To the General Manager, Coffs Harbour City Council
UNDERTAKE OR MODIFY:
SANITARY PLUMBING AND DRAINAGE; OR
ON-SITE SEWAGE MANAGEMENT SYSTEM
Local Government Act 1993 – Section 68, Parts B and C
Local Government (General) Regulation 2005 – Section 26
Locked Bag 155, Coffs Harbour 2450;
Administrative Centre, 2 Castle Street, Coffs Harbour
Email: coffs.council@chcc.nsw.gov.au Phone: (02) 6648 4000 Fax: (02) 6648 4199
Website: www.coffsharbour.nsw.gov.au ABN 79 126 214 487
1.
Details of the applicant
It is important that Council is able to contact you if more information is required. Please give as much detail as possible.
Mr
□
Ms
□
Mrs
□
Dr
□
Other:
Given name/s
Surname
Company/organisation
ABN
Postal address
Suburb or town
State
Daytime telephone
Postcode
Mobile
Email address
2.
Details of the property
Unit/street no.
Street name
Suburb, town or locality
State
Postcode
Lot/DP or Lot/Section/DP or Lot/Strata No.
3.
Type of Building
Provide details of the type of building (eg. dwelling, dual occupancy, office, factory)
.................................................................................................................................................................................................
OFFICE USE ONLY
(CASHIERS CODE: SEPT)
Date received
Fee (if applicable)
Inspection(s)
No.
Total:
$
ST No.
$
Property Number
$
Receipt No.
D/A Number:
Sewer Diagram No.
OS No.
IR No.
Undertake or Modify Sanitary Plumbing and Drainage or On-Site Sewage Management System (FRM E056) 02/09/2015
4.
Nominate and describe the type of approval sought
Page 2
Complete either Section A OR Section B by ticking the applicable box and providing details of the type
of work proposed:
SECTION A
Approval to carry out or modify sanitary plumbing and drainage and any works associated with connection to
Council’s sewer system.
□
□
New development (ie new dwelling, dual occupancy, multi-residential, commercial, industrial development)
Amendment to an existing development
Description of proposed works:
.................................................................................................................................................................................
Number of NEW water closets (toilets) – applies only to multi residential, commercial, industrial developments:
Number: ……………………………….
If a) Proceed to Section 5
OR
SECTION B
Approval to install or modify an on-site sewage management system (septic/aerated wastewater system) or any
associated works connected thereto.
□ Initial application to install and operate new or replace an on-site sewage management system
□ Minor system amendment
□ Alteration or addition to internal house drainage only
Description of proposed works:
.................................................................................................................................................................................
Number of NEW water closets (toilets):– applies only to multi residential, commercial, industrial developments:
Number: ……………………………….
If b) proceed to Section 5 AND Complete Appendix A as well as the “Checklist for Lodgement of
Application/Amendment to an On-Site Sewage Management System” and attach relevant information.
5.
Inspection requirements
Work requiring inspection includes internal drainage, external drainage, effluent collection tank and associated drain
field. Inspection fees will be levied on the basis of number of separate site visits required for inspection(s).
Nominate the type and number of expected site visits required:
□ Internal drainage
□ External Drainage
□ Installation of effluent disposal tank and associated drain-field
Total No. of inspections requested: …………………………………………………………………………………………….
Appendix B is to be completed and attached when more than one plumber will be responsible for different
components of the work.
6.
Applicable fees and charges
To view the applicable fees and charges associated with this application please refer to Council’s adopted fees and
charges at www.coffsharbour.nsw.gov.au/fees
Undertake or Modify Sanitary Plumbing and Drainage or On-Site Sewage Management System (FRM E056) 02/09/2015
7.
8.
Privacy and personal information protection notice
Page 3

this information is voluntarily required to process your request and will not be used for any other
purpose without seeking your consent, or as required by law;

your information may comprise part of a public register related to this purpose;

your application will be retained in Council’s Records Management System and disposed of in
accordance with the Local Government Disposal Authority;

