Application to Operate Sewage Management Facility

Application to Operate Sewage Management Facility

Section 68 Local Government Act 1993

Location of Land to Which Application Relates
Address*

Street Address

Street Address Line 2

CityState

Postcode
Lot/Section/DP*

System Details
Type
Commercial SystemDomestic System
Additional Information

Additional System
Type
Commercial SystemDomestic System
Additional Information

Owner Details and Declaration
As the owner/s of this property, I/we consent for Council officers to enter the premises for the purpose of carrying out inspections in conjunction with this application.I acknowledge that it is my responsibility to ensure repairs of the system are undertaken so that it does not cause a risk to public health and safety or the environment.
Please note that ALL owners must sign; If a company, please provide contact details of the Secretary also.
Applicants Name*

First NameLast Name
Applicants Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Signature of Applicant*

Clear
Company Name (if applicable)
Secretary Name

First NameLast Name
Secretary Phone Number
Please enter a valid phone number.
Secretary Email
example@example.com
Owners Name(s)*
Postal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Mobile Phone Number*
Please enter a valid phone number.
Email
example@example.com
Owners Consent

I/We, the undersigned are/am the owner(s) of the property described in this application and consent to its lodgement. I/We herby permit a duly authorised officer of Yass Valley Council to enter the land or premises to carry out inspections as required for the administration of the Act(s), Regulations or Planning Instruments.
Signature*

Clear
Signature

Clear
Date*

DayMonthYear
Date

Installation Details
Installers Name

First NameLast Name
Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone
Please enter a valid phone number.
Licence Number

For Existing Aerated Waste Treatment Systems
Is your AWTS maintained on a quarterly basis by a qualified maintenance firm/individual?

YesNo
Who maintains your AWTS?
Company Name
Company Address

Street Address

Street Address Line 2

CityState

Postcode
Business Phone/Mobile
Please enter a valid phone number.
Are there warning signs displayed near the irrigation system (minimum 2)?

YesNo
How many sprinklers are there?

For Existing Septic Systems
Are there any apparent leaks in the septic tank?

YesNo
Does the disposal area pond, leak or overflow?

YesNoNA
When was the septic tank last pumped out?

DayMonthYear
Date

Additional Information & Payment
Once your application is received by Council, an Environmental Health Officer may contact you to arrange an inspection before the approval to operate is issued.

The annual approval to operate fee will be incorporated into your rates in accordance with Council's Fees and Charges Policy.

Should you require additional information or advice, please contact Council's Customer Service Team on +61 2 6226 1477.

Payment *

Initial Fee - Operate Sewage Management Facility

$175.00AUD

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: