Application for a Permit to Construct or Demolish

This form is authorized under subsection 8(1.1) of the Building Code Act,1992

For use by Principal Authority

Application number: Permit number (if different):

Date received: Roll number:

Application submitted to:

(Name of municipality, upper-tier municipality, board of health or conservation authority)

A. Project information
Building number, street name Unit number Lot/con.

Municipality Postal code Plan number/other description

2
Project value est. $ Area of work (m )

B. Purpose of application
Addition to an Conditional
New construction Alteration/repair Demolition
existing building Permit
Proposed use of building Current use of building

Description of proposed work

C. Applicant Applicant is: Owner or Authorized agent of owner

Last name First name Corporation or partnership

Street address Unit number Lot/con.

Municipality Postal code Province E-mail

ON
Telephone number Fax Cell number

D. Owner (if different from applicant)

Last name First name Corporation or partnership

Street address Unit number Lot/con.

Municipality Postal code Province E-mail

Telephone number Fax Cell number

Application for a Permit to Construct or Demolish – Effective January 1, 2014 Page 1 of 4

 E. Builder (optional)
Last name First name Corporation or partnership (if applicable)

Street address Unit number Lot/con.

Municipality Postal code Province E-mail

Telephone number Fax Cell number

F. Tarion Warranty Corporation (Ontario New Home Warranty Program)

i. Is proposed construction for a new home as defined in the Ontario New Home Warranties Yes No
Plan Act? If no, go to section G. ✔
ii. Is registration required under the Ontario New Home Warranties Plan Act? Yes ✔ No

iii. If yes to (ii) provide registration number(s):

G. Required Schedules
i) Attach Schedule 1 for each individual who reviews and takes responsibility for design activities.
ii) Attach Schedule 2 where application is to construct on-site, install or repair a sewage system.

H. Completeness and compliance with applicable law

i) This application meets all the requirements of clauses 1.3.1.3 (5) (a) to (d) of Division C of the
Building Code (the application is made in the correct form and by the owner or authorized agent, all
✔ Yes No

applicable fields have been completed on the application and required schedules, and all required
schedules are submitted).
Payment has been made of all fees that are required, under the applicable by-law, resolution or
regulation made under clause 7(1)(c) of the Building Code Act, 1992, to be paid when the ✔ Yes No
application is made.
ii) This application is accompanied by the plans and specifications prescribed by the applicable by-law,
resolution or regulation made under clause 7(1)(b) of the Building Code Act, 1992.
✔ Yes No

iii) This application is accompanied by the information and documents prescribed by the applicable by-
law, resolution or regulation made under clause 7(1)(b) of the Building Code Act, 1992 which enable
✔ Yes No

the chief building official to determine whether the proposed building, construction or demolition will
contravene any applicable law.
iv) The proposed building, construction or demolition will not contravene any applicable law.
✔ Yes No

I. Declaration of applicant

I declare that:
(print name)

1. The information contained in this application, attached schedules, attached plans and specifications, and other attached
documentation is true to the best of my knowledge.
2. If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership.

Date Signature of applicant

Personal information contained in this form and schedules is collected under the authority of subsection 8(1.1) of the Building Code Act, 1992, and will be
used in the administration and enforcement of the Building Code Act, 1992. Questions about the collection of personal information may be addressed to: a)
the Chief Building Official of the municipality or upper-tier municipality to which this application is being made, or, b) the inspector having the powers and
duties of a chief building official in relation to sewage systems or plumbing for an upper-tier municipality, board of health or conservation authority to whom
this application is made, or, c) Director, Building and Development Branch, Ministry of Municipal Affairs and Housing 777 Bay St., 2nd Floor. Toronto, M5G
2E5 (416) 585-6666.

