Online Form - Application to Construct or Install an Apparatus for the Treatment of Sewage

Location of System

Lot Number

House Number

Street Name

Town or Suburb

Nearest Crossroad

Local Government (City / Town / Shire)

Plumber's Name

Plumber's Licence Number

Plumber's Contact Number

Owner / Applicant Details

Owner's Name

Applicant's Name

Applicant's Postal Address

Suburb

Postcode

Applicant's Phone Number

Premises Details

Please select the type of premises

Residential PremisesNon-Residential Premises

Residential Premises

PLEASE ONLY COMPLETE THIS SECTION OF THE FORM IF YOUR APPLICATION IS FOR A RESIDENTIAL PREMISES

Number of Bedrooms

Number of persons on premises

Number of other dwellings on the lot

Is this an ancillary accommodation?

YesNo

Is there a Spa(s) on the premises?

YesNo

Non-Residential Premises

PLEASE ONLY COMPLETE THIS SECTION OF THE FORM IF YOUR APPLICATION IS FOR A NON-RESIDENTIAL PREMISES

Please give details of the premises and the nature of its use

Number of persons on premises and/or any other volumes of liquid waste generated onsite

Expected Daily Wastewater Volume (Litres/Day)

Any notes you may wish to add

Treatment System Details

Please indicate the type of treatment system you are applying for

Standard Septic Tank to Leach Drains or Evaporation PondsAerobic Treatment Unit (Listed on DOH website's approved list)Wastewater Treatment Plants (includes Commercial ATUs)Greywater Reuse System
Alternative Wastewater Treatment Systems

Standard Septic Tanks to Leach Drains or Evaporation Ponds

PLEASE ONLY COMPLETE THIS SECTION OF THE FORM IF YOU ARE APPLYING FOR STANDARD SEPTIC TANKS TO LEACH DRAINS OR EVAPORATION PONDS

Septic Tank Sizes

Septic Tank Manufacturer

Leach Drain Lengths

Leach Drain Manufacturer

Is it an alternating system?

Yes
No

Aerobic Treatment Unit

PLEASE ONLY COMPLETE THIS SECTION OF THE FORM IF YOU ARE APPLYING FOR AN AEROBIC TREATMENT UNIT

IF LEACH DRAINS ARE USED FOR DISPOSAL, PLEASE COMPLETE THE POINTS ON LEACH DETAILS IN THE PREVIOUS SECTION ON "STANDARD SEPTIC TANKS TO LEACH DRAINS OR EVAPORATION PONDS"

Name and Model of Aerobic Treatment Unit

Disposal Area (metres square)

Please select the disposal method

Surface IrrigationSubsurface IrrigationSubstrata Irrigation

Please upload a copy of your maintenance agreement

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Wastewater Treatment Plants

PLEASE ONLY COMPLETE THIS SECTION OF THE FORM IF YOU ARE APPLYING FOR WASTEWATER TREATMENT PLANTS

Please attached technical details and plant specifications with this application. The following must be covered: capacity, volume of treatment tanks, buffer tank(s) volume(s), treatment train details, water quality objectives, maintenance, alarms, technical drawings of system

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Please indicate the disposal method

Surface IrrigationSubsurface IrrigationSubstrata Irrigation

Disposal Area (metres square)

Grey Water Reuse System

PLEASE ONLY COMPLETE THIS SECTION OF THE FORM IF YOU ARE APPLYING FOR A GREY WATER REUSE SYSTEM

IF LEACH DRAINS ARE USED FOR DISPOSAL, PLEASE COMPLETE THE POINTS ON LEACH DETAILS IN THE PREVIOUS SECTION ON "STANDARD SEPTIC TANKS TO LEACH DRAINS OR EVAPORATION PONDS"

Name and Model of Grey Water Reuse System

Please indicate the disposal method

Surface IrrigationSubsurface IrrigationSubstrata Irrigation

Disposal Area (metres square)

Alternative Wastewater Treatment Systems

PLEASE ONLY COMPLETE THIS SECTION OF THE FORM IF YOU ARE APPLYING FOR AN ALTERNATIVE WASTEWATER TREATMENT SYSTEM

Please attach the system's technical specifications from the manufacturer with application

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Information for Government Sewerage Policy Compliance Assessment

Lot Size (metres squared)

Are there any existing on-site effluent disposal systems on the lot?

YesNo

System and Site Layout Plans

Unless the following are provided according to the requirements specified, the application will be returned to the applicant for resubmission

Please upload a copy of plan and specifications of the proposed apparatus showing the top and longitudinal section to a scale of not less than 1:50

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Please submit a site plan of the premises to a scale not less than 1:100

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Declaration

I hereby apply as the owner, or the person authorised to act on behalf of the owner, for approval to construct or install the apparatus as referred to above. I have completed Section 1-6 of this application form and provided plans that meet the requirements detailed in Section 7.

Your Name