Wastewater Permit Application Step 1 of 9 - Application information 11% HiddenRecord ID Incremental ID HiddenSubmitted by HiddenSource HiddenApplication Date MM slash DD slash YYYY HiddenApplication Time Hours : Minutes AM PM AM/PM Application Information At any stage when filling in the form you can use the 'Save and continue later' button at the bottom of each page to save your application and return to it later. You will be sent an email with a link to return to the form when you are ready to continue filling it in. If you require any assistance completing the form please contact the Environmental Health Team on 5358 8700. After you submit your application: You will receive an automatic email response confirming that your application has been received by council. Please note that your application will not be processed until payment has been made. The fee will be calculated and payment instructions will be sent within 3 days to the applicant email address provided in this application. Please Note: Only one wastewater system per permit is allowed. The fees for this wastewater application will be as follows: New installation or major alteration: $798 Minor Alteration: $608 - alteration that consists of installation, replacement or relocation of the internal plumbing, fixtures or fittings of an onsite management system. Exemption from a permit: $239 Is the capactiy of the waste water system less than 5000L per day?*Please note council can only receive applications for systems with a daily capacity of less than 5000L per day. Yes No Council only can issue permits for smaller-scale systems with a design or actual flow rate of sewage not more than 5000L on any day. Systems that can treat more than 5000L per day need an EPA development licence and operating licenses (unless an exemption applies) Please contact the council Environmental Health Officer , or the Environment Protection Authority Victoria for more information. Is the wastewater site located in Northern Grampians Shire Council?* Yes No Council only can issue permits for sites in the Northern Grampians Shire What will the system be used for?* Residential use only Business use only Residential and Business use Application Type*Please select what you wish to do: Install a new wastewater system Alter an existing wastewater system Apply for an exemption from a permit Have you spoken to an Environmental Health Officer? Yes No Name of Enviromental Health Officer*Please provide the name of the Environmental Health Officer. To apply for an exemption for a permit you must have spoken to a council environmental health officer first. Please call us on 03 5358 8740 to speak with one of our officers. Applicant Billing address* Street address Locality State Postcode Applicant name* Given name(s) Middle Surname Applicant phone number(s)* Applicant email*This will be used for all correspondence during the submission stage of this application. You may elect to have an alternative primary contact for correspondence during the assessment and processing stages of this application.Applicant residential address* Street address Locality State Postcode Postal address*Is there a different postal address? Yes No Applicant postal address* Postal address Locality State Postcode Primary contact*Is there an alternative primary contact for communication during the processing of this application and/or during building works? Yes No Primary contact name* Given name(s) Middle Surname Primary contact email*This will be used for all correspondence once the application has been submitted and is in the assessment and processing stages. Primary contact phone number*Primary contact role*Please provide details of the role of the primary contact that is detailed above Property owner*Are you the property owner? Yes No Property owner name* Given name(s) Middle Surname Property owner address* Address Locality State Postocde Property owner contact number*Property owner email Agent detailsWhat role are you filling in completing this form on behalf of either the property or business owner? Address of the installationIf the site has a registered addess please add it else please provide the legal description for the particular parcel of land for which the application is made. A land parcel may be described either by Lot number, lodged plan type and lodgement plan number or Crown allotment number, section number and a parish or township name. This information can be found on the Certificate of Title under the heading LAND DESCRIPTION. Is there a registered address for the site.A registered address has a street number in addition to the name that the waste water installation or works will occur on. Yes No Address Street Number Street Name City State ZIP / Postal Code Legal description type*Please select the applicable legal description of the particular parcel for which the application is made: Lot number and lodgement plan number Crown allotment number, section number and parish or township name Lot number* Lodged plan type* Lot Plan - LP Plan of Consolidation - CP Plan of Consolidation - PC Plan of Subdivision - PS Title Plan - TP Lodgement plan number* Crown allotment number* This will be displayed as CA X on the Certificate of TitleSection number Parish