Application to Install Waste Control System

Transcription

1 Application to Install Waste Control System The Waste Control Regulations under the Public and Environmental Act have been framed to enable administration by Local Government of waste control systems covered by a prescribed code. The code requires interpretation and non-compliance with its provisions is deemed to be an offence for which the relevant authority may institute legal proceedings. It is therefore, strongly recommended that all applicants obtain a copy of the code during the planning stages of a waste control system. Applicants without prior experience in waste control systems are strongly advised to employ the services of a plumber or other professional to accept responsibility for the application. The following information is a guide only and is to be used in conjunction with the waste control systems standards, and the completion of the appropraite Application for a Waste Control System which is available from your local council. SITE LAYOUT PLAN Detailed site layout plan (in duplicate) drawn to a scale of 1:5000 showing. 1. Block dimensions and contours indicating natural ground fall. 2. Proposed location of buildings, sheds, swimming pool and driveways. 3. Position of the proposed waste control system including distances from boundaries, buildings. Location of any buildings on the boundary alignment. 4. Details of any site modifications eg benching, cutting and filling. 5. Details of location of surface and roof water disposal and any diversion tenches to collect any surface or migrating sub surface water. 6. Details of any well, bore, dam or any watercourse, (identified on the current 1:50,000 Department of Environment & Natural Resources topographical map), used or likely to be used for human/domestic purposes; any water source used for agricultural, aquacultural, or stock purposes. 7. Type and capacity of proposed septic tank. 8. Method of effluent disposal, full details of system including length, width and depth. Depth from surface level to the top of the effluent disposal system. 9. Position of boreholes used in soil reports. 10. Where the tank is to be connected to an effluent disposal scheme, line of drain and connection point.

2 BUILDING LAYOUT PLAN Detailed building plan (in duplicate) drawn to a scale of 1:100 showing 1. Position and description of all sanitary fixtures to be connected to the waste control system. 2. Method of connection of fixtures to drainage system, including location of sewer drain, inspection openings, junctions, bends, size and grade of sewer drain, position and size of traps, vents and waste pipes. 3. Intended use of building, use of rooms within building and if non residential maximum number of persons using system. GEOTECHNICAL CRITERIA Evidence of site capability in nominated effluent disposal area. 1. General site assessment and examination of soil characteristics. (Determination of soil permeability by either direct (5 borelogs) or indirect (2 borelogs) method *bore holes to be located in the effluent disposal area *) 2. A statement is to be provided by the geotechnical engineer as to the horizon best suited for long term percolation of septic tank effluent, including the estimated rate of percolation, eg minimum of 15mm per hour. GENERAL INFORMATION All septic tank access shafts are to terminate 50mm above natural ground level. Access shafts shall be effectively sealed to prevent the ingress or egress of water or gas. All septic tanks and components are to be approved by the South Australian Health Commission. Evidence of this may be required. Copies of typical plans of septic tank design, building lay-out and site lay-out as per examples. Figure 1: Typical Site Layout Plan

3 Figure 2: Building Layout Plan For further information contact Environmental Health Section Telephone

4 FOR OFFICE USE ONLY City of Onkaparinga APPLICATION TO INSTALL AN AEROBIC SAND FILTER SYSTEM To obtain the necessary information to complete this application form, you will need to refer to the SA Health Commission Code, WASTE CONTROL SYSTEMS - STANDARD FOR THE CONSTRUCTION, INSTALLATION AND OPERATION OF SEPTIC TANK SYSTEMS IN SOUTH AUSTRALIA AND SUPPLEMENT A. The STANDARD and SUPPLEMENTS can be purchased from the SA Health Commission Public & Environmental Health Service Office or from the City of Onkaparinga. Failure to provide the correct information, which must include a detailed assessment of the land capability of the site (ie: suitability for disposal of reclaimed water), will result in approval delays. A fee & two copies of the detailed building plan and site plan (refer Chapter 3 of the STANDARD and Section 11 of SUPPLEMENT A) must accompany the application for each septic tank. Cheques to be made payable to the "City of Onkaparinga. PLEASE PRINT CLEARLY 1. LOCATION OF INSTALLATION Refer to Chapter 3 of the STANDARD and Section 11 of SUPPLEMENT A for further information Street Township or Region Street No Lot Number Section/Pt Sect Hd of Where the installation is not located in a defined township, please provide a location plan with clear directions. 2. OWNER / APPLICANT DETAILS Refer to Chapter 3 of the STANDARD and Section 11 of SUPPLEMENT A for further information Owner Name: Owner Address: Township or Region: P/C Ph: Where the person completing this application is NOT the owner, please provide applicant details: Please insert As Above if the applicant is the property owner. Applicant Name: Applicant Address: Township or Region: P/C Ph: Tick as appropriate Builder Plumber Other (please specify)

