Site Classification Request Form

Site Classification Request Form
Branch*
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Site Classification/Effluent Request
Site Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Block Size*
Proposed Development*
Does the Development Include:*
If Basement, Depth of Basement:
Number of Dwelling to be Built on site?*
E.g. How many Units/townhouses.
If Required, Can we access the new building footprint with a vehicle*

YesNo
Site Access: Please provide information about current residents/tenants, locked gates, dogs or any obstruction on the site.*
Do you Require an Effluent Disposal Assessment? (Only applies to Rural Blocks)*

YesNo
ONLY FILL IN THE BELOW QUESTIONS, IF YOU HAVE ANSWERED YES TO REQUIRING AN EFFLUENT DISPOSAL ASSESSMENT.

Please answer the following for the residence

	1	2	3	4	5	6	7	8
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 WaterReticulated/Bore Water
Are there any nearby domestic bores (used for drinking, watering of edible plants, etc.)?

YesNo
Is the site prone to flooding?

YesNo

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)

Please Include and construction plans for the block and upload below

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Site Contact Details
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.

Site Classification Request Form

Site Classification/Effluent Request

Site Contact Details

Billing Information for Invoice