Application for Registration - Existing On-Site Sewage Management System

Property & Contact Details

Address of property

(If your address can't automatically be found, you can still enter it manually)

Lot & DP numbers

Assesment number - see rates notice (Optional)

Area of land (acres/hectares - please specify)

Owners name

Best contact number

Email Address

Postal address

(If your address can't automatically be found, you can still enter it manually)

Occupier's name - If different to owner (Optional)

Occupier's contact number (Optional)

Occupier's postal address (Optional)

Council officers may need to inspect your on-site sewage management system. Please provide the name, address and phone numbers of the person to be contacted should an inspection be necessary: (Optional)

System Details

Manufacturer - If known (Optional)

Size (lt)

Type of system

Septic Tank
Aerated Wastewater Treatment System (AWTS)
Other (please specify below)

Other info (Optional)

For an AWTS who will maintain the system? (Optional)

Name of service agent (Optional)

Licence No (Optional)

Address (Optional)

Contact phone no (Optional)

Site Details

Number of bedrooms in house - residential (Optional)

Number of occupants on premises - Non-residential (Optional)

Please indicate the predominant soil type on the property

Sand
Clay
Loam
Unknown

Please indicate the slope of the land

Steep
Gentle
Flat

Are there any stony outcrops near the disposal area?

How far is your disposal area from the nearest body of water? (m/km - please specify)

Describe the body of water (eg: permanent creek, dam etc)

Distance of disposal area from the nearest downhill boundary (m/km - please specify)

Distance of disposal area from nearest residence (m/km - please specify)

Distance of disposal area from nearest bore (m/km - please specify)

Level of groundwater if known (m) (Optional)

Is stormwater runoff diverted away from the disposal area?

Please upload a sketch showing the location of your tank, disposal area and all buildings in the immediate areas. Please show approximate distances between these items

Please note: maximum file size is 20MB

Are there any other aspects of your waste treatment system or property you consider to be of relevance to the registration of the system? (Optional)

Declaration

As owner of the above described property, I hereby apply for approval to register the On-site Sewage Management System described in this application and grant Council the power to carry out inspections in relation to this application.

I Agree

Name of property owner

Date

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