5 3. PREMISES AND SYSTEM DETAILS Refer to Chapters 3, 5, 6 and 7 of the STANDARD and SUPPLEMENT A for further information 3.1 PREMISES DESCRIPTION (ie: house / flats / units, offices etc) Number of Persons: For Units / Flats etc (eg: 3 units with 2 bedrooms, 1 unit with 3 bedrooms = 9 bedrooms and 18 persons) Number of Units / Flats No of bedrooms & persons per Unit / Flat 3.2 INFORMATION REQUIRED TO CALCULATE DISPOSAL SYSTEM REQUIREMENTS Refer to Chapter 7 of the STANDARD Water supply to premises Reticulated mains water (including any supply from dam or river) Roof catchment or storage or carted supply Occupation conditions Full-time occupation Intermittent occupation (No reduction in system size permitted for intermittent use) 3.3 NON-RESIDENTIAL PREMISES Refer to Chapter 11, Table 1 of the STANDARD and SUPPLEMENT A to determine requirements for variable use conditions If additional information is required to assist in approval, please attach details on a separate sheet eg: anticipated frequency of use for hotel / motel. For constant use state TOTAL NUMBER using the system: For variable use state TOTAL NUMBER using the system EACH DAY over a 7 day period (highest number over 12 months) and indicate below the number for each day. Sun Mon Tues Wed Thur Fri Sat 4. NON-STANDARD FIXTURES TO BE INSTALLED Refer to Chapter 5 of the STANDARD and SUPPLEMENT A for further information (Tick as appropriate) Food waste disposal unit Spa bath capacity (litres) Other (please provide details) The Council may require additional information such as hydraulic flows for other non standard fixtures. 5. SEPTIC TANK TO BE INSTALLED Refer to Chapter 5 and 6 of the STANDARD and SUPPLEMENT A for further information. Type: All waste Sewage Only (separate application is required for sullage waste water treatment system) Type of Construction: Precast Cast in situ Concrete Fibreglass Concrete Brick Effective capacity of the septic tank (litres):

6 5. SEPTIC TANK TO BE INSTALLED (cont) PUMP SUMP AND PUMP Where a pump sump and pump is required to lift the effluent from the septic tank to the aerobic sand filter system, please attach full details as outlined in Chapter 7 of the STANDARD. 6. LAND CAPABILITY ASSESSMENT Refer to Chapter 7 of the STANDARD and SUPPLEMENT A for further information 6.1 SITE DETAILS Land Slope (% gradient or ratio) Flooding Frequency (eg once in 7 years) Depth to permanent / seasonal or tidal water table (mm) Depth to bedrock (mm) 6.2 SOIL CLASSIFICATION Attach details of soil assessment, providing a description of the soil to a depth of one (1) metre. The test holes shall be identified and their location shown on the site plan. Please provide certification from a geo-technical engineer that the installation and operation of the surface irrigation disposal system will not have any impact on the structural integrity of the building(s) on the site or adjoining sites. 6.3 PROXIMITY TO A WATER SOURCE Is the proposed effluent disposal system to be installed in any of the following locations? (tick as appropriate) Within 50m of a well, bore, dam, or water course used for human/domestic purposes? Yes No Above shallow underground water supplies used for human/domestic purposes? Yes No Within 50m of a water source used for agricultural, aqua-cultural or stock purposes? Yes No Within 50m of a water course as identified on a 1: DENR * topographic map and used or likely to be used for human or domestic purposes? Yes No Within 100m of the mean high water mark along coastal foreshore area? Yes No In an area likely to be subject to flooding or inundation in a 1:10 year return event? Yes No Within 100m of the pool level of the River Murray and Lakes? Yes No Within the 1956 River Murray and Lakes flood zone? Yes No If YES to any one of the above please provide full details including location depth and measurements with the application * DENR Department of Environment and Natural Resources 7. AEROBIC SAND FILTER SYSTEM Refer to Chapter 7 of the STANDARD and SUPPLEMENT A for further information. Manufacturer of the System: Model No: SYSTEM RATING Organic load (grams BOD 5 /day) Hydraulic Load (litres/day) Top surface area m ² CALCULATIONS FOR PROPOSED SYSTEM Organic load (grams BOD 5 /day) Hydraulic Load (litres/day) Top surface area m ² Number of Persons

