QES Management System
Issue Date: 19/09/2014
Recycled Water Standpipe Permit
Application or Renewal
City West Water
Address Locked Bag 350, Sunshine 3020
Email connections@citywestwater.csdfom.au
Phone 9313 8379
To apply for a permit to use a Recycled Water Standpipe within City West Water’s operating area, please read and complete this form, sign
and submit by mail to Connections & Metering Services, City West Water, Locked Bag 350, Sunshine Vic 3020. In addition to the
posted copy if filled in electronically this form can be emailed to the address below to quicken processing of your application. However, a
Permit will not be issued until the signed hard copy is received. **For queries regarding permits – phone 9313 8379 or email
connections@citywestwater.com.au
OFFICE USE ONLY
Permit No:
Usage:
Applicant details
Company name:
Company address:
ABN/ACN:
Owner/CEO name:
Company contact:
Office phone:
Fax:
Mobile:
Email:
Upon approval of a permit application, the terms and conditions set out in this document (including the Conditions of Permit set
out below) apply to the permit that is issued.
Usage information
A.
Number of vehicles that will be used to connect to Standpipe:
B.
Approx. number of times standpipe will be used (per vehicle):
C.
Have you stated the Intended End Uses of the recycled water you supply?
D.
Have the Conditions of Permit been read and signed, and do you understand that all sites receiving recycled water must be declared
to CWW & must have an approved End User Permit/EIP?
Yes
E.
No
Yes
No
If no, please contact City West Water to discuss.
Please provide the following information for all vehicles – see next page (if more than 3 vehicles require a permit, please complete
“Application for Additional Vehicles” form.
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Vehicles to Register
Vehicle 1
Vehicle Reg. no:
Tanker Reg. No:
Do you currently hold a hydrant permit for this vehicle?:
If yes, provide details below
Size (kL):
Yes
No
With which Water Authority does this vehicle have a hydrant permit?
CWW
SEW
YVW
Other (please detail)
Name of permit holder:
Hydrant permit number:
Backflow prevention device:
Registered Air Gap
Registered Pressure Zone Device (RPZ)
Provide latest test results of Registered Air Gap or RPZ device
Test results included
Do you currently hold a recycled water (RW) permit for this vehicle from another Water Authority? If yes, provide details below.
Yes
No
With which Water Authority does this vehicle have a hydrant permit?
CWW
SEW
YVW
Other (please detail)
Name of permit holder:
Recycled water permit number:
Recycled water class:
Bottom filling tankers only (top filling not permitted)
Type of air release:
Manual
Auto
None on roof
Describe method of opening/closing roof hatch including detail of release mechanism as an attachment.
Vehicle 2
Vehicle Reg. no:
Tanker Reg. No:
Do you currently hold a hydrant permit for this vehicle?:
If yes, provide details below
Size (kL):
Yes
No
With which Water Authority does this vehicle have a hydrant permit?
CWW
SEW
YVW
Other (please detail)
Name of permit holder:
Hydrant permit number:
Backflow prevention device:
Registered Air Gap
Registered Pressure Zone Device (RPZ)
Provide latest test results of Registered Air Gap or RPZ device
Test results included
Do you currently hold a recycled water (RW) permit for this vehicle from another Water Authority? If yes, provide details below.
Yes
No
With which Water Authority does this vehicle have a hydrant permit?
CWW
SEW
YVW
Other (please detail)
Name of permit holder:
Recycled water permit number:
Recycled water class:
Bottom filling tankers only (top filling not permitted)
Type of air release:
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Manual
Auto
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None on roof
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Vehicle 3
Vehicle Reg. no:
Tanker Reg. No:
Do you currently hold a hydrant permit for this vehicle?:
If yes, provide details below
Size (kL):
Yes
No
With which Water Authority does this vehicle have a hydrant permit?
CWW
SEW
YVW
Other (please detail)
Name of permit holder:
Hydrant permit number:
Backflow prevention device:
Registered Air Gap
Registered Pressure Zone Device (RPZ)
Provide latest test results of Registered Air Gap or RPZ device
Test results included
Do you currently hold a recycled water (RW) permit for this vehicle from another Water Authority? If yes, provide details below.
Yes
No
With which Water Authority does this vehicle have a hydrant permit?
CWW
SEW
YVW
Other (please detail)
Name of permit holder:
Recycled water permit number:
Recycled water class:
Bottom filling tankers only (top filling not permitted)
Type of air release:
Manual
Auto
None on roof
Intended End Uses
Please state the intended End Use of the recycled water you will be supplying. You may nominate more than one intended use.