Application for a Permit to Construct or Demolish – Effective January 1, 2014 Page 2 of 4

 Schedule 1: Designer Information
Use one form for each individual who reviews and takes responsibility for design activities with respect to the project.
A. Project Information
Building number, street name Unit no. Lot/con.
0 Centreville Creek Road
Municipality Postal code Plan number/ other description
Caledon

B. Individual who reviews and takes responsibility for design activities

Name Firm
Nicholas Acchione Allto Construction Services
Street address Unit no. Lot/con.
23 Robb Blvd 1
Municipality Postal code Province E-mail
Orangeville L9W3L1 ON [email protected]
Telephone number Fax number Cell number
519-941-6402 519-941-9551 519-288-6402
C. Design activities undertaken by individual identified in Section B. [Building Code Table 3.5.2.1. of
Division C]
House HVAC – House Building Structural
Small Buildings Building Services Plumbing – House
Large Buildings Detection, Lighting and Power Plumbing – All Buildings
Complex Buildings Fire Protection ✔ On-site Sewage Systems
Description of designer’s work
Septic design for proposed dwelling.

D. Declaration of Designer

I Nicholas Acchione declare that (choose one as appropriate):

(print name)

I review and take responsibility for the design work on behalf of a firm registered under subsection 3.2.4.of Division
C, of the Building Code. I am qualified, and the firm is registered, in the appropriate classes/categories.
Individual BCIN: 110044
__________________________________________

Firm BCIN: 17183

__________________________________________

I review and take responsibility for the design and am qualified in the appropriate category as an “other designer”
under subsection 3.2.5.of Division C, of the Building Code.
Individual BCIN: __________________________________________

Basis for exemption from registration: ________________________________________________________

The design work is exempt from the registration and qualification requirements of the Building Code.
Basis for exemption from registration and qualification: ___________________________________________
I certify that:
1. The information contained in this schedule is true to the best of my knowledge.
2. I have submitted this application with the knowledge and consent of the firm.

21-Dec-22
Date Signature of Designer

NOTE:
1. For the purposes of this form, “individual” means the “person” referred to in Clause 3.2.4.7(1) (c).of Division C, Article 3.2.5.1. of
Division C, and all other persons who are exempt from qualification under Subsections 3.2.4. and 3.2.5. of Division C.
2. Schedule 1 is not required to be completed by a holder of a license, temporary license, or a certificate of practice, issued by the Ontario
Association of Architects. Schedule 1 is also not required to be completed by a holder of a license to practise, a limited license to practise,
or a certificate of authorization, issued by the Association of Professional Engineers of Ontario.

Application for a Permit to Construct or Demolish – Effective January 1, 2014 Page 3 of 4

 Schedule 2: Sewage System Installer Information
A. Project Information
Building number, street name Unit number Lot/con.

Municipality Postal code Plan number/ other description

B. Sewage system installer

Is the installer of the sewage system engaged in the business of constructing on-site, installing, repairing, servicing, cleaning or
emptying sewage systems, in accordance with Building Code Article 3.3.1.1, Division C?

Installer unknown at time of

✔ Yes (Continue to Section C) No (Continue to Section E)
application (Continue to Section E)

C. Registered installer information (where answer to B is “Yes”)

Name BCIN
Nicholas Acchione 110044
Street address Unit number Lot/con.
23 Robb Blvd 1
Municipality Postal code Province E-mail
Orangeville L9W3L1 ON [email protected]
Telephone number Fax Cell number
519-941-6402 519-941-9551 519-288-6402
D. Qualified supervisor information (where answer to section B is “Yes”)
Name of qualified supervisor(s) Building Code Identification Number (BCIN)

Nicholas Acchione 110044

E. Declaration of Applicant:

I declare that:
(print name)

I am the applicant for the permit to construct the sewage system. If the installer is unknown at time of application, I shall
submit a new Schedule 2 prior to construction when the installer is known;
OR
I am the holder of the permit to construct the sewage system, and am submitting a new Schedule 2, now that the installer is
known.

