Application to Install /Alter a Domestic
Waste Water Treatment system
Environmental Protection Act 1970
Part IXB – Septic Tank System
To the Brimbank City Council , I / We the undersigned, hereby apply for permission to
install/ alter a Waste Water Treatment System by a registered Plumber and Drainer.
In order for the application to be assessed you will need to fill in all sections of this form and
submit 2 copies of the site plan.
Failure to complete the form may delay the process.
¡ Installation of a new Septic Tank ¡Alteration to an existing Septic Tank
¡ Existing permit number (if known)
APPLICANT – PERSON / COMPANY SUBMITTING APPLICATION / PLANS
¡ Project Manager
¡ Builder
¡ Drafts Person
¡ Plumber
¡ Company
Title* Given Name* Surname*
*If the proprietor is a company or association the company name will need to be filled in below
or
Company Name (If applicable)
Street Address *
Suburb/Town* State* Postcode*
Business Phone* After Hours Phone* Mobile Phone*
Email address*
PROPERTY DETAILS
Street Address *
Suburb/Town* State* Postcode*
Please list the total number of the following: (if you have 2 baths put 2 in the box next to baths).
Units/ Flats Bedrooms People
WC Baths Basins
Sinks Troughs Showers
Does the House / Flat / Unit / land have the following:
Food waste unit ¡ YES ¡ NO Dishwasher ¡ YES ¡ NO
Spa Bath ¡ YES ¡ NO Dam ¡ YES ¡ NO
Swimming Pool ¡ YES ¡ NO
(Please note: the installation of a spa >180L may require the installation of a larger or second tank).
Your plans must accurately identify the following: |
➢ Location of the house, shed(s), pools, driveway, drainage lines, underground power; ➢ Location of proposed wastewater system and irrigation area; ➢ Location of natural watercourses, dams, vegetation, trees.
|
Addition information that may assist with the application:
OWNER OF PROPERTY DETAILS
Title* Given Name* Surname*
*If the proprietor is a company or association the company name will need to be filled in below
Home Address *
Suburb/Town* State* Postcode*
Business Phone* After Hours Phone* Mobile*
Email address*
PLUMBER / DRAINER DETAILS
Title* Given Name* Surname*
*If the proprietor is a company or association the company name will need to be filled in below
or
Company Name (If applicable)
Street Address *
Suburb/Town* State* Postcode*
Business Phone* After Hours Phone* Mobile Phone*
Email address*
Licence Number*
SYSTEM DETAILS
Type Of System*
Description
Permit type: ¡ Installation ¡ Alteration
Allotment Size m²
Connected to Reticulated Supply Yes ¡ No ¡
Water Authority
Tank Capacity litres
Pump Capacity litres
Chamber Capacity litres
Effluent Disposal ¡ Irrigation ¡ Subsoil
Effluent Irrigation area m²
Average Effluent daily flow
Trans Beds length Trans Beds Lines Width Effluent Lines Depth
Trench Type Trench ORG Trench Backfill
Invert Outlet
GPS of Tank GPS of Abbs Field
Sub Terrain Disposal Area m²
Land Capability Assessment
EPA Approval number
Eg: Aqua Nova 2000.
PROPERTY ASSESSMENT
Please Note : Site inspections will be carried out in order to assess your application.
¡ Access To the property is not restricted
¡ Access to the property is restricted and an appointment will be required
¡ There are animals / dogs on the property
PLEASE NOTE
This application is for a permit to install only, please do not commence installation or alterations prior to the permit being issued.
It is an offence under the Environmental Protection Act 1970 to use a wastewater system proposed for installation prior to an inspection being carried out and a permit to use being issued.
The installation, operation and maintenance of the septic tank will occur in accordance with the permit conditions and the EPA approval conditions.
Owners are required to service their wastewater system serviced in accordance to the conditions to the EPA approval conditions.
You may be required to consult with other departments within Council and externally to ensure that you meet their requirements.
Have you contacted Council’s planning department about this application: Yes ¡ No ¡
Signature:
Date:
To contact Planning department please contact Brimbank City Council – (03) 9249 4000
FEES
New Application: $734.65 (GST inclusive)
Application to alter: $734.65 (GST inclusive)
In person
Present the completed and signed form to make payment (eftpos, cash, visa, master card, cheque or money order)
At one of our Customer Service Centres
301 Hampshire Road, Sunshine
(Brimbank Community & Civic Centre)
Watergardens Town Centre
Station Street, Taylors Lakes,
(Library Building)
By mail (cheque or money order only).
Send the completed and signed form with your cheque or money order payable to
‘Brimbank City Council
Mail to Brimbank City Council,
PO Box 70, Sunshine Vic 3020
Office Use Only
Debtor #:
DECLARATION
I understand and acknowledge that:
• The information provided in this application is true and complete to the best of my knowledge
• This application is a legal document and penalties exist for providing false or misleading information
• Please ensure that you have completed the form and have attached the requested information. Failure to do this may
All property owners are required to sign and print their name in the declaration.
Signature Signature
Print Name Print Name
Date Date
PRIVACY
PRIVACY STATEMENT: Personal information collected by Council is used for municipal purposes as specified in the Local Government Act 1989 or other relevant legislation. The personal information will be used solely by Council for these purposes and/or directly related purposes. Council may disclose this information to other organisations, if required by legislation. The applicant understands that the personal information provided is for the above purpose and that he/she may apply to Council for access to and/or amendment of the information. Requests for access and/or correction should be made to Council’s Privacy Officer.
CHECK LIST
To enable us to effectively assess your application to install or alter a septic tank
ensure that you have completed and attached the following:
Application completely filled in
Copy of Site Plan of Effluent Disposal
Certificate of Title
Floor Plan of House and Buildings Involved
Copy of the Land Capability Study
Payment
Contacted Brimbank City Council’s Planning department
Contacted Local Water Authority – City West Water