APPLICATION TO INSTALL/ALTER A SEPTIC TANK SYSTEM

Installing a new system - $445.00 / Office Use only
Major alterations to an existing system - $445.00 / File Number:
Minor Alterations to an existing system - $185.00 / Date:
Permit Extension or Alteration to existing permit - $125.00
(Please do not use this form) / Amount:
Additional Inspections - $160.00 / Receipt No:
Link to Council’s online payments
/ Ledger No. / 2125025.52

Please refer to the Septic Tank Application and Maintenance Guide before completing the application form.

Environment Protection Act 1970 New Installation ☐
Septic Tank Code Of Practice 2013
As/Nzs 1547:2012 On-Site Domestic Waste Water Management Alteration ☐
ADDRESS (Where to be Installed)
CA(s)
Click here to enter text. / Section
Click here to enter text. / Parish/Township
Click here to enter text. / Lot no(s)
Click here to enter text. / LP no.
Click here to enter text.
Council Property Number Click here to enter text. Lot No Click here to enter text.
Street No.& NameClick here to enter text.
Town Click here to enter text.. Postcode Click here to enter text.
OWNER
Name Click here to enter owner’s name
Postal Address Click here to enter text. PostcodeClick here to enter text.
Telephone (Home) Click here to enter text.Mobile Click here to enter text.Email Click here to enter text.
APPLICANT (If not the Owner)
Name Click here to enter applicant’s name
Postal Address Click here to enter text.PostcodeClick here to enter text.
Telephone (Work) Click here to enter text. Mobile Click here to enter text.EmailClick here to enter text.
PLUMBER
Name Click here to enter text.Company Name Click here to enter text.
Postal Address Click here to enter postal address.Postcode Click here to enter text.
Telephone (Work)Click here to enter text.Mobile Click here to enter text.EmailClick here to enter text.
Licence NumberClick here to enter text.
DRAINER / CONTRACTOR (If Applicable)
Name Click here to enter text.Company NameClick here to enter text.
Postal Address Click here to enter postal address.
Telephone (Work) Click here to enter text.Mobile Click here to enter text.EmailClick here to enter text.
Licence NumberClick here to enter text.
BUILDING SURVEYOR
NameClick here to enter text.Company NameClick here to enter text.
Postal AddressClick here to enter postal address.PostcodeClick here to enter text.
Email Click here to enter text.
TYPE OF BUILDING AND DETAILS
Click here to select from the drop down box.
Number of BedroomsClick here to enter text. Study/Studio Click here to enter text.
Number of Fixtures to be Connected:
Toilets Click here to enter text. Sinks Click here to enter text. Baths Click here to enter text.
Troughs Click here to enter text. Basins Click here to enter text. Showers Click here to enter text.
Other Click here to enter text. No of Fixtures Click here to enter text.
Food Waste Yes ☐ No ☐ Spa Bath Yes ☐ No ☐ Dishwasher Yes ☐ No ☐
Please note: Consultation with the Environmental Health Officer is required if spa baths of more than 200L or waste disposal units are to be connected.
PROPOSED SEPTIC SYSTEM/S (If a combination of systems is to be installed please include all details)
☐Conventional septic tank
☐Packaged treatment plant Make and model: Click here to enter text. EPA C/A: Click here to enter text.
☐Other (specify)Click here to enter text. Make and model:Click here to enter text.
EPA C/A: Click here to enter text.
PROPOSED DISPOSAL METHOD: Detail the specific type of disposal method proposed to be installed/altered
(Tick the appropriate box)
☐ETA/ Trench system Length:Click here to enter text. Width: Click here to enter text. Depth: 450mm
☐Subsurface Pressure Compensating Irrigation Area Click here to enter text.M2
Secondary treatment only
☐NETAFIM ☐KISSS ☐TRIANGLE ☐TORO ☐OTHER BRAND (SPECIFY) Click here to enter text.
☒Other disposal method (please specify)Click here to enter text.

If the applicant is not the owner, give the name of the owner and complete box B.

Owner to complete box A.

I/We certify that all on-site septic tank system works proposed and specified in this application will be in compliance with the EPA Act 1970 and the EPA Septic Tanks Code of Practice (Publication 891.3 2013), and the Mount Alexander Shire Council Septic Tank specifications.
A. I Am The Owner Of The Land, I Have Seen This Application. / Owner’s Signature……………………………………
Owner’s NameClick here to enter text.
Date Click here to select date.
B.I/We The Applicant, Declare That I/We Have Notified The Owner About This Application. / Applicant’s Signature……………………………….
Applicant’s Name:Click here to enter text.
Date Click here to select date.

****The Fee for this application is exempt from GST under Division 81 of the GST Act

SITE PLAN

Site AddressClick here to enter property address.

The following details must be provided: Location and dimension of the proposed septic tank system, all proposed and existing buildings and driveways, the location of any streams, watercourses, gullies, dams, ponds, bores or wells for domestic supply, water tanks, swimming pools, excavations, water, phone, gas or electrical trenches (existing or proposed) and any existing septic tank and sullage systems.

REAR OF ALLOTMENT

FRONT OF ALLOTMENT

#Please note: For clarification, applications with larger properties should show the whole allotment on one plan, and submit a close-up extract of the building envelope, showing the septic plan in closer detail.

Endorsement of Plumber / Endorsement of Owner
Signature: …………………………………………
Date Click here to select date. / Signature: ………………………………………….
Date Click here to select date.
Name:Click here to enter text. / Name:Click here to enter text.

Septic Tank Application Checklist

Property AddressClick here to enter property address.

Applicant’s Name Click here to enter applicant’s name.

Owner’s Name Click here to enter owner’s name.

  1. Application Form completed signed and dated.
  1. Land Capability Assessment (LCA) required – See attached Information Sheet
  1. Planning Permit required – YES ☐NO☐

Attachments to septic tank system application form:

  • Copy of Title attached
  • Copy of Planning Permit (if required) attached
  • A detailed floor plan of the proposed dwelling
  • Land Capability Assessment (if required) attached
  • Site Plan attached
  • A general locality map, including directions on how to locate and identify the property and any other relevant information. Please provide a stake or landmark on the property indicating where the septic tank is to be installed.
  • If gates to the property are locked please liaise with the Environmental Health Officer to arrange access to the property.
  • If there is a guard dog on the property you will need to provide details to the Environmental Health Officer to arrange for the dog to be restrained during inspection times.

Please note: For Permits to Alter the above information is also required with the application. However you will also need to include details of the existing system on the site plan and a detailed floor plan of the existing dwelling. Also provide details of the proposed changes to be made to both the septic system and the dwellings floor plan. It is advisable that the plumber provides details on the existing systems operating status and details of how fall from the proposed new fixtures to the septic tank can be achieved.

Major alterations as described in the application form include replacement or relocationof septic tank, treatment plant, sand filter, effluent dispersal system or any component of the septic tank system, or the installation of extra trenches/irrigation (may be required for dwelling extensions).

Minor alterations include alterations to internal plumbing and/or inlet to the septic tank system. Installation, replacement or relocation of the internal plumbing, fixtures, fittings, appliances.

Payment:

  • Link to Council’s online payments
  • Cheque enclosed for payment of fees (if mailing)
  • Credit Card Payment (Available at Council Civic Centre – 27 Lyttleton Street Castlemaine or by phoning customer service on 5471 1700)
  • Cash payment (Only available at Council Civic Centre)

DOC/14/28421