1. Site inspection (prior to any works commencing)2. When sewerage treatment plant installed and inlet laid (Water Test required on inlet)3. When the system is ready for use, including installation of warning light.IrrigationAs detailed on the Permit to Install.Septic Tank System MUST comply with the requirements of the Environment Protection Authority (EPA).All plumbing and drainage relating to the system MUST be installed in accordance with Australian Standards 3500, theNational Plumbing & Drainage Code and Victoria Water Supply & Sewerage Plumbing Regulations 1994.A copy of the Certificate of Compliance from the plumber or drainer is to be forwarded to Council within 5 days ofcompletion and approval of works.The system may not be used until an ‘APPROVAL TO USE CERTIFICATE’ has been issued.Signature of Applicant: ………………………………………………………………………..Date:…………………………………………………………………………………………….3