Wastewater Management Facility - Approval to Install

WASTEWATER MANAGEMENT FACILITY

APPROVAL TO INSTALL

Fees & Charges: As per the Protection of Enviornment Operations Act section of Council's Fees & Charges.

For further information or questions regarding this form, please contact Council via 9911 6555.

Applicant Details

Please note: Approval will be issued to the property owner.

Surname *

First Name *

Email *

Contact Number *

Address of Wastewater installation *

Postcode *

Is the Property address the same as the Applicant address? *

YesNo

Property Address *

Property Postcode *

Lot *

DP *

Consent of ALL Owners - Essential

Council will not accept or register the Application ift he consent of the Owner(s) has not been provided.

How many Owners are there? *

123+

Owner 1 Surname *

Owner 1 First Name *

Owner 1 Address *

Owner 1 Postcode *

Owner 2 Surname *

Owner 2 First Name *

Owner 2 Address *

Owner 2 Postcode *

For 3+ owners, please upload a document with the Consent of all Owners *

Browse

Include all owners full names, full addresses and signatures

Are you submitting on behalf of a company? *

YesNo

Company Seal *

ABN/ACN *

Installer/Plumber Details

Business Name *

Company Contact Surname *

Company Contact First Name *

Company Contact Number *

Licence No *

Company Email *

System Details - Number Bedrooms/Studies

Type/Name of Treatment Systems *

Proposed Site Plan

Please provide a Proposed Site Plan to scale, showing the location of:

The dwelling in relation to the block and the proposed effluent disposal area
The greywater treatment system proposed to be installed or constructed on the premises
Any related greywater disposal area
The location of any bore holes
Any related drainage line or pipe work (whether natural or constructed)
Connection for overflow into sewer
Connection for overflow into sewerMethod for manual switch of greywater when disposal area has become saturated

Please upload your Proposed Site Plan *

Browse

Specifications

Please upload full specifications, the Certificate of Accreditation and associated conditions of the greywater treatment system proposed *

Browse

Statement of Environmental Effects

This application must be accompanied by details of the climate, geology, hydrogeology, topography, soilcomposition and vegetation of any related effluent application areas together with an assessment on the site inthe light of those details.Note: This does not need to be geotechnical report.

Please upload your Statement of Environmental Effects *

Browse

Effluent Disposal Area

Please upload calculations which indicate an appropriately sized greywater disposal area *

Browse

Operation and Maintenance

Please upload the operation and maintenance requirements for the proposed greywater treatment system *

Browse

Please upload the proposed, maintenance and servicing agreements intended to meet those requirements *

Browse

Please disclose the action to be taken in the event of a breakdown in, or other inference with its operation *

Applicant Declaration

I have read and fully understand the Greywater Reuse Policy adopted by the City of Canada Bay. I have completedthe checklist provided above and comply with all of Council's requirements. All information provided on this form istrue and correct.

Owners Signature *

Draw signature|Type signatureClear

Date *

Owner 2 Signature *

Draw signature|Type signatureClear

Owner 3 Signature *

Draw signature|Type signatureClear