7 7. AEROBIC SAND FILTER SYSTEM (cont) CONTAINMENT PUMP SUMP AND PUMP Where a separate containment pump sump and pump is required, provide full details on materials and method of construction, capacity and detention times, access openings and covers, pump, electrical and alarm systems. DISINFECTION Type, form and method of dosing: NOTE: A licence may be required from the Environment Protection Authority in situations where the treatment and disposal system is situated in a Water Protection Zone and the system size is greater than 100 persons. Licence No: 8. SURFACE IRRIGATION DISPOSAL AREA Refer to SUPPLEMENT A for further information Area for disposal of reclaimed water (m 2 ) TYPE OF IRRIGATION APPLICATORS Sprays Micro Sprays Drippers Bubblers Others (provide details) Please provide details of landform modification: 9. ALARM SYSTEM Refer SUPPLEMENT A for further information An alarm system must be installed as part of the aerobic waste water treatment system to indicate electrical or mechanical component malfunction or failure, including those components associated with separate containment sumps and pumps. Type and location of audible and visual alarm: 10. DECLARATION OF PROPERTY OWNER & APPLICANT PLEASE NOTE: Where the applicant is NOT the property owner, then BOTH the property owner's and the applicant s signatures are required, otherwise approval will be delayed. The property owner should ensure that the form is completed BEFORE signing. I / WE hereby declare that the information provided in this application attachments and accompanying plans is true and correct. I / WE hereby undertake to have the system serviced by trained operators to ensure that the system will be maintained in accordance with the requirements of SUPPLEMENT A and/or specific approval conditions. Property Owner s Signature: Applicant s Signature: Date: Date: Plumber s Details: Registration No: Penalties apply for the provision of false or misleading information

8 City of Onkaparinga OFFICE USE ONLY APPLICATION TO INSTALL A SEPTIC TANK SYSTEM To obtain the necessary information to complete this application form, you will need to refer to the SA Health Commission Code, WASTE CONTROL SYSTEMS STANDARD FOR THE CONSTRUCTION, INSTALLATION AND OPERATION OF SEPTIC TANK SYSTEMS IN SOUTH AUSTRALIA. If you intend to use an aerobic sand filter or aerobic waster treatment system as an alternative method for treating and disposing for septic tank effluent, you will also need to refer to SUPPLEMENTS A or B and obtain the relevant application form(s). The STANDARD and SUPPLEMENTS can be purchased from the SA Health Commission, Public & Environmental Health Service Officer or from the City of Onkaparinga. Failure to provide the correct information, which must include a detailed assessment of the land capability of the site (ie: suitability of the site for treatment / disposal of septic tank effluent) will result in approval delays A fee & two copies of the detailed building plan & site plan (refer to the GUIDELINE) must accompany the application for each connection to the STEDS. Note: If the installation is in an area serviced by a SEPTIC TANK EFFLUENT DISPOSAL SCHEME (STEDS) a $600 connection fee is payable prior to approval being granted. Cheques to be made payable to the "City of Onkaparinga. PLEASE PRINT CLEARLY 1. LOCATION OF INSTALLATION Refer to Chapter 3 of the STANDARD for further information Street Township or Region Street No Lot Number Section/Pt Sect Hd of Where the installation is not located in a defined township, please provide a location plan with clear directions. 2. OWNER / APPLICANT DETAILS Refer to Chapter 3 of the STANDARD for further information Owner Name: Owner Address: Township or Region: P/C Ph: Where the person completing this application is NOT the owner, please provide applicant details: Please insert As Above if applicant is the owner of the property. Applicant Name: Applicant Address: Township or Region: P/C Ph: Tick as appropriate Builder Plumber Other (please specify)

