A well designed system protects our natural water resources...

The Online Form below is information for BC Interior Health
Thank you for taking the time to fill out the information form.

Our local agent will contact you.

Red Fields Only are required to be filled in or checked off.

Tax Assessment Roll#

(Note: We will need a copy of your tax assessment for filing):
Date of Application:

SYSTEM TYPE

New Construction Repair Alteration Amendment or Update

Email Address:
Owner's Name(s):
Owner's Phone Number:
Owner's Mailing Address:
Name of Authorized Person:
Authorized Person Phone Number:
Legal Description of where lot is to be constructed:
Street Address and General Description of lot location:

Sewage System will serve:

Single Family Dwelling Duplex Other
Other Description:

Estimated Daily Sewage Flow:
Number of Bedrooms:
Is there a finished basement:
Do you intend to add a basement suite or more bedrooms in future?:
Total Living area:
Lot Size (acres, sq ft, or sq m):

Type of Sewage Disposal System:

Conventional Privy Lagoon Holding Tank Raised Mounds Seepage Bed Deep Trench Other
Other Description:

Material of Tank:
Liquid Volume of Tank:
Total length of Drainage pipe:
Type of Drainage Pipe:
Inside Diameter of pipe:
Package Treatment Plant (if used) Make and Model:
Treatment Capacity (if used):
Will a sewage pump be used:
Field Dose Volume pumped per cycle:
Is pressure distribution proposed:
Lagoon Size:
Depth of Clay Soil:
Is a garburator to be used:

Site Information:

Is depth of soil over or under 4 feet:
If under is it due to rock or clay, and how deep from surface:
Is depth to water table over four feet:
Who performed the percolation tests:
What is the average slowest rate from each test hole:
Describe the source of your domestic water:
Distance of disposal field to domestic water:
Describe any covenants or easements which restrict the system design:
Do you have a plot plan (with dimensions) that shows where you would like tank and drainfield: