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APPLICATION FOR SEPTIC TANK SYSTEM PERMIT TO INSTALLALTER I

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					                                                PUBLIC HEALTH UNIT

                                    APPLICATION FOR SEPTIC TANK
                                  SYSTEM PERMIT TO INSTALL/ALTER
                                                           OFFICE USE ONLY
                                                             L 24200 1081
 I hereby apply for permission to install
 or alter a septic tank system and supply             FEE $…………   DATE ……/……./…..
        the following information.
                                                      RECEIPT NUMBER:……………………

APPLICANT
Name:         ……………………………………………………………………………………………………..
Postal Address:      ……………………………………………………………………………………………..
Postcode:            ………………………………..        Phone: ……………………………………………..

ADDRESS OF PROPOSED/EXISTING SEPTIC SYSTEM
Street No.:   ………………………..……………..           Lot No.:      ……………………………………..
Street: ……………………………………………….                Suburb:       ……………………………………..

OWNER (where applicant is not the owner)
Name:         ……………………………………………………………………………………………………..
Address:      ……………………………………………………………………………………………………..
Postcode:     ………………………………………..            Phone: …………………………………………….

BUILDER
Name:         ……………………………………………………………………………………………………..
Address:      ……………………………………………………………………………………………………..
Postcode:     …………………………………………             Phone: ……………………………………………..

DRAINAGE CONTRACTOR
Name:         ………………………………………..…………………………………………………………
Address:      ……………………………………………………………………………………………………..
Postcode:     ………………………………………….            Phone: ……………………………………………..
Drainer’s Licence Number:   ……………………………………………………………………………………..

PLUMBING CONTRACTOR
Name:         ………………………………………..…………………………………………………………….
Address:      ……………………………………………………………………………………………………..
Postcode:     ………………………………………….            Phone: ……………………………………………..
Plumber’s Licence Number:   ……………………………………………………………………………………..
                                       1
                                                                                  PTO
SYSTEM SPECIFICATIONS

 Capacity of Septic Tank         …………………………………………………………. Litres


                                 Type: ………………………………………………………….
 Type of Treatment Plant
                                 EPA Approval No.:
                                 ……………………………………………

                                  q   Irrigation System
                                  q   Absorption Trenches
                                  q   Transpiration
 Type of Effluent Disposal
                                  q   Dome Drain


                                 Length: ……………………………………………. Metres
         AG Drains               Width: ……………………………………………..Millimetres


         Sand Filter             Dimensions: …………………………………………………


          Irrigation             Area: ………………………………………………. Sq.
                                 metres


     Type of Building             q   House
                                  q   Office
                                  q   Shop
                                  q   Factory
                                  q   Other: ……………………………….……………….



NUMBER OF FIXTURES TO BE CONNECTED

     Baths              Basins                  Dish Washers          Spa Baths


     Toilets            Sinks                   Food Waste Disposal   Other
                                                Unit


     Showers            Troughs



NOTE: FOOD WASTE DISPOSAL UNITS ARE NOT RECOMMENDED FOR SEPTIC SYSTEMS.
                                            2
SIZE OF BUILDING

                                 Number of Bedrooms


                                 Maximum number of persons expected to use system daily.


PLANS: Attach two copies of a layout plan of the proposed septic tank system (scale of
       1:200) 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 out
by an approved consultant.

MINIMUM INSPECTIONS REQUIRED
Effluent 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 covered
4. When the system is ready for use. (Water Test required on inlet)
Sand Filter Systems
1. 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 Plants
1. 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.
Irrigation
As 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, the
National 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 of
completion and approval of works.

           The system may not be used until an ‘APPROVAL TO USE CERTIFICATE’ has been issued.

Signature of Applicant: ………………………………………………………………………..

Date:
…………………………………………………………………………………………….

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Description: APPLICATION FOR SEPTIC TANK SYSTEM PERMIT TO INSTALLALTER I