Permitted uses of Class A recycled water:
Irrigation of lawns, trees and garden beds
External pressure cleaning
Irrigation of sports grounds and parklands
Fire fighting
Washing vehicles
Irrigation of food and non-food crops
Dust suppression
Other (please describe):
Livestock drinking water
IMPORTANT:
A vehicle that has been used to supply recycled water must not be used to supply potable water for human consumption, food
preparation, swimming pools or ice making. For more information on food safety requirements and the carting of drinking water,
see the Environmental Health section of the Department of Human Services website (http://www.health.vic.gov.au/environment/).
If at any time the Permit holder becomes aware of an incident which may involve a contamination of the drinking water supply
system or recycled water supply, the Permit holder must immediately contact City West Water on 131 642.
What is the End User (EU) Permit number of the end user(s) you are intending to supply?
EU
EU
EU
EU
Applying separately for own EU permit
Intended end user
is applying separately for own EU permit
(company name)
(http://www.citywestwater.com.au)
Not yet know – details intentions:
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Conditions of permit
Cartage of Recycled Water
Training
1. Only those vehicles listed on this permit are authorised to
access and take water from the recycled water standpipe. If
there are additional vehicles that the applicant wishes to
register the permit holder must make application in respect
of these vehicles and obtain written confirmation from CWW
that these vehicles are covered by this permit.
1.
2. All vehicles used to cart recycled water must have a
Recycled Water Permit Holder sticker displayed at all times
as issued by City West Water.
1. The Permit holder:
Use of Recycled Water
(a) acknowledges and agrees that the recycled water is only
to be used for Intended End Uses that have been
approved by City West Water;
3. All vehicles used to cart recycled water must have signage
permanently located on all outlets displaying Prohibition Sign
No. 404 and the words “Recycled Water Do Not Drink”
visible from 5m (minimum height of lettering 25mm).
(b) without limiting 1:
i. acknowledges that recycled water must be used in
accordance with applicable legal and regulatory
requirements, including Department of Human
Services (DHS) requirements and Environment
Protection Authority (EPA) requirements set out in
Publication 464.2 Guidelines for Use of Reclaimed
Water;
4. The Permit holder acknowledges that unauthorised
connection of a recycled water vehicle to the potable water
system presents a significant risk to public health and must
not be undertaken under any circumstances.
5. A vehicle that has been used to supply recycled water must
not be used to supply potable water for human consumption,
food preparation or ice making. For more information on food
safety requirements and the carting of drinking water, see
the Environmental Health section of the Department of
Human Services website
(http://www.health.vic.gov.au/environment/).
ii. must ensure that all sites receiving recycled water are
registered with City West Water and have an approved
Environment Improvement Plan (EIP) or End Use
Protocol/Permit which specifies the conditions of use
of recycled water use on that site
(c) acknowledges and agrees that it is responsible for the
recycled water during transit and will deal with any
spillage or discharge of recycled water in accordance
with EPA Publication 464.2 Guidelines for Use of
Reclaimed Water Guidelines
6. A vehicle that has been used to collect, transport or deliver
Class A recycled water must not subsequently be used to
collect, transport or deliver potable water (for any purpose)
unless a registered air gap or reduced pressure zone device
as depicted in AS/NZS 3500.1:2003 Page 8 diagrams a) or
b) is permanently installed on the vehicle, and testing
results/ certification of registered air gap or backflow
prevention device is supplied to City West Water on an
annual basis.
2.
The Permit holder must keep records of all sites receiving
recycled water and of volumes supplied to all sites.
General Conditions
1. Recycled water is a limited resource and CWW is entitled to
revoke this Permit by notice to the Permit holder at any time
in its unlimited discretion in order to ensure that the resource
is directed towards the most appropriate uses. Without
limiting this right, where the Permit holder is in breach of one
or more of these Conditions of Permit CWW will be entitled
to revoke the Permit immediately by notice.
7. The Permit holder must only collect recycled water that is
of a Class A quality and must not use the vehicle to collect,
transport or deliver water that is of a quality inferior to
Class A.
8. Recycled Water Permit holders who also hold a Permit to
access fire hydrants and fire plugs must act in accordance
with the terms of the Hydrant Permit.
2. The Permit holder must provide City West Water with access
to any property or information reasonably required by CWW
in order to allow CWW to audit compliance with these
Conditions of Permit, or to perform audits required by the
Environment Protection Authority or under applicable
laws/regulations.
9. If at any time the Permit holder becomes aware of an
incident which may involve a contamination of the drinking
water supply system or recycled water supply, the Permit
holder must immediately contact City West Water on
9313 8379.
Occupational Health & Safety
3. CWW may suspend the supply of recycled water under this
permit if the water quality does not meet the Class A
requirements.