your personal information can be accessed and corrected at any time by contacting this Council.
Owner’s details
All owner(s) of the land being developed must sign the application.
It is the applicant’s responsibility to clearly demonstrate that all owners have consented to the lodging of the
application. Individual owners must sign and print their names. Where the owners are companies or involve a
body corporate, sufficient detail demonstrating the authority of the person signing as/or on behalf of owner
must accompany the application.
If the applicant is not the owner of the land, a statement signed by the owner of the land to the effect that the
owner consents to the making of the application is required.
By signing this application the owner acknowledges and accepts that works identified in Part 4, Section B to
install and operate or modify an On-site Sewage Management system and disposal field will be subject to
compliance with the covering regulation and any supplementary conditions issued pursuant to this application;
and that an approval to operate will only be granted upon satisfactory completion of all building infrastructure
and vegetation landscaping.
Signature
Signature
Name
Name
Date
Date
Email address
Daytime telephone
Mobile
Applicant’s Signature/s
I declare that to the best of my knowledge all particulars supplied by me are correct and completed.
I understand that inaccurate or false statements may cause my application to be delayed or rescinded.
Signature(s): ……………………………………………………………
Date: ……/……./…….
Undertake or Modify Sanitary Plumbing and Drainage or On-Site Sewage Management System (FRM E056) 02/09/2015
APPENDIX A
Disposal System Details
SECTION1 – COMPLETE AND PROCEED TO SECTION 2
WC Flush capacity ...................................................... Litres
Tank Capacity .................................................. Litres
Collection well capacity ............................................... Litres
Number of persons ....................................................
Number of bedrooms ..............................................................
System type (if applicable) ...........................................
Distance to permanent water course .................................. metres
Bore water supply

Yes

Rainwater supply

No

Yes
Town water supply

No
Yes

No
Vegetation type proposed for effluent irrigation area: ......................................................................................................
Provide details of system Operation & Maintenance requirements:
............................................................................................................................................................................................
Provide details of system Servicing requirements to meet above operation and maintenance requirements: ................
...........................................................................................................................................................................................
Action to be taken in the event of a breakdown or fault: ..................................................................................................
...........................................................................................................................................................................................
SECTION 2 – COMPLETE IF MAKING AMENDMENT TO EXISTING SYSTEM
AMENDMENT
A.
B.
Yes

Complete Sections A to D
Septic tank replacement:
Yes

No

Tank desludgement
Number of OSSMs:
Existing:

N/A
Number: .........
Proposed:

N/A
Number: .........
Yes

No

EXISTING DISPOSAL SYSTEM:


Other ...................................................
Septic Tank with Disposal trenches:
.......................... 
Pumpout: ....................................................................... 
REPLACEMENT / UPGRADE OF SYSTEM TO:



AWTS: ...............................................
Other: .................................................
No replacement: ................................
D.

GENERAL DETAILS:
AWTS: ................................................
C.
No
ST with Disposal trenches: ............................................ 
...................................................... 
Pumpout:
UPGRADING OF DISPOSAL FIELD:
Existing trenches will still be used
Yes
Existing trench length ......................... m

