Effluent Disposal Request

Effluent Disposal - Applies to Rural Blocks ONLY

Wastewater treatment for rural blocks. Please allow a minimum of 10 business days from scheduling for this work order to be completed.
Full Name *

First Name Last Name
Phone Number *
Your E-mail *
E-mail of third party to receive report, if required
example@example.com
SITE Address *

Street Address

Block & Section

Suburb State

Post Code
Proposed Development?
Please choose from the drop down
Site Access: Please provide information about current residents/tenants, locked gates, dogs or any obstruction on the site. *

Please answer the following for the residence *

Number of bedrooms (include all rooms that could be used as bedrooms i.e. office or studio).

What is the make and model of preferred treatment system?
What is the preferred land application system? (Spray/Drip Irrigation, Conventional Trenches/Bed, Mound, etc.)
Will the proposed build use Tank Water or Reticulated/Bore Water? *

Tank Water Reticulated/Bore Water
Are there any nearby domestic bores (used for drinking, watering of edible plants, etc.)? *

Yes No
Is the site prone to flooding? *

Yes No
Please provide a site plan/sketch indicating the locations of the proposed residence/extension and proposed land application system (you may also e-mail a copy of this plan to admin@actgeoeng.com.au)

Browse Files
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Please note that the location of the land application system should be downhill from the residence /extension and should satisfy the following minimum buffer distances. *Note: some Councils have different requirements.

Site Constraint	Required Buffer Distance
Permanent Surface Waters (river, creek, lake,etc.)	100m
Domestic Groundwater Well/Bore	100m
Other Waters (farm dam, intermittent creeks, drainage channels, etc.)	40m
Property Boundaries	12m (uphill) 6m (downhill)
Dwellings, swimming pools & driveways	6m (uphill) 3m (downhill)

Billing information for invoice

Required
Business or Personal Name *
Contact Person for Invoice
Accounts Email to Receive Invoice *
example@example.com
Phone Number *
Postal Address

Postal Address

Street Address Line 2

Suburb State

Post Code
I have already received a quoted price *

Yes No
The price I have been quoted is:
e.g. $750.00 ex GST
PLEASE NOTE: AN INVOICE WILL BE ISSUED FOR PAYMENT IN FULL, PRIOR TO THE REPORT BEING RELEASED.
Online Signature *

By signing this form you have agreed with our payment terms. Clear
Comments:
ACT GEOTECHNICAL ENGINEERS PTY LTD

Unit 5, 9 Beaconsfield Street, Fyshwick ACT 2609

Phone 02 6285 1547

Email admin@actgeoeng.com.au

ABN: 1906 3673 530
Should be Empty:

Effluent Disposal - Applies to Rural Blocks ONLY

Billing information for invoice