On Site Sewage Management Facility Inspection Form V3

OSSM Inspection

• OSSM File

• Property Owner

• Property Address

• Lot and DP

• Conducted on

  Date

• Prepared by

• Personnel

Property Details

• Type of System

  Select Absorption Aerated Dry & Wet Composting / Humus Transpiration Pump Out Grey Water

  • Absorption
  • Aerated
  • Dry & Wet Composting / Humus
  • Transpiration
  • Pump Out
  • Grey Water

• Number of Bedrooms

  Select 1 2 3 4 5+ Other

  • 1
  • 2
  • 3
  • 4
  • 5+
  • Other

• Number of Bathrooms

  Select 1 2 3 4 5+ Other

  • 1
  • 2
  • 3
  • 4
  • 5+
  • Other

• Water Source

  Town

  Tank

  Other

Risk Assessment Factors

• Is the property sufficiently large enough for the system being used?

  Yes

  No

  N/A

• Risk Rating

  High

  Medium

  Low

  N/A

• Is the volume of waste putting the system at risk of failure?

  High

  Medium

  Low

  N/A

• Is the site well covered with either grass or established gardens?

  Yes

  No

  N/A

• What basic soil type is present (if known)?

  Clay

  Loam

  Sand

  Shallow bedrock

  Unknown

• Risk based on soil type

  High

  Medium

  Low

  N/A

Effluent Disposal Area

• Add media

  Media

• Is there an established effluent disposal area that is being satisfactorily managed?

  Yes

  No

  N/A

• Does the system have a sufficient number of sprinklers to evenly distribute treated effluent over the irrigation area?

  Yes

  No

  N/A

• Location of nearest water course

  <20m

  20-50m

  50-100m

  100m+

• Distance to drain

  <20m

  20-50m

  50-100m

  100m+

• Distance to neighbouring property

  <20m

  20-50m

  50-100m

  100m+

• Is there evidence of surface effluent or water logging of ground?

  Yes

  No

• Risk created by surface effluent or water logging?

  High

  Medium

  Low

  N/A

• Is any effluent migrating off the property

  Yes

  No

• Is there any odours detectable?

  Yes

  No

System Components and Servicing

• Are all components of the tank in working order

  Yes

  No

  N/A

• Risk created by faulty components

  High

  Medium

  Low

  N/A

• Add media

  Media

• Has the solids tank been de-sludged?

  Yes

  No

  N/A

• Does the owner / occupant have a good understanding of the components and operation of the system?

  Yes

  No

  N/A

• Risk based on owners knowledge of the system

  High

  Medium

  Low

  N/A

• Is there a reason for immediate failure?

  Yes

  No

• Reason for immediate failure

  Media

• Assessment date

  Date

• Assessor

  Sign

• System rating

  High

  Low