Sewage Management Facility Assessment Sheet

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Facility Details

• Application Number

• Type of System

  Septic

  Aerated

  Other

• Water source

  Select Reticulated Council Tank Bore Reticulated Private

  • Reticulated Council
  • Tank
  • Bore
  • Reticulated Private

• Inspection Fee

  Select Initial Inspection fee $100 Re-inspection - No Fee Re-inspection fee $100 Additional System fee $30

  • Initial Inspection fee $100
  • Re-inspection - No Fee
  • Re-inspection fee $100
  • Additional System fee $30

Location

• Tank and trenches/irrigation

• Nearest gully/watercourse

Risk Assessment

• Does the disposal area pose a risk of contamination?

  Safe

  At Risk

  N/A

• Does the system pose a risk to neighbouring properties?

  Safe

  At Risk

  N/A

Tank Inspection

• Is there sufficient crust on the anaerobic chamber?

  Yes

  No

  N/A

• Is the tank and surrounds free of odour?

  Yes

  No

  N/A

• Is the layout of tanks and irrigation as per approval?

  Yes

  No

  N/A

• Is the tank and surrounding areas free of damage?

  Yes

  No

  N/A

• Is the tank lid elevated at least 100mm - 200mm above ground level or vegetation? If no, advise to clear vegetation/grass/roots/soil or create a diversion bank.

  Yes

  No

  N/A

• Is the sub-surface irrigation area/trenches free of damping and overgrown?

  Yes

  No

  N/A

• Is the surface irrigation using appropriate sprinklers, hose and within a location that poses no health risks to occupants, neighbours or the environment?

  Yes

  No

  N/A

• If owners present, have they ever flushed irrigation?

  Yes

  No

  N/A

• Is the irrigation area or disposal area free of any fruit trees or vegetables gardens?

  Yes

  No

  N/A

• Is there at least two 'reclaimed water, do not drink' warning signs posted?

  Yes

  No

  N/A

Approval

• Are all conditions of approval complied with?<br><br>Notes<br><br><br>

  Yes

  No

  N/A

• Is the system operating OK and does not require remediation and a further inspection?<br><br>Notes<br><br>

  Yes

  No

  N/A

• Is the site free of any officer dangers or recommendations for next inspection, ie dogs/padlocks?

  Yes

  No

  N/A

• Issue Operational Approval

  Select 7 years 2 years TBA - pending further inspection

  • 7 years
  • 2 years
  • TBA - pending further inspection

Site Images

• Photo1

  Media

• Photo2

  Media

• Drawings

  Drawing

Officer Approval

• Rod Diacono Senior Environmental Health Officer Goulburn Mulwaree Council 184 Bourke Street Goulburn NSW 2580 T: 02 4823 4458 M: 0407 489 038

  Sign

• Date and Time of Approval

  Date