Camden Council Site Assessment For An Approval To Operate

• Property No.

• Conducted on

  Date

• Diana Davis

• Location
  Address

Owners Details

• Name

• Address

• Phone

Occupier Details

• Name

• Address

• Phone

• Slope

• Water Source

  Reticulated

  Tank

• Exposure

  Good

  Average

  Poor

• Number of Bedrooms

  2

  3

  4

  5

  6

• Number of Occupants

  2

  3

  4

  5

  6

• Nearest house (m)

• Rental Property

  Yes

  No

• Allotment size

• Water conservation devices

• Septic tank/pump out

• Septic tank/transpiration bed

• Septic tank/absorption area

• Waterless Composting Toilet

• AWTS/surface irrigation

• AWTS/sub-surface irrigation

• Greywater system

• Wet Composting Toilet

• Other

• Last service/desludging

• AWTS service agent

• Number of tanks

  1

  2

• Age of system

• Are the tanks above ground 100mm

  Yes

  No

• Condition of tank

  Excellent

  Good

  Fair

  Poor

• Manufacturer

• Grease Trap

  Yes

  No

  N/A

• Does trap require cleaning

  Yes

  No

• Grease trap condition

  Excellent

  Good

  Fair

  Poor

• Comments

• Greywater system present

  Yes

  No

  N/A

• Is greywater system Council approved

  Yes

  No

• Comments

• If the system is pump out, who collects the effluent Contractors name and license number

• Type of application area

• Size of primary application area (msq)

• Size of secondary application area (msq)

• Flood potential

  Yes

  No

• Erosion potential

  Yes

  No

• Any run-on or seepage

  Yes

  No

• Condition of disposal field

  Good

  Average

  Poor

• Vegetation present

• Topography

• Site drainage

  Excellent

  Good

  Fair

  Poor

• Surface rocks present

  Yes

  No

Distance of land application area to (m)

• Water course/dam

• Bush land

• Property boundary

• Easement

• Swimming pool

• Paths/driveways

• Buildings

• Other

• Do buffer distances satisfy Environment & Health Guidelines

  Yes

  No

• Distribution line buried

  Yes

  No

• Condition of line

  Satisfactory

  Unsatisfactory

• Odour present (chlorine, effluent)

  Yes

  No

• AWTS operating at time of assessment

  Yes

  No

• Is effluent distributed only within the property

  Yes

  No

• Are any unapproved fittings used on the irrigation system

  Yes

  No

• Comment

• Is the service history up to date for previous 12 months

  Yes

  No

• Is the AWTS fitted with a malfunction warning system

  Yes

  No

• Is there an operator's manual on site

  Yes

  No

• What activities is the land application used for

• Is there any run-off from the land application area

  Yes

  No

• Number of sprinklers

• Coverage of sprinklers (msq)

• Comment

• Is the absorption trench parallel with the contours of the land

  Yes

  No

• Is the absorption trench / transpiration bed protected from damage

  Yes

  No

• Is the absorption trench / transpiration bed area fenced off dimensions of

  Yes

  No

• Dimensions of trench or bed (msq)

• Are the visible signs of effluent resurfacing / pooling

  Yes

  No

• Comments

• Is there an external door or extraction chute to collect humus

  Yes

  No

• Does the fan operate continuously

  Yes

  No

• How is the compost humus used

• How is greywater managed

• Is there an instruction notice in a fixed position

  Yes

  No

• Comment

• Are there any specific environmental constraints

• Is there any specific health constraints

• Are there any impacts to adjoining properties

• Site Plan

  Drawing

• Recommendations

System Assessment

• Rating code: 1. Unlikely impact
  2. Potential impact
  3. Existing impact

• Impact on Public Health

  1

  2

  3

• Impact on water quality

  1

  2

  3

• Impact on native flora

  1

  2

  3

• Impact on community amenity

  1

  2

  3

• Impact on soil

  1

  2

  3

• Readier/Operating Approval Due

  High 2 years

  Moderate 4 years

  Low 6 years

• Signature

  Sign