or township name* Assessment NumberTo help expediate the application please provide the Assessment number which can be found on your rates notice. More parcels*Are there more parcels involved in this application? Yes No Other parcel informationPlease enter the remaining parcel details in the textbox below.HiddenChoose Location*Enter the street location or use the map and right click on the position of the installation Search for Address Longitude Latitude HiddenInstallation Address Planning permit NumberAdd the planning permit number if known. Adding the planning permit number will help to expedite the application Plumber detailsPlumber name* First Last Plumber contact number* Plumber email* Plumber practitioner registration number* Plumber business/company name* Plumber business address* Street Address Locality State Postcode Business address as postal*Is there a different postal address? Yes No Plumber postal address* Postal address Locality State Postcode Additional PlumbersHow many additional plumbers are there?012Second plumber name* First Last Second plumber email* Second plumber practitioner registration number* Second plumber business/company name* Second plumber business address* Street Address Locality State Postcode Second plumber postal addressIf different than business address Postal address Locality State Postcode Third plumber name* First Last Third plumber email* Third plumber practitioner registration number* Third plumber business/company name* Third plumber business address* Street Address Locality State Postcode Third plumber postal addressIf different than business address Postal address Locality State Postcode Is the person installing or altering the wastewater system the same as above?* Yes No Person installing or altering system name* First Last Person installing or altering system contact number* Person installing or altering system email* Private Building Surveyor / ContractorIs there a Private Building Surveyor/Contactor?* Yes No Building Surveyor/Contractor name* First Last Building Surveyor/Contractor business/company name* Building Surveyor/Contractor business postal address* Street Address Locality State Postcode Building Surveyor/Contractor email* Building Surveyor/Contractor contact number* Building Surveyor/Contractor registration number* Water supply*Please select the relevant source(s) of water supply Select All Water authority Rain water Bore River or Dam Other Other water supply*Please provide details of 'other' water supply Water usageIt is important to provide the number of facilities to be connected to the system. Please enter '0' if there are none of the particular facility type to be connected.Wastewater daily usage*How many people are expected to use the system daily?Number of rooms connected to system.*How many rooms in the dwelling are connected to the system you are applying for?Please enter a number greater than or equal to 0.Number of toilets*Number of spasPlease enter a number greater than or equal to 0.Number of baths*Number of showers*Number of sinks*Number of troughs*A trough is a large sink, such as in a laundryNumber of dishwashersEffluent treatment system detailsYou may need your plumber or wastewater system designer to assist with this section.Effluent treatment systems*Please select which type(s) of effluent treatments systems will be used Septic Aerated wastewater treatment system (AWTS) Worm Farms Reed beds Manufacturer Septic capacity*What is the capacity of the septic (primary treatment) tank in litres?AWTS model*What model aerated wastewater treatment system will be used? Sand filter system length*How long is the sand filter system in metres?Sand filter system width*How wide is the sand filter system in metres?Sand filter system depth*How deep is the sand filter system in millimeters?Effluent disposal system detailsYou may need your plumber or wastewater system designer to assist with this section.Effluent disposal method*Please select which type(s) of effluent disposal systems will be used Absorption/evapotranspiration trenches Pressurised drip irrigation Total disposal length (m)*How long is the trench/effluent distribution or mound in metres?How many trench lines?*Please enter a number greater than or equal to 1.Disposal width (m)*How wide is the trench/effluent distribution or mound in metres?Disposal depth (mm)*How deep is the trench/effluent distribution or mound in millimeters?Space between each trench (m)*Drip irrigation subsurface area (m^2)*How many square metres subsurface will the drip irrigation cover?Drip irrigation surface area (m^2)*How many square metres above ground will the drip irrigation system cover?How many distributor lines?