NOTIFICATION OF INSTALLATION AND UNDERTAKING
TO MAINTAIN A SEpTIC TANK AND SOIL AbSORpTION SySTEM
INSTRUCTIONS:
1. The owner or agent shall contact Environmental Health Office at least 72 hours before backfilling.
2. Details of any variation from the system proposed and a copy of the appropriate authorization of such
variation must be supplied with this notification.
3. Attach photographs of the system installed, indicating clearly its layout, components
(including geotextile/styrofoam), design features and location on the property. Identify on the back of
each photograph the legal description and permit number.
4. Prior to the issuance of the letter indicating the completion of the permitting process
(should the installation appear satisfactory), this form and attached photographs are to be submitted to:
Environmental Health Services • #2 Hospital Road, Whitehorse, Yukon Y1A 3H8
phone: (867) 667-8391 • fax: (867) 667-8322 • e-mail: Environmental.Health@gov.yk.ca
NOTIFICATION:
Please be advised that an Environmental Health Officer (EHO) was notified (prior to backfilling) that on
___________________ a septic tank and soil absorption system was being installed by self
or:
(date)
Name of installer:
______________________________________________________
Phone number:
__________________________
Fax number:
__________________________
at _____________________________________________________________________________________
(legal description, municipal address, if applicable & plan number)
and that said system was installed in accordance with the permit numbered ___________________________
issued on ___________________.
(date)
UNDERTAKING:
As the owner of the above listed property, I undertake to:
•
inspect and monitor the septic system periodically for integrity and operation;
•
maintain and utilize the system so as to protect the environment and human health;
•
desludge the septic tank at regular intervals to ensure that the sludge depth does not rise above one third
of the liquid depth of the tank (recommended every 2 years);
•
maintain and improve the in-ground soil absorption system, as necessary, so as to effectively receive and
adequately treat all sewage effluent emanating from the unit(s) served; and
•
protect the system from vehicular traffic, and during the winter months, also from pedestrian/animal
traffic, so as not to disrupt snow cover.
I agree that the health officer may carry out such inspection on the premises to determine compliance with
the Public Health and Safety Act and its regulations in relation to the installation or operation of a sewage
disposal system.
Signature of owner: _____________________________
Print name: _______________________________
Address: ___________________________________________________ Postal Code: _________________
Signature of witness: ____________________________
Print name: _______________________________
Date signed: ______________________________
YG(4674EQ)F2 Rev. 01/2008
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