9 3. PREMISES AND SYSTEM DETAILS Refer to Chapters 3, 5, 6 and 7 of the STANDARD for further information 3.1 PREMISES DESCRIPTION (ie: house / flats / units, offices etc) Number of Persons: For Units / Flats etc (eg: 3 units with 2 bedrooms, 1 unit with 3 bedrooms = 9 bedrooms and 18 persons) Number of Units / Flats No of bedrooms & persons per Unit / Flat 3.2 INFORMATION REQUIRED TO CALCULATE DISPOSAL SYSTEM REQUIREMENTS Refer to Chapter 7 of the STANDARD Water supply to premises Reticulated mains water (including any supply from dam or river) Roof catchment or storage or carted supply Occupation conditions Full-time occupation Intermittent occupation (No reduction in system size permitted for intermittent use) 3.3 NON-RESIDENTIAL PREMISES Refer to Chapter 11, Table 1 of the STANDARD and SUPPLEMENT A to determine requirements for variable use conditions If additional information is required to assist in approval, please attach details on a separate sheet eg: anticipated frequency of use for hotel / motel. For constant use state TOTAL NUMBER using the system: For variable use state TOTAL NUMBER using the system EACH DAY over a 7 day period (highest number over 12 months) and indicate below the number for each day. Sun Mon Tues Wed Thur Fri Sat 4. NON-STANDARD FIXTURES TO BE INSTALLED Refer to Chapter 5 of the STANDARD for further information (Tick as appropriate) Food waste disposal unit Spa bath capacity (litres) Other (please provide details) The Council may require additional information such as hydraulic flows for other non standard fixtures. 5. SEPTIC TANK TO BE INSTALLED Type: All waste Sewage Only Type of Construction: Precast Cast in situ Concrete Fibreglass Concrete Brick Effective capacity of the septic tank (litres):

10 6. LAND CAPABILITY ASSESSMENT Refer to Chapter 7 of the STANDARD for further information 6.1 SITE DETAILS Land Slope (% gradient or ratio) Flooding Frequency (eg once in 7 years) Depth to permanent / seasonal water table (mm) Depth to bedrock (mm) 6.2 SOIL CLASSIFICATION Attach details of soil classification assessment, providing a description of the soil at each horizon taken to a depth of (3) three metres, or 500mm beyond the intended level of the base of the sub surface soakage system whichever is the greater. The description should include an indication of the likely permeability of each soil horizon. At least one test hole should be taken within the area of the proposed soakage system. The test holes shall be identified and their location indicated on the site plan. 6.3 SOIL PERMEABILITY (Percolation) Where the soil assessment indicates a soil type such as clay or where it is known that the soil type is unlikely to be suitable for long term effluent disposal recognised percolation tests (eg: Static or Falling Head Tests using 100mm diameter bore holes) should be carried out in the area where the disposal system is to be located. The test holes shall be identified and their location indicated on the site plan. Attach results of percolation tests carried out using a recognised test method, or show results below: Test Method Static Head Test Falling Head Test Duration of pre-soaking (hours) Depth of water used to conduct test (mm) Diameter of test hole (mm) Test Hole No Depth test taken (mm) Results (mm/hr) 6.4 CALCULATION OF REQUIRED CONTACT AREA FOR SUB SURFACE DISPOSAL Refer to Chapter 7 of the STANDARD for information on calculating required contact area Effluent percolation rate as calculated by you (in litres/m 2 /day) Required contact area for sub-surface disposal as calculated by you (m 2 ) 6.5 PROXIMITY TO A WATER SOURCE Is the proposed effluent disposal system to be located? (tick appropriate) Within 50m of a well, bore, dam, or water course used for human/domestic purposes? Yes No Above shallow underground water supplies used for human/domestic purposes? Yes No Within 50m of a water source used for agricultural, aqua-cultural or stock purposes? Yes No Within 50m of a water course as identified on a 1: DENR * topographic map and used or likely to be used for human or domestic purposes? Yes No Within 100m of the mean high water mark along coastal foreshore area? Yes No In an area likely to be subject to flooding or inundation in a 1:10 year return event? Yes No If YES to any one of the above please provide full details (including location depth and measurements) on your plans. * DENR Department of Environment and Natural Resources