* The supporting documents requested are an important part of the permit process.Incorrect or insufficient information may delay your application. Please note that plans submitted as part of this application must not include a previously endorsed stamp.Certificate of Title*A copy of a current Certificate of Title for the allotment, including a plan of subdivision. Drop files here or Select files Max. file size: 128 MB. A site plan is a large scale drawing that shows the full extent of the site for an existing or proposed development.Locality of Map*Including directions on how to locate and identify the property and any other relevant information (such as if the gate is locked who to telephone for access etc). Drop files here or Select files Max. file size: 128 MB. A site plan is a large scale drawing that shows the full extent of the site for an existing or proposed development.Wastewater site plan block*The block plan must show the point North, the location of the dwelling, fall of land, the position of the proposed septic system, all existing and proposed buildings, driveways, easements, dams, creeks, underground water tanks, bores or wells and the position of all existing and proposed services such as stormwater drains, underground power lines, telephone cables, gas pipes or any other services. Drop files here or Select files Max. file size: 128 MB. A floor plan is a bird's-eye view of the existing and proposed structures in your development. It should show the layout of the building, its relationship to existing buildings, the location and dimension of walls, windows and doors, and the use of each room and area within the building.Floor plan(s)*Please check the notes below for information that must be included in your floor plan(s). Click here to download an example. Drop files here or Select files Max. file size: 128 MB. A floor plan is a bird's-eye view of the existing and proposed structures in your development. It should show the layout of the building, its relationship to existing buildings, the location and dimension of walls, windows and doors, and the use of each room and area within the building.System Plan*The system plan must indicate the exact proposed location of the septic tank or wastewater treatment system and the layout of the proposed effluent disposal area as well as the reserved disposal area. Irrigation plans should indicate the location of all taps, valves and flush points, whether the system is sub surface or of the surface drip irrigation type and the distance between drippers. Drop files here or Select files Max. file size: 128 MB. Elevation plans are side-on views of a proposed development.Land capability assessmentTo assess the capability of the site to sustainably manage wastewater within allotment boundaries and identify a management program to put in place to minimise the health and environmental impacts of on-site wastewater management. Refer to EPA publication 746.1. Drop files here or Select files Max. file size: 128 MB. A landscape concept plan is a scaled drawing of a development conceptually showing the existing and proposed areas to be landscaped. It may extend to works outside of the site, such as streetscape works or overhanging vegetation located on adjoining sites.Certificate of Conformance or exemption from EPATreatment system brands and models must be certified by an accredited conformity assessment body (CAB) as conforming with the relevant Australian Standard (AS). This accreditation is given by JAS-ANZ (the Joint Accreditation System of Australia and New Zealand) Drop files here or Select files Max. file size: 128 MB. A landscape concept plan is a scaled drawing of a development conceptually showing the existing and proposed areas to be landscaped. It may extend to works outside of the site, such as streetscape works or overhanging vegetation located on adjoining sites.Any other supporting documentationAny other documentation which will support your application. or if you have discussed this application with Council prior to delivering the application to Council, Council may request additional information based upon the nature of the application. Drop files here or Select files Max. file size: 128 MB. AcknowledgementPrivacy collection statement*Personal information requested on this form will only be used by council to carry out its functions and activities and will not be disclosed without your consent except where authorised by law. If you do not provide all or part of the personal information required we may not be able to process your request in an effective and efficient manner. You have the right to seek access to and correction of your personal information. I acknowledge that: I have read and understood the Privacy Collection Statement and consent to my personal information being used for the purpose specified Submission Statement*This request can only be made by the named applicant. If you are submitting this application on behalf of another person or entity you must be duly authorised to do so. By submitting this application you are confirming that you are authorised to do so and declare that the information is correct to the best of your knowledge. I acknowledge that: I have read and understood, and confirm that I am complying with the Submission Statement above Information statement*This application forms a legal document. It is against the law to provide false or misleading information. Providing false or misleading information could result in a heavy fine and cancellation of the permit. I declare that: information provided in this application is true and complete to the best of my knowledge. Total amount to pay: $ 0.00 Credit Card* Stripe uses secure payment systems (SPS) and fraud detection systems (FDS) to protect your financial information.