I certify that:
1. The information contained in this schedule is true to the best of my knowledge.

2. If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership.

Date Signature of applicant

Application for a Permit to Construct or Demolish – Effective January 1, 2014 Page 4 of 4

Client Name: Pavel Wali
Project Address: 0 Centreville Creek Road, Caledon
Project Number: S-21-212
Date: December 22, 2021
Design By: P.Roque
Check By: D.Summers

T' time Assumed T= > 50

Total m² of dwelling (m²) 420 m²
Total # of bedrooms 7

Daily Design Flow Rates for Residential Occupancy "Q"

5 bedroom dwelling 2,500 L/Day

Additional Flow Calculations

1) For each bedroom over 5 = 500L/Day = 1,000 L/Day
Total Daily "Q" Based on # of Bedrooms = 3,500 L/Day
2) a) For each 10m² over 200m² up to 400m² = 100L/Day = 2,000 L/Day
b) For each 10m² over 400m² up to 600m² = 75L/Day = 150 L/Day
c) For each 10m² over 600m² = 50L/Day = 0 L/Day
Total additional flow from m² = 2,150 L/Day
Total Daily "Q" Based on m² = 4,650 L/Day
3) For each fixture unit over 20 fixture units = 50L/Day = 50 L/Day
Total additional flow from fixtures units over 20 = 1,775 L/Day
Total Daily "Q" Based on Fixture Units = 4,275 L/Day
Total Daily Design "Q" 4,650 L/Day

Type "Q" Multiplier Septic Tank Size (L)

Residential 4,650 2 9,300

Type A Dispersal Beds

Area of stone if Q > 3000L = Q/50 = 93.00 m²
Area of sand if T > 15 min/cm = QT/400 = 581.25 m²

Septic Design Brief

We propose to install a new Anerobic Digestor Model, ADIPC-13500 concrete tank with an internal pump chamber
that pumps to a Waterloo Biofilter Model BA50 basket treatment system unit, housed in a BT-11250 concrete tank.
The basket treatment unit is then pumped to a Type 'A' Dispersal Bed.

We further propose to install a Type 'A' Dispersal Bed with a contact area of 627m² (> 581.25m²) complete with a
15m mantle, stone area of 101.5m² (> 93m²) and seven (7) PVC runs that are 13.5m in length and 75mm in
diameter. The runs will be complete with a double header, tied ends and filter cloth as required. Distribution pipes
to be detectable by means of 20M rebar at the outside corners and to meet all set back requirements laid out by
the Ontario Building Code.
 t- So
Design Galeul ons For
Cel/-r1zA/tur PA

TOTAL BEDROOTV1S 5 t 2s<fr Base Daity Fiow Arnount

of GoNunrn will he addeel'tothe Ease Rate
Additisnal orrer 5----------> Each bedroor"n over 5, 500 {_ per beclroorn

EiXT,tlRE try{lTS Totail# t_oad TAIAL

BATI..IROO;VI GROUP 6 6 36 of one domestic-type lavatory or 2

single with common trap, one water closet and
one bathtub, or one shower.

BATHTUB 1.5 l,r with or without shower head

TOILET t 4 4
SHOWER UiliIT 1.5
SINK I 1.5 /, i'
Flatorz bflfn\J P" I z z
LAVATORY 3 1
3
BIDET 1

KITCHEN SINK
DISFIWASHER
z/ 1.5
1.5 e3l.r No load if connected to a domestic sink.
LAUNDRY TUts / 1.5
CLOTHES WASHER
GARBAGE GRINDER
z 1.5
3
3
F'IXTIJRE UirllT TOTA[-
Additional over 20 r additional fixture unit over 20, adcl 50L

Itotat tiving Space (Exctuding Basement)

Itotatmz So Each 10m2 over200 upto400, 100 L per 10m2

BASE Taken from bedroom total

Additional F

Maximum Daily Flow Potentialof Residence.

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