No

Upgraded to

Trenches – ......................................... m

Field size – ....................................... m2
NOTE: Three (3) copies of a suitably scaled site plan, drainage plan & tank specifications must accompany this
application (clearly identifying buildings, boundaries, distances, the effluent application area & size, disposal type &
specifications, water bores, dams, gullies & streams within 100m, of the proposed installation).
Undertake or Modify Sanitary Plumbing and Drainage or On-Site Sewage Management System (FRM E056) 02/09/2015
APPENDIX B
The following details are to be completed and attached with the application when more than one
plumber / drainer is responsible for different components of the work.
Address ......................................................................................................................................
License number ..........................................
Licensed for .......................................................
License expiry date ....................................................................................................................
Plumber / Drainer Signature .......................................................................................................
Details of the work being undertaken / responsible for:
...................................................................................................................................................
...................................................................................................................................................
Address ......................................................................................................................................
License number ..........................................
Licensed for .......................................................
License expiry date ....................................................................................................................
Plumber / Drainer Signature .......................................................................................................
Details of the work being undertaken / responsible for:
...................................................................................................................................................
...................................................................................................................................................
Name .........................................................................................................................................
Address ......................................................................................................................................
License number ..........................................
Licensed for .......................................................
License expiry date ....................................................................................................................
Plumber / Drainer Signature .......................................................................................................
Details of the work being undertaken / responsible for:
...................................................................................................................................................
...................................................................................................................................................
Undertake or Modify Sanitary Plumbing and Drainage or On-Site Sewage Management System (FRM E056) 02/09/2015
Checklist for Lodgement of Application/Amendment to an
On-Site Sewage Management System
The assessment of on-site sewage management systems by Coffs Harbour City Council is an
on-going process that requires cooperation from designers, installers and owners in being
efficient and timely.
The submission of complete applications that provide all information required for assessment
not only speeds up the process but helps applicants receive approvals as expediently as
possible.
Refer below for details as to Council’s minimum requirements for submission of complete
applications. All information must be provided unless otherwise advised by Council.
(1)
Wastewater Hydraulic Load Estimates
An estimate of the wastewater hydraulic load (L/day) produced by the house/shed is to
be indicated. The estimate of the hydraulic load is to be taken as 1.5 x the number of
bedrooms (i.e. 4bdr x 1.5 = 6 persons). This is then multiplied by the inflow relating to
the type of water supply and water restriction devices utilised in the house/shed. Refer
to Table H1 & H2 of AS/NZS1547:2012 for wastewater design flow allowances.
(2)
Site and Soil Assessment
A professional assessment of soil type and site selection is to be provided in
accordance with AS/NZS1547:2012. A professional assessment of the site and soils is
required to identify limitations relating to the capability of the site to sustainably manage
the application of treated wastewater.
(3)
Proposed Wastewater Treatment and Disposal System
Details of the proposed treatment system should be included in the report submitted to
council. This should include the systems accreditation with NSW Health and relevant
construction and installation specifications. Details of the proposed disposal system
should also be included making reference to specific design/installation requirements
set out in AS/NZS1547:2012.
(4)
Detailed Site Plan
A site plan indicating the size of the allotment and the location of the proposed effluent
disposal field is to be provided with an application. The plan should show buffer
distances of the disposal field to property boundaries, dwellings (existing/proposed),
watercourses, intermittent waterways/gullies/dams, water bores, driveways, site
gradient and other distinguishing features. Allowance should be made on this plan for a
100% reserve effluent disposal area for future usage. Buffer distances are to comply
with the performance criteria in Table R1 of AS/NZS1547:2012.
(5)
Stormwater Diversion Methods
The location of surface water diversion banks or cut of berms/drains are to be indicated
on the site plan. Stormwater must be diverted away from the disposal field with the
design relevant to slope and run off velocities.
Undertake or Modify Sanitary Plumbing and Drainage or On-Site Sewage Management System (FRM E056) 02/09/2015
(6)
Schematic of Proposed Effluent Disposal System
A cross-sectional diagram of the proposed effluent disposal system must be provided.
This is to include sizing requirements and construction materials to be referenced
during installation. The separation distance between trenches and beds must be
specified.
The disposal field must be constructed in accordance with
AS/NZS1547:2012.
(7)
Water Balance Calculations
Climatic conditions in Coffs Harbour must be considered when calculating the size of
effluent disposal field. Up to date rainfall and evaporation data should be utilised based
on the closest available weather station to the Site. Water balance calculation sheets
should be used for this purpose.
(8)
Nutrient Balance Calculations
Consideration should be given to the uptake and absorption of nitrogen and
phosphorous in effluent disposal field sizing. It should be noted that AS/NZS1547:2012
does not account for nutrient assimilation in the sizing of absorption disposal systems.
Council will not require nutrient sizing of absorption system, though where there is
sufficient land area available, increasing the separation distance between trenches and
beds is recommended.
(9)
Site and Use Considerations
The type of development and its intended use must be considered in the design
process.
(10) Irrigation Design
Wastewater reports which nominate irrigation as the land application method must be
accompanied by an irrigation hydraulic design prepared by a suitably qualified person
or Certified Irrigation Designer (CID).
(11) Operation and Management Plan
Council recommends that designers provide individualised management plans for each
system. A simple operation and maintenance (O&M) plan should be provided for single
domestic systems. A more detailed O&M plan should be provided where the system is
of a commercial nature and or the system is installed without NSW Health Accreditation
under Clause 41 (2) of the Local Government (General) Regulation 2005, and is unique
to the premises.
Further assistance regarding any of the above information please contact Coordinator
On-Site Sewage Management Systems on (02) 6648 4000.
Undertake or Modify Sanitary Plumbing and Drainage or On-Site Sewage Management System (FRM E056) 02/09/2015