11 7. DISPOSAL METHODS Refer to Chapter 7 of the STANDARD for further information 7.1 SOAKAGE TRENCH using Plastic tunnel Perforated pipe Length (m): Width (mm): Depth*(mm): *Depth of trench used to calculate the contact area. Depth below natural ground surface to top of trench (mm): 7.2 SOAKAGE WELL (Note a permit may be required from SA Water if depth exceeds 2.5m) Depth below inlet (mm): Diameter of excavation (mm): Number of wells: Contact area provided by each well (m 2 ): Where an SA Water Permit is required, please state Permit Number: 7.3 SOAKAGE BED Length (m): Width (mm): Depth*(mm): *Depth of bed used to calculate the contact area. Depth below natural ground surface to top of bed (mm): 7.4 OFF-SITE DISPOSAL (tick as appropriate) Temporary On-site containment for tanker removal from site If temporary on-site containment, state capacity of storage sump (litres) 7.5 PUMPING SUMP & PUMP Where a pump is required to lift the effluent from the septic tank to the disposal system, please provide details: Capacity of pump sump: Type of pump: Type and Location of the Alarm: 8. DECLARATION OF OWNER & APPLICANT PLEASE NOTE: Where the applicant is NOT the owner of the property, then BOTH the owner's and the applicant s signatures are required, otherwise approval will be delayed. The owner should ensure that the form is completed BEFORE signing. I / we hereby declare that the information provided in this application attachments and accompanying plans is true and correct. Property Owner s Signature: Date: Applicant s Signature: Date: Plumber s Details: Registration No: Penalties apply for the provision of false or misleading information

12 City of Onkaparinga OFFICE USE ONLY APPLICATION TO CONNECT TO A S.T.E.D. SCHEME To obtain the necessary information to complete this application form, you will need to refer to the SA Health Commission Code, GUIDELINES FOR THE CONNECTION OF A WASTE CONTROL SYSTEM TO A SEPTIC TANK EFFLUENT DISPOSAL SCHEME (STEDS) ( The Guidelines ) AND WASTE CONTROL SYSTEMS STANDARD FOR THE CONSTRUCTION, INSTALLATION AND OPERATION OF SEPTIC TANK SYSTEMS IN SOUTH AUSTRALIA ( The Standard ) The GUIDELINE and the STANDARD and SUPPLEMENTS can be purchased from any Council office or SA Health Commission Public & Environmental Service Office. Failure to provide the correct information will result in approval delays A SEPTIC TANK EFFLUENT DISPOSAL SCHEME (STEDS) CONNECTION FEE of $600 applies in addition to the application and is payable prior to approval being granted. The fees & two copies of the detailed building plan & site plan (refer to the GUIDELINE) must accompany the application for each connection to the STEDS. Please contact the relevant authority for details regarding the fee and method of payment. The relevant authority is: the local council for the area where the system is to be installed; or the South Australian Health Commission for areas of the State not under local government control Cheques to be made payable to the "City of Onkaparinga. PLEASE PRINT CLEARLY 1. LOCATION OF INSTALLATION Refer to the GUIDELINE for further information Street Township or Region Street No Lot Number Section/Pt Sect Hd of Where the installation is not located in a defined township, please provide a location plan with clear directions. 2. OWNER / APPLICANT DETAILS Refer to the GUIDELINE for further information Owner Name: Owner Address: Township or Region: P/C Ph: Where the person completing this application is NOT the owner, please provide applicant details: Please insert As Above if applicant is the owner of the property. Applicant Name: Applicant Address: Township or Region: P/C Ph: Tick as appropriate Builder Plumber Other (please specify)

