Application for a permit to
install or alter a septic tank system
Fields marked with an asterisk (*) are mandatory and must be completed.
Council-specific information
Use this form to apply to Cardinia Shire Council to either install a septic system or alter an existing septic systeminstallation.
Note: you cannot install or alter the system until Council has approved the application and provided you with a permit to install. After the septic is installed you then need to receive a permit to use before using the system.
Application type
*Select what you wish to do:
q Install a new septic tank system q alter an existing septic tank system
q No alteration proposed (letter of consent report)
Planning permit details
Do you have a planning application? q Y q N
If yes, please provide the reference number for your planning application: ………………………………..
Does the planning unit require you to have a planning permit for your proposal? q Y q N
Has the application been approved? q Y q N
SITE ADDRESS FOR INSTALLATION/ALTERATION
Address
*Street address
*Suburb/town *State *Postcode
Note: formal land description information can be found on the ‘Certificate of Title’.
Lot number Subdivision plan number Lodged plan Title plan (volume) Title plan (folio)
Crown allotment number Section number Parish name
APPLICANT DETAILS
Is the applicant the owner or an agent of the owner? q Owner q Agent of owner
(Owner’s consent required*)
*Surname *Given name(s)
Business phone Home phone Business fax Mobile
Address
*Street address
*Suburb/town *State *Postcode
Postal address
Correspondence regarding the septic installation / alteration will be sent to the plumber and the propertyowner.
q *Tick if postal address is the same as above; if different please provide details below.
Street address/PO Box
Suburb/town State Postcode
PROPERTY OWNER DETAILS
q Site address of installation is the same as property owner details
Only complete this section if the applicant’s details are not the owners.
*Surname *Given name(s)
I hereby acknowledge that I have authorised the applicant to make the application on my behalf and council may provide information to the applicant in relation to the application.
*Signature: *Date:
Contact details
*Please provide at least one contact number.
Business phone Home phone Business fax Mobile
Address
*Street address
*Suburb/town *State *Postcode
Postal address
*Street address/PO Box
*Suburb/town *State *Postcode
PLUMBER/DRAINER
Plumber 1
Is the plumber also the drainer/contractor? q Y q N
Person responsible for installation or alteration work for the septic tank – if not the plumber.
*Surname *Given name(s)
Contact details
*Please provide at least one contact number.
Business phone Home phone Business fax Mobile
Postal address
Correspondence regarding the septic installation/alteration will be sent to the plumber and the property owner.
*Street address/PO Box
*Suburb/town *State *Postcode
*Licence number
DRAINER/CONTRACTOR
Is the plumber also the drainer/contractor? q Y q N
Person responsible for installation or alteration work for the septic tank – if not the plumber.
*Surname *Given name(s)
Contact details
*Please provide at least one contact number.
Business phone Home phone Business fax Mobile
Postal address
Correspondence regarding the septic installation/alteration will be sent to the plumber and the propertyowner.
*Street address/PO Box
*Suburb/town *State *Postcode
*Licence number
BUILDING DETAILS
*Type of building (house, office, factory, other)
*Number of bedrooms (including studies)* *Number of people expected to use the system per day*
Number of fixtures
*List proposed number of fixtures to be connected to the proposed septic system.
Maximum number of persons using the systemNumber of / Bedrooms: / Study/ rumpus: / Other:
Bath / Spa> 250 L / q No / q Yes - Capacity in Litres:
Rain water tank supply: / qYes / q No / Mains water supply: / qYes / qNo
Fixture Rating: / q Extra waste water producing fixtures
q Full water reduction fixtures
q Standard water fixtures
PROPOSED OR CURRENT SYSTEM DETAILS
*Proposed installation/alteration date Septic tank capacity (litres)
Waste management system
*Model name EPA approved number
Absorption trenches
*Length (m) *Width (m) *Depth
Irrigation system
*Sub-surface (m2) *Surface (m2)
Sand filter/polishing sand filter details
*Length (m) *Width (m) *Depth (m)
Other methods of effluent disposal
(Please enter the method by which the Blackwater from the septic tank will be discharged).
*Method type *Effluent lines width *Effluent lines length
Different method types are:
· primary: 90mm slotted UPVC (AG drain) – absorption trenches.
· secondary: sand filter discharge on-site, irrigation system.
· alternatives: transpiration bed, dome drain, bio-filter matrix, soil cell, worm farm.
SUPPORTING DOCUMENTS
Only one copy of each is required for our records.
Note: If providing an attachment electronically, please supply as doc or pdf.
Block plan – provide a block plan (minimum scale 1:100) showing the location of the premise including the street/lot number, location of all nearby streets, dimensions of all boundaries, location and dimensions of all buildings or proposed buildings, easements, streams, water tanks, swimming pools, excavations, driveways, gas pipes, and underground services, stormwater drains, water pipes, existing tank systems; location of the proposed septic tank, treatment plant & effluent disposal system: the position of north and fall of land.
Floor plan – detailed floor plan of the dwelling; clearly distinguish between existing and proposed details. Only one copy is required however if plans are to be returned two copies should be submitted.
Owner’s certification – if applicant is not the owner please provide written authorisation from the owner if the form is signed by someone other than the owner.
System plan – detailed plan and section (scale of not less than1:100) of all parts of the proposed system, showing all dimensions and grades (including any applicable wells, dams, etc.)
Specifications – specifications describing materials to be used in the construction and where required by the Council’s Authorised Officer, other additional information necessary to show that the septic system will, if constructed in accordance with such specifications, comply with regulations.
Summary of data calculations – provide a summary of calculations used to size components.
Council may request additional information based upon the nature of the application.
PAYMENT DETAILS
Application fees and payment details below:
The fee payable depends upon whether it is a new installation or an amendment to an existing installation.
Type of installation / FeesNew installation / $367.10 (GST exempt)
Alteration to existing system / $184.60 (GST exempt)
Extension of time (reissue an expired permit) / $38.20 (GST exempt)
Septic Tank Consent Report / $48.80 (GST exempt)
PAYMENT
Credit card, cash or cheque - payment can be made in person at Council’s main office or alternatively, you can make credit card payments over the phone. To use this option please contact the customer service desk on 1300787 624.
Declaration
I understand and acknowledge that:
· the information provided in this application is true and complete to the best of my knowledge.
· this application forms a legal document and penalties exist for providing false or misleading information.
· I am over 18 years at the time of completing this application.
q *By marking this checkbox I confirm that I have read and understood all the statements above.
*Name of person completing this application
*Signature
*Date
*Please note: You must submit a block plan (supporting documents) for council to able to process the form.
Privacy statement
The information gathered in the form is used by Council to process the application.
To view Council's privacy policy, either visit Council's offices or go to Council’s privacy statement located on www.cardinia.vic.gov.au/privacy
Lodgement
You can lodge your form by doing the following:
In person: 20 Siding Ave, Officer
Post: PO Box 7, Pakenham 3810
Email: Website: www.cardinia.vic.gov.au
Site Plan
Details as requested on application must be shown on the Plan
REAR OF ALLOTMENT
FRONT OF ALLOTMENT
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