1. The Permit holder must ensure that any person involved in
accessing the standpipe and drawing water under the
authority of this permit attends a site induction at the
Western Treatment Plant (WTP) to become familiar with site
protocols and access arrangements to the standpipe prior to
accessing the standpipe, and they must be available to
attend safety meetings if requested by Melbourne Water.
The site induction can be arranged by contacting WTP on
Phone: 9742 9211 or Mobile: 0419 553 821.
Document FOR-261
The Permit holder is responsible for ensuring all drivers and
recycled water operators are aware of and comply with all
Conditions of Permit and are trained to handle recycled
water accordingly.
4. The Permit holder will not be entitled to any compensation,
costs, loss or damages arising from or in any way related to
the revocation of this Permit or the suspension of supply of
recycled water.
5. The Permit holder agrees to indemnify CWW from and
against any claims, costs, loss or damage suffered or
incurred by CWW as a direct result of any breach of these
Permit Conditions by the Permit Holder.
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Applicant to sign:
I have read and agree in full with terms and conditions of this Permit including the Conditions of Permit:
Signature:
Title & name of signatory:
Date:
Important privacy notice
By completing this form you are providing personal information to City West Water for the primary purpose of City West Water providing you
with a water or sewerage supply. To read City West Water's complete privacy statement, please visit citywestwater.com.au.
CWW to complete
This permit application has been approved by:
Signature:
Date:
Metering & Compliance Coordinator
Signature:
Date:
Manager Connections and Metering
Comments:
Information for Recycled Water Standpipe Permit Holders
Ongoing Requirements
Standpipes Hours of Operation
Western Treatment Plant
Monday - Sunday 6am - 9pm
Hoppers Lane
24 hrs - access key required
Signage on Vehicles
All vehicles used to cart recycled water must have Recycled Water Permit Holder stickers displayed at all times. Stickers will be
mailed to the recycled water permit holder with the recycled water standpipe approval letter.
Accessing Recycled Water through the Electronic System

Upon approval of your permit, a recycled standpipe permit card will be issued to each vehicle.

Card must be kept in your corresponding vehicle at all times as it displays your PIN to access recycled water.

Carters must also have an End User PIN provided by the end user to enter into the system.
Ongoing Requirements of Permit Holders
All sites that receive recycled water must be registered with City West Water and must have an approved Environmental
Improvement Plan (EIP) or End Use Protocol which specifies the conditions of recycled water use at that site.
Permit holders must ensure that all end users are registered with City West Water prior to supplying recycled water.
Ongoing Auditing by City West Water
City West Water has an ongoing monitoring program to ensure that Standpipe Permit Holders and Recycled Water End Users are
fulfilling their requirements. The Permit Holder must provide City West Water with access to any property or information reasonably
required by CWW in order to allow CWW to audit compliance with the Conditions of Permit, or to perform audits required by the
Environment Protection Authority or under applicable laws/regulations.
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Information for Recycled Water Standpipe Permit Holders who also hold a Hydrant Permit
Persons holding a Recycled Water Standpipe Permit who also hold a
Hydrant Permit must read and understand the following.
Vehicles that have been used to collect recycled water MUST NOT be
used to cart water that is intended for drinking.
City West Water permits a truck to access both Class A recycled water
and potable water under the following strict conditions. Failure to
comply with these conditions will result in immediate annulment of
both permits.
UNAUTHORISED ACCESS TO THE POTABLE WATER SYSTEM IS A
PUBLIC HEALTH RISK AND IS CONSIDERED A SERIOUS
OFFENCE.
A vehicle that wishes to be a dual permit holder:
1. Should NOT supply potable water for human consumption/drinking
2. Should only collect recycled water that is of a Class A standard
supplied by City West Water
3. Should have one of the following filling arrangements permanently
installed on the vehicle:
i.
A permanent registered air-gap as depicted in Figure A.
ii.
A reduced pressure zone device as shown in Figure B.
4. Certification of the registered air gap or the reduced pressure zone
must be provided to City West Water on an annual basis.
5. Should have prohibition sign 404 with the words ‘Recycled Water Do
Not Drink” permanently displayed on all outlets of the truck (See
Figure C)
6. Should have both permit stickers displayed at all times.
7. Must be approved by City West Water. Arrangements can be made
by contacting City West Water’s Water Connections and Technical
Officer on 9313 8379.
City West Water has an auditing program in place to ensure the ongoing
compliance of all recycled water permit holders.
City West Water
ABN 70 066 902 467
Locked Bag 350
Sunshine Victoria 3020 Australia
Document FOR-261
Account and general enquiries: 131 691
Faults and emergencies: 132 642
Interpreter service: 131 450
Internet: citywestwater.com.au
Email: connections@citywestwater.com.au
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