13 3. PREMISES AND SYSTEM DETAILS Refer to the GUIDELINE and Chapters 5, 6 and 7 of the STANDARD for further information 3.1 PREMISES DESCRIPTION (ie: house / flats / units, offices etc) Number of Persons: For Units / Flats etc (eg: 3 units with 2 bedrooms, 1 unit with 3 bedrooms = 9 bedrooms and 18 persons) Number of Units / Flats No of bedrooms & persons per Unit / Flat 3.2 INFORMATION REQUIRED TO CALCULATE TREATMENT SYSTEM REQUIREMENTS Refer to the GUIDELINE and Chapter 7 of the STANDARD Water supply to premises Reticulated mains water (including any supply from dam or river) Roof catchment or storage or carted supply Occupation conditions Full-time occupation Intermittent occupation (No reduction in system size permitted for intermittent use) 3.3 NON-RESIDENTIAL PREMISES Refer to the GUIDELINE and Chapter 11, Table 1 of the STANDARD to determine requirements for variable use conditions If additional information is required to assist in approval, please attach details on a separate sheet eg: anticipated frequency of use for hotel / motel. For constant use state TOTAL NUMBER using the system: For variable use state TOTAL NUMBER using the system EACH DAY over a 7 day period (highest number over 12 months) and indicate below the number for each day. Sun Mon Tues Wed Thur Fri Sat 4. NON-STANDARD FIXTURES TO BE INSTALLED Refer to Chapter 5 of the STANDARD for further information (Tick as appropriate) Food waste disposal unit Spa bath capacity (litres) Other (please provide details) The Council may require additional information such as hydraulic flows for other non-standard fixtures. 5. SEPTIC TANK TO BE INSTALLED Refer to the GUIDELINE and Chapters 5 and 6 of the STANDARD for further information (Tick as appropriate) Type: All waste Sewage Only Type of Construction: Precast Cast in situ Concrete Fibreglass Concrete Brick Effective capacity of the septic tank (litres):

14 6. SULLAGE TANK TO BE INSTALLED Refer to the GUIDELINE and Chapters 5 and 6 of the STANDARD for further information Type of Construction: Precast Cast in situ Concrete Plastic or similar Concrete Brick Effective capacity of the sullage tank (litres): 7. HYDRAULIC & ORGANIC LOADING OF SULLAGE WASTES Refer to the GUIDELINE AND Chapters 5 and 6 of the STANDARD for further information 7.1 CALCULATION FOR PROPOSED SULLAGE SYSTEM Organic load (in grams BOD5 / day/ person Hydraulic load (in litres / day / person Number of persons 7.2 ITEM CONFIGURATION Tick as appropriate One tank system: Two tank system: Other (attach details): 8. PUMP SUMP AND PUMP Refer to the GUIDELINE AND Chapter 7 of the STANDARD for further information If a pump sump and pump is required to lift the effluent and/or sullage waste water to the STEDS connection, please attach details as outlined in Chapter 7 of the STANDARD and include details of detention times, access openings and covers, electrical and alarm systems. Pump sump materials and type of construction Capacity of pump sump (litres) Type of pump Type and location of alarm 9. DECLARATION AND SIGNATURE OF OWNER AND APPLICANT Refer to the GUIDELINE and the STANDARD for further information PLEASE NOTE: Where the applicant is NOT the owner, then BOTH the owner s signature and the applicant s signature are required, otherwise approval will be delayed. The owner should ensure that the form is completed BEFORE signing. I/ we hereby declare that the information provided in this application, attachments and accompanying plans is true and correct. Property Owner s Signature: Applicant s Signature: Plumber s Details: Date: Date: Registration No:

