Title Page
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Address / Council ID
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Conducted on
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Prepared by
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Location
Audit & Entry
Property/Owner
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Property Name
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Property Owner
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Date & Time
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Entry available?
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Safe to enter?
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Owner/tenant available?
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Comments
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Type of Inspection
Tank
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Type of system
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Tank structure
- Satisfactory
- Vegetation in tank
- Vegetation around tank
- Replace inspection lid
- Tank health unsatisfactory
- Repairs required
- Gaps, cracks
- Replacement required
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Comment
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T-piece?
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Prevents the spread of disease by micro-organisms?
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Prevents persons coming into contact with untreated sewage or effluent?
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No smell present?
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Prevents insects and vermin from entering system?
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Add media
Disposal Area
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Type of disposal
- ETA
- Trench
- Surface irrigation
- Subsurface irrigation
- Reedbed
- Other
Surface irrigation
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Sprinkler head meets AS/NZS (1547:2012)?
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Does the effluent hose meet AS/NZS (1547:2012)?
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Are effluent sprinklers within approved area?
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No pooling present?
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No smell present?
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Correct signage?
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>6m up-gradient & >3m down-gradient of driveways/property boundaries
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>6m to swimming pools
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>15m to dwellings
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Satisfactory?
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Comment
ETA bed/Trench
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Can you identify the ETA bed/Trench?
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Size?
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No signs of failure?
Buffer distances
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Distance to permanent water source
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Distance to ground water well
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Distance to other water sources (dams, