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Department of the Environment

Water (Northern Ireland) Order 1999

Application For Consent To Discharge Sewage Effluent From A Single Domestic

Dwelling (Form WO2)

Applicant

Agent

n/a

Name:

Address:

Post Code:

Telephone Number:

Email:

Site Details (as above

)

Please provide Grid Reference of

Address:

discharge point

(please indicate on accompanying site plan)

EITHER

Irish Grid (IGR) (letter and 8 digits)

Post Code:

Eastings and Northings

Is there an NI Water Ltd foul sewer/private

C sewer within 30 metres available ?

yes

If yes, please state reason why connection is not possible:

If discharge is to sub-surface irrigation system (soakaway) please complete page 2

If discharge is to waterway please complete page 3

PLEASE ALSO REMEMBER TO SIGN AND DATE DECLARATION AT PART K BELOW

Please note that if this application relates to a sewage treatment system which is in place at the time of application (ie an existing system), the system will be inspected by an authorised officer of the Department to ascertain the current condition of the facilities as part of the application process.

	Please Complete This Section If The Application Is For Discharge To
	Soakaway (Sub-Surface Irrigation System)

D	Type of system proposed or existing:	pre-constructed septic tank (factory built)
D	Type of system proposed or existing:	pre-constructed septic tank (factory built)
		packaged wastewater treatment plant


		block built septic tank


		other (please specify)

E	Is the discharge Proposed	(complete part F )		Existing	(complete part G )
E	Is the discharge Proposed	(complete part F )		Existing	(complete part G )


F Are all elements of the sub surface irrigation system…

	……...at least 7m from any habitable dwelling?		yes	no

	....……...….. at least 10m from any waterway?		yes	no

	….at least 50m from any drinking water supply?		yes	no
	For septic tanks: Is the system certified to		yes	no
	For septic tanks: Is the system certified to		yes	no
	BSEN 12566-1?		if yes, please supply CE certification
			if no, please supply full details
			of the proposed treatment system
			(only for systems not covered by
			part 1 of BS 12566)

For packaged wastewater treatment plants: Is the system certified to BS 12566-3 as

capable of 95% removal of biological oxygen demand (BOD)?

yes

*if yes, please supply CE certification*

if no, please supply full details of the proposed treatment system (only for systems not covered by part 3 of BS 12566)

Enter average Vp value from percolation test (See annex 1 of Guidance) (please complete results table on appendix 1 of this form)

Enter total length and width of proposed drainage trench

G For packaged wastewater treatment plants: Has the system been maintained according
to the manufacturer's specifications?	yes	no	don’t know

For septic tanks and package wastewater treatment plants:

Is the existing sub-surface irrigation system (soakaway) capable of dispersing all of the

effluent	yes		no		don’t know

Please Complete This Section If The Application Is For

Discharge To Waterway

Is the discharge Proposed		or	Existing

I Type of treatment system proposed or existing: (please give details, eg package treatment system please also state if any tertiary treatment eg reedbed will be provided)

Is the system certified to BS 12566-3

yes

n/a (only to be selected

for existing systems)

If yes, please state treatment efficiency (if known)

(% BOD removal. This information can be obtained

from the supplier of your treatment system)

*Please supply CE certification*

If no, please supply full details of the proposed

treatment system

(Only for systems not covered by part 3 of BS 12566)

Declaration

I confirm that I have not provided any information on this form or in the associated documentation

which I know to be false or do not believe to be true.

Signed

applicant

Date

agent

Date

APPLICANT MUST SIGN ABOVE

Please Note: Should the Department discover that any false or misleading information has been

provided, any consent issued shall be invalid. The applicant may also be liable to prosecution.

On completion this form should be returned to; Northern Ireland Environment Agency,

Water Management Unit, 17 Antrim Road, LISBURN, BT28 3AL

Please ensure that you have enclosed:

Site Plan(s)

(1:500)

Location map (1:2500)

Fee

Full details of proposed

treatment system, including

CE certification if applicable

For Official Use Only

Application File Number:

Date Received

Fee Paid (£):

Ref Number:

Appendix 1 Percolation Test Recording Table

Percolation test results and Calculation of Vp.

Hole No.	Test	TEST	START	FINISH	ELAPSED TIME			Vp
	Date	NO.	TIME	TIME				(seconds
								/mm)
					Hours	Minutes	Seconds	(Seconds
								divided
								y 150)

		1
		2
1		3
					Average value for Hole 1

		1
		2
2		3
					Average value for Hole 2

		1
		2
3		3
					Average value for Hole 3

Question	Answer
Form Name	Wo2 Form
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	Northings, wo2 tax form, false, soakaway

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