LOCAL GOVERNMENT (WATER POLLUTION) ACTS, 1977 AND 1990
APPLICATION FOR LICENCE TO DISCHARGE TRADE OR SEWAGE
EFFLUENT TO WATERS
TO: Environment Section
Cavan County Council
17 Farnham Street
Cavan
Co. Cavan
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For Official Use
Date Received: _____________________
Reference No.: _____________________
Licence No.: _______________________
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I/We hereby make application for a licence under Section 4 of the Local Government
(Water Pollution) Act, 1977 & 1990 to discharge _________________________ effluent
(insert “trade”, “sewage” or “trade and sewage” as required)
in accordance with the attached particulars and plans.
1
Signed:
_____________________________
Date:
_____________________________
Name of Applicant
________________________________* (Block Capitals)
Address
________________________________
________________________________
________________________________
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Telephone number
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Address for correspondence
_________________________________
_________________________________
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(Please note that at least one of the addresses provided above must be within
the Republic of Ireland.)
* If you, the Applicant are;
(a) an individual trading under some name, then please forward a “Certificate of
Registration of Trade Name”, OR
(b) a limited liability company, then please forward a copy Certificate of
incorporation and a confirmation of location of registered office
2
Name and Address of the premises for which the effluent is to be discharged:
______________________________________________________________
______________________________________________________________
______________________________________________________________
(BLOCK CAPITALS)
3
If the effluent is a trade effluent, give a general description of the process or
activity giving rise to the discharge.
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(1)
Location of Point of Discharge
Please include GPS co-ordinates of the point of discharge and indicate
the exact location of the point of discharge on a 1:2500 OS Map.
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(2)
Description of waters to which discharge is to be made
__________
_______________________________________________________________
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(3)
Details of size and construction of outlet. Plans, indicating the premises,
drainage systems and any works, apparatus or plant from which the
effluent is to be discharged, must accompany this application form (4 no.
copies). Point of discharge should be shown on 1:2500 O.S. Map.
5
Details of provision made for sampling and measuring flow of the effluent: ___
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6
Particulars of any other discharges from the premises in question: ___________
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7
Details of any special arrangements to prevent accidental discharges: ________
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GENERAL
Date of commencement of Discharge
______________________________
EFFLUENT
a
Number of persons served
____________________________
b
Anticipated dry weather flow
____________________________
c
Volume of effluent to be discharged _____________________________
d
Mean volume per day
e
Maximum volume in any one day
f
Maximum volume rate per hour _____________________________
g
The period or periods of the day in which the discharge is to take place
_____________________________
_____________________________
_________________________________________________________
_________________________________________________________
h
Any seasonal, or other variations (including any arising from plant
malfunction) in volumes of effluent to be discharged. ______________
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__________________________________________________________
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Characteristics of Effluent
Complete for all applicable characteristics giving concentration ranges where
available. Concentration to be expressed in mg/l, where applicable. The
following list is meant to be indicative only- such other physical, chemical or
other characteristics as are pertinent to the effluent in question should be
specified.
If you have any queries regarding the analysis required please contact the
Environment Section of Cavan County Council on 049 - 437 8486.
Characteristics
Prior to Treatment
As Discharged
Temperature oC
______________
______________
pH
______________
______________
Colour (degree Hazen)
______________
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B.O.D. (mg/L)
______________
______________
C.O.D. (mg/L)
______________
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Suspended Solids (mg/L)
______________
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Settleable Solids (mg/l)
______________
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Dissolved Solids
______________
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Ammonia (mg/l as N)
______________
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Oxidised Nitrogen (mg/L as N)______________
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Kjeldahl Nitrogen (mg/L as N) ______________
______________
Total Phosphorus (mg/L as P) ______________
______________
Molybdate Reactive
Phosphorus (mg/L as P)
______________
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Sulphates (as SO4)
______________
______________
Chlorides (mg/L as C1)
______________
______________
Phenols (mg/L as C6H5OH)
______________
______________
Detergents
(mg/L as MBAS)
______________
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Oils, Grease and Fats (mg/L) ______________
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Metals – (Specify Each)
______________
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Organohalogen
Compounds (Specify)
______________
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Organophosphorus
Compounds (Specify)
______________
______________
Organotin
Compounds (Specify)
______________
______________
Mineral Oils or
Hydrocarbons of
petroleum origin
______________
______________
Characteristics (Contd.)
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Other toxic
substances (Specify)
______________
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Other relevant characteristics
(including fish toxicity data from
tests carried out on all or part of
the effluent)
______________
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Particulars of effluent treatment employed or proposed ____________________
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Particulars of the use of any dangerous substances as categorised under the
European Communities Environmental Objectives (Surface Water)
Regulations 2009 (S.I. No. 272 of 2009). These details shall include the
compounds they occur in and the quantities used.
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