ࡱ>  bjbj 4||nE(((8`l(4Xn_V$74949494949494$6d9R]4__]4r4R7474r{&T{'Y&#4404&99{'{'9' L96o,$]4]4?49 :   REBATE ON APPROVED RAINWATER TANK INSTALLATION (ONE PER DWELLING) SINGLETON COUNCIL PO BOX 314 SINGLETON NSW 2330 Phone: 02 6578 7290 Fax: 02 6572 4197 www.singleton.nsw.gov.au Please note the offer applies to ratepayers who are connected to the town water supply of Singleton, Broke or Jerrys Plains. The purchases must be made after 1July2012 and be installed in a dwelling constructed and occupied before 1July2004 (pre BASIX dwellings). To apply for the rebate, you must be the owner or managing agent of the property where the tank is to be installed. PERSONAL DETAILSName:Installation Address:Date the dwelling was constructed and occupied:Phone (Home):Phone (Work):Assessment No:Parcel No: PAYEE DETAILSName:Postal Address:Phone (Home):Phone (Work): OFFICE USE ONLYGeneral Ledger No:6000.707Rebate Amount:$Parcel No: TANK DETAILSPurchased from:Purchased Date:_____ / _____ / _____(please attach your receipt to this form)Tank Volume:(please advise volume in litres)Installed by:Material of Manufacture: (please tick the appropriate box)( Polyethylene( Aquaplate( Corrugated Iron( Zincalume( Concrete( Other (please describeIs the tank new?:( Yes( NoHas the tank already been installed?:( Yes( No LEVEL OF REBATE Which level of rebate and options are you applying for? (please tick appropriate boxes) LevelVolume (litres)Rebate ($)(12,000 3,999$100.0024,000 8,999$250.0039,000 or more$450.00 INSTALLATION DETAILS Please note that where tank water is supplied for toilet flushing and/or the laundry, and where there is the potential for indirect or direct connection to the town drinking (potable) water supply, special precautions in order to ensure backflow prevention, must be taken and a Development Application will be required to be submitted. Where the tank volume exceeds 22,500 litres, Council approval for the installation of the tank will be required under all circumstances. Please also note that installation of a rainwater tank on properties carried by a mains pressure town water supply may also require development consent under other circumstances. You are therefore required to refer to Councils Exempt and Complying Development DCP:  HYPERLINK "http://www.singleton.nsw.gov.au/templates/singleton_content.aspx?edit=false&pageID=432" \o "http://www.singleton.nsw.gov.au/templates/singleton_content.aspx?edit=false&pageID=432" http://www.singleton.nsw.gov.au/templates/singleton_content.aspx?edit=false&pageID=432 or contact Councils Customer Service Centre prior to proceeding. Does the installation include an indirect connection of the town water supply for the purpose of topping up the rainwater tank during periods of low rainfall?( Yes( No If yes, has a visible air gap, external to the rainwater tank, been provided?( Yes( No Does the installation include a direct inter-connection (cross-connection) of the town water supply and rainwater supply pipework?( Yes( No Has a Backflow Prevention Device been fitted by a licensed plumber?( Yes( No What type of Backflow Prevention Device has been fitted? (please tick appropriate boxes) No new device has been fitted New dual check valve water meter Non testable dual check valve Testable double check valve Reduced pressure zone valve (RPZ) LICENSED PLUMBERS DECLARATIONName:Business Name:Plumbers License No:Postal Address:Phone (Business):Mobile: I certify that I have done the plumbing work required to connect the rainwater tank supply on this property and this has been done in accordance with Council plumbing requirements and all relevant standards and codes. Signature:Date: PROPERTY OWNER/MANAGING AGENT DECLARATION I declare that: I have read and understand the information provided with this form. The information contained in this application is truthful and correct and I am eligible for the rebate. The rainwater tank supplier has explained the design and expected performance of the rainwater tank to me in full. I have read and understood the Terms and Conditions of the rebate program and agree that by signing this application, I accept these Terms and Conditions. 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