On-site Sewage Management System Inspection Checklist

• Site conducted

  Select

• Date of Inspection

  Date

• Date of Last Inspection

  Date

• Property Address

• File Number

• Prepared by

• Does anyone in your household have COVID-19 symptoms?

  Yes

  No

  N/A

• Has anyone in your household been in contact with a positive case of COVID-19?

  Yes

  No

  N/A

• Has anyone in your household been to any hot-spot locations or venues of concern?

  Yes

  No

  N/A

General

• Treatment method/system type

  Septic

  Aerated

  Other

• Disposal method

  Absorption Trench

  Surface Irrigation

  Subsurface irrigation

  Pump-out

  Other

• Grey water system present

  Yes

  No

  N/A

• Type of tank

  Select Concrete Plastic Fiberglass Baffled

  • Concrete
  • Plastic
  • Fiberglass
  • Baffled

• Tank capacity ltrs

• Tank location

  Frontyard

  Backyard

  Side

  Unable to be identified

• Disposal area location

  Frontyard

  Backyard

  Side

  Unable to be identified

• Lid above ground level (100mm)

  Yes

  No

• Condition of tank

  Good

  Cracked

  Needs Repair

• Inspection openings

  Accessible

  Concreted

  Inaccessible

  Buried

• Inlet junction

  Clear

  Blocked

  In Place

  MIssing

  Inaccessible

• Outlet junction

  Clear

  Blocked

  In Place

  MIssing

  Inaccessible

• Scum level

  Low

  Medium

  High

  Not Seen

• Desludge required

  Yes

  No

  Suggested

• Filter installed

  Yes

  No

  Suggested

• Odour present at time of inspection

  Yes

  No

• Surface water present at time of inspection

  Yes

  No

• Disposal area dry at time of inspection

  Yes

  No

  Damp but Firm

  Very Damp

  Water Pooling

• Disposal area maintained

  Yes

  No

• Treatment tank distance from residence

• Disposal area distance from residence

• Distance from nearest body of water

• Description of body of water

  Creek

  River

  Dam Permanent

  Storm-water easement

  Intermittent

• Is there are bore or well?

  Yes

  No

• Distance of tank from the nearest boundary

• Distance of disposal area from nearest boundary

• Distance of disposal area from nearest downhill boundary

• Is Stormwater runoff diverted away from the disposal area?

  Yes

  No

• Are there any stony outcrops near the disposal area?

  Yes

  No

• Number of bedrooms in house

• Number of adults/children in residence

• Water source

  Tank

  Town

  Bore

• Geology/soil type

• Slope

  Flat

  Gentle

  Steep

  Terraced

Septic

• Is a collection well installed

  Yes

  No

• Collection well level at time of inspection

  Select Empty Quarter Half Three Quarters Full Overflowing

  • Empty
  • Quarter
  • Half
  • Three Quarters
  • Full
  • Overflowing

• Collection well capacity ltrs

• Number of absorption trenches

• Absorption trench dimensions

Aerated Wastewater Treatment System

• Manufacturers name

• Aerator operational

  Yes

  No

• Pump operational

  Yes

  No

• Treatment tank

  Yes

  No

• Dimensions of irrigation area

• Type of sprinklers

  Pop Up

  Drip Lines

  Fixed

  Moveable

  Subsurface

• Sludge/Skimmer return to inlet junction

  Yes

  No

• Number of sprinklers

• Are the irrigation lines buried

  Yes

  No

• Are there at least two warning signs posted

  Yes

  No

• AWTS service provider

• Date of last service report

  Date

Work To Be Done

• undefined

Sign Off

• Name and Signature

  Sign