15 FOR OFFICE USE ONLY City of Onkaparinga APPLICATION TO INSTALL AN AEROBIC WASTE WATER TREATMENT SYSTEM To obtain the necessary information to complete this application form, you will need to refer to the SA Health Commission Code, WASTE CONTROL SYSTEMS - STANDARD FOR THE CONSTRUCTION, INSTALLATION AND OPERATION OF SEPTIC TANK SYSTEMS IN SOUTH AUSTRALIA AND SUPPLEMENT B. The STANDARD and SUPPLEMENTS can be purchased from the SA Health Commission Public & Environmental Health Service Office or from the City of Onkaparinga. Failure to provide the correct information, which must include a detailed assessment of the land capability of the site (ie: suitability for disposal of reclaimed water), will result in approval delays. A fee & two copies of the detailed building plan & site plan (refer to Chapter 3 of the STANDARD and Section 8 of SUPPLEMENT B) must accompany the application for each septic tank. Cheques to be made payable to the "City of Onkaparinga. PLEASE PRINT CLEARLY 1. LOCATION OF INSTALLATION Refer to Chapter 3 of the STANDARD for further information Street Township or Region Street No Lot Number Section/Pt Sect Hd of Where the installation is not located in a defined township, please provide a location plan with clear directions. 2. OWNER / APPLICANT DETAILS Refer to Chapter 3 of the STANDARD for further information Owner Name: Owner Address: Township or Region: P/C Ph: Where the person completing this application is NOT the owner, please provide applicant details: Please insert As Above if the applicant is the property owner. Applicant Name: Applicant Address: Township or Region: P/C Ph: Tick as appropriate Builder Plumber Other (please specify)

16 3. PREMISES AND SYSTEM DETAILS Refer to Chapters 3, 5, 6 and 7 of the STANDARD and SUPPLEMENT B for further information 3.1 PREMISES DESCRIPTION (ie: house / flats / units, offices etc) Number of Persons: For Units / Flats etc (eg: 3 units with 2 bedrooms, 1 unit with 3 bedrooms = 9 bedrooms and 18 persons) Number of Units / Flats No of bedrooms & persons per Unit / Flat 3.2 INFORMATION REQUIRED TO CALCULATE DISPOSAL SYSTEM REQUIREMENTS Refer to Chapter 7 of the STANDARD Water supply to premises Reticulated mains water (including any supply from dam or river) Roof catchment or storage or carted supply Occupation conditions Full-time occupation Intermittent occupation (No reduction in system size permitted for intermittent use) 3.3 NON-RESIDENTIAL PREMISES Refer to Chapter 11, Table 1 of the STANDARD and SUPPLEMENT B to determine requirements for variable use conditions If additional information is required to assist in approval, please attach details on a separate sheet eg: anticipated frequency of use for hotel / motel. For constant use state TOTAL NUMBER using the system: For variable use state TOTAL NUMBER using the system EACH DAY over a 7 day period (highest number over 12 months) and indicate below the number for each day. Sun Mon Tues Wed Thur Fri Sat 4. NON-STANDARD FIXTURES TO BE INSTALLED Refer to Chapter 5 of the STANDARD and SUPPLEMENT B for further information (Tick as appropriate) Food waste disposal unit Spa bath capacity (litres) Other (please provide details) The Council may require additional information such as hydraulic flows for other non standard fixtures. 5. SEPTIC TANK TO BE INSTALLED Refer to Chapter 5 and 6 of the STANDARD and SUPPLEMENT B for further information. Type: All waste Sewage Only (separate application is required for sullage waste water treatment system) Integral within aerobic waste water treatment unit or separate Type of Construction: Precast Cast in situ Concrete Fibreglass Concrete Brick Effective capacity of the septic tank (litres):

