Title Page
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Street Order Reference
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Street Address
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Photo of Property (Show property number)
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SSD Number
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Access Type
- Road
- path
- front yard
- backyard
- bush
- Parklands
- other
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Access Issues
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Inspection Conducted on
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Inspection Completed by
Drainage Connection
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Is Stormwater Drainage pipe system available in Street?
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Is there any stormwater outlet to the street?
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Take photo of stormwater outlet
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If not connected to stormwater system, stormwater discharges to?
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Take photo of soakage pit
General Observations
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Sewer service diagram appears to reflect the current arrangement?
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Mark SSD in red pen showing actual plumbing arrangement and take photo at end of report
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Take photo of marked up SSD Drawing
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Trees located in vicinity of HSL?
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Take photo of tree/s
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Is property likely to be impacted by local flooding?
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Approximate age of house?
- 0-5 years
- 6-10 years
- 11-20 years
- 21-30 years
- 31-40 years
- 41-50 years
- 51+ years
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Is there a swimming pool?
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Is the swimming pool connected to the wastewater system?
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Is there a rainwater tank?
Down Pipe
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Does down pipe empty over gully?
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Take photo of down pipe over gully
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Does down pipe from shed empty over gully?
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Take photo of down pipe over gully
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Does down pipe run into canal then enter the gully?
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Take photo of down pipe leading into canal then entering the gully
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Does down pipe drain onto path and runoff enters gully?
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Take photo of down pipe leading onto path then entering the gully
Overflow Relief Gully
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Low gully with broken surrounds?
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Take photo of gully
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Low gully next to vent pipe?
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Take photo of vent pipe next to gully
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Old cracked low gully?
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Take photo of cracks in gully
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Low gully near vent pipe on driveway?
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Can local flooding drain into gully?
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Does the rainwater tank overflow pipe drain to the gully?
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Take photo of rainwater tank overflow pipe draining into gully
Boundary Trap
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Is there a Boundary trap in the property?
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Boundary trap location?
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Is the Boundary trap low or damaged?
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Is the Boundary trap cover broken and acting as drain?
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Take photo of broken boundary trap cover
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Is there a broken collar on boundary trap acting as drain?
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Take photo of broken boundary trap collar
Inspection Opening (I/O)
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Is the I/O visible?
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I/O surface level location
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Is the location of the I/O likely to result in damage to the HSL?
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Take photo of I/O location
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Is the I/O cap broken and acting as drain?
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Take photo of broken I/O cap
Outdoor Plumbing
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Is the Vent pipe broken at the base?
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Take photo of Vent pipe broken at the base
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Is the vent pipe cut off acting as a drain?
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Take photo of vent pipe
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Is the vent pipe rusted through at the base allowing water to drain through?
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Take photo of rusted vent pipe
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Is there broken / open pipework allowing water to enter pipe?
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Take photo of broken / open pipework
House Service Line (HSL)
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House Service Line material
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Is there a broken pipe exposed to the surface near gully?
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Take photo of broken pipe
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Is there a large hole in pipe next to gully?
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Take photo of hole
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Is there open pipe visible through ground next to path?
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Take photo of depression
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Is there a depression in the ground near boundary trap?
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Take photo of open pipe
Smoke Test Result
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Smoke Test Completed
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Reason for not completing smoke test?
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Down pipe connected to sewer?
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Take photo of down pipe emitting smoke
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Down pipe from shed connected to sewer?
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Take photo of shed down pipe emitting smoke
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Stormwater gullies / pits connected to sewer?
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Take photo of Stormwater gully / pit emitting smoke
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Property drains connected to sewer?
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Take photo of property drain emitting smoke
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Is there smoke emitted from ground at location of HSL?
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Take photo of smoke emitted from ground
Dye Test Result
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Dye test completed?
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Dye observed in sewer?
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Point of dye infiltration
