Certification of hydrostatic testing / Economy, Planning Environment
Engineering and Environmental Assessment
City Development
PO Box 5042 GOLD COAST MC QLD 9729
P075582 8393F075582 8870
E
Wcityofgoldcoast.com.au

Please use BLOCK LETTERS and complete all details in full

Privacy statement

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Note: All pipe work must be inspected by a Council plumbing inspector.

This form is to be completed and submitted to Plumbing and Drainage prior to final inspection.

This certificate is to be used for the Certification of Hydrostatic Testing on bath wastes, air testing soil and waste stacks and/or pressure testing of the in-groundwater service and rough-ins in houses and duplexes only.

Approval details
Lot number / Registered plan number
Property address
Existing approval number / (if applicable)
Licensed plumber / drainer details
Name
Postal address
Primary phone / Alternative phone
Licence number
Fees
There is no fee associated with this form.
Declaration
I declare that:
  • The information provided in this form is complete and correct.
  • I have read the privacy notice.
  • I, the approved person stated above have tested and commissioned the plumbing and drainage in accordance with the relevant applied provision. I hereby state the plumbing and drainage complies with the relevant applied provision in accordance with the Standard Plumbing and Drainage Regulation 2003.

Date of test / Checked
Floor waste gully branches to bath outlets have been hydrostatically tested and comply with section 15 AS/NZ3500.2.2015.
Soil and waste stacks/elevated pipework have been air testedand comply with section 15 AS/NZ3500.2.2015.
Water rough-in has been hydrostatically tested and complies with section 18 AS/NZ3500.1.2015.
In-ground water service has been hydrostatically tested and complies with section 18AS/NZ3500.1.2015.
Print name / Licence number
Signature / Date

Document # 17214728 v17Last Updated9/04/14Page 1 of 1