17 5. SEPTIC TANK TO BE INSTALLED (cont) PUMP SUMP AND PUMP Where a pump sump and pump is required to lift the effluent from the septic tank to the aerobic waste water treatment unit, please attach full details as outlined in Chapter 7 of the STANDARD. 6. LAND CAPABILITY ASSESSMENT Refer to Chapter 7 of the STANDARD and SUPPLEMENT B for further information 6.1 SITE DETAILS Land Slope (% gradient or ratio) Flooding Frequency (eg once in 7 years) Depth to permanent / seasonal or tidal water table (mm) Depth to bedrock (mm) 6.2 SOIL CLASSIFICATION Attach details of soil assessment, providing a description of the soil to a depth of one (1) metre. The test holes shall be identified and their location shown on the site plan. Please provide certification from a geo-technical engineer that the installation and operation of the surface irrigation disposal system will not have any impact on the structural integrity of the building(s) on the site or adjoining sites. 6.3 PROXIMITY TO A WATER SOURCE Is the proposed effluent disposal system to be installed in any of the following locations? (tick as appropriate) Within 50m of a well, bore, dam, or water course used for human/domestic purposes? Yes No Above shallow underground water supplies used for human/domestic purposes? Yes No Within 50m of a water source used for agricultural, aqua-cultural or stock purposes? Yes No Within 50m of a water course as identified on a 1: DENR * topographic map and used or likely to be used for human or domestic purposes? Yes No Within 100m of the mean high water mark along coastal foreshore area? Yes No In an area likely to be subject to flooding or inundation in a 1:10 year return event? Yes No Within 100m of the pool level of the River Murray and Lakes? Yes No Within the 1956 River Murray and Lakes flood zone? Yes No If YES to any one of the above please provide full details including location depth and measurements with the application * DENR Department of Environment and Natural Resources 7. AEROBIC WASTE WATER TREATMENT SYSTEM Refer to Chapter 7 of the STANDARD and SUPPLEMENT B for further information. Manufacturer of the System: Model No: SYSTEM RATING Organic load (grams BOD 5 /day) Hydraulic Load (litres/day) CALCULATIONS FOR PROPOSED SYSTEM Organic load (grams BOD 5 /day) Hydraulic Load (litres/day) Number of Persons

18 7. AEROBIC WASTE WATER TREATMENT SYSTEM (cont) SYSTEM CONFIGURATION Tank System One tank Two tank Three tank Four tank Other (attach details) CONTAINMENT PUMP SUMP AND PUMP Where a separate containment pump sump and pump is required, provide full details on materials and method of construction, capacity and detention times, access openings and covers, pump, electrical and alarm systems. DISINFECTION Type, form and method of dosing: NOTE: A licence may be required from the Environment Protection Authority in situations where the treatment and disposal system is situated in a Water Protection Zone and the system size is greater than 100 persons. Licence No: 8. SURFACE IRRIGATION DISPOSAL AREA Refer to SUPPLEMENT B for further information Area for disposal of reclaimed water (m 2 ) TYPE OF IRRIGATION APPLICATORS Sprays Micro Sprays Drippers Bubblers Others (provide details) Please provide details of landform modification: 9. ALARM SYSTEM Refer SUPPLEMENT B for further information An alarm system must be installed as part of the aerobic waste water treatment system to indicate electrical or mechanical component malfunction or failure, including those components associated with separate containment sumps and pumps. Type and location of audible and visual alarm: 10. DECLARATION OF OWNER & APPLICANT PLEASE NOTE: Where the applicant is NOT the property owner, then BOTH the property owner's and the applicant s signatures are required, otherwise approval will be delayed. The property owner should ensure that the form is completed BEFORE signing. I / WE hereby declare that the information provided in this application attachments and accompanying plans is true and correct. I / WE hereby undertake to have the system serviced by trained operators to ensure that the system will be maintained in accordance with the requirements of SUPPLEMENT B and/or specific approval conditions. Property Owner s Signature: Applicant s Signature: Date: Date: Plumber s Details: Registration No: Penalties apply for the provision of false or misleading information