Form Builder

Required fields are marked with asterisks (*)

Application for a Review of Septic System Requirements for Building Additions, Renovations, and Additional Buildings

Any fields not marked with an asterisk are optional. Providing this information, if known, is helpful but not mandatory.

Owner Name

Telephone

Mailing Address

Lot Number

Concession Number

Lot Size

Roll Number

Plan Number

Sub Lot Number

Street Address

Type of Building

Water Supply

Proposed Changes

Please provide a description of your proposed changes and upload a lot diagram and septic system plan. Be sure to show all structures and well locations, dimensions and separation distances for what is existing and proposed.

Please describe your proposed changes:

Please attach a lot diagram and septic system plan showing all structures and well locations, including dimensions and separation distances for what is existing and proposed.

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Existing Septic System

Select the type(s) of septic system(s) currently serving the premises? (Select all that apply.)

Class 1: Outhouse

Class 2: Grey Water Pit

Class 3: Cesspool

Class 4: Septic System (Tank & Filter Bed or Trenches)

Class 5: Holding Tank

Installation year:

Who was the owner at the time of original installation?

File number:

If available, please attach a copy of the Installation Report/Use Permit for your existing system:

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Existing Use

Total Bathroom Fixture Unit Value

Total Powder Room Fixture Unit Value

Total Clothes Washer Fixture Unit Value

Total Laundry Sink Fixture Unit Value

Total Kitchen Sink Fixture Unit Value

Total Existing Fixture Units

Please list any non-standard fixtures, if any, that have not been included above:

Current total area of living space (in metres squared) on property, including guest cabins, bunkies, etc.

If the record of your sewage system is not available and if there is an increase in the sewage flow, it will be assumed that the system is not up to Code and a new system will be required.

Alternatively, the applicant may engage the services of an engineer (with a BCIN number) to conduct a study on the sewage system for which a permit does not exist. If the system is found to meet all the requirements of the Ontario Building Code, the existing system may be accepted. Please contact your Sewage System Inspector to discuss further.

A decrease in the "performance level" beyond the capacity of any component in the system would require compensating construction (upgrading).

Proposed Use

Total Bathroom Fixture Unit Value

Total Powder Room Fixture Unit Value

Total Clothes Washer Fixture Unit Value

Total Laundry Sink Fixture Unit Value

Total Kitchen Sink Fixture Unit Value

Total Proposed Fixture Units

Please list any non-standard fixtures, if any, that have not been included above:

Total area of proposed living space (in metres squared) on property, including guest cabins, bunkies, etc.

Signature of Owner or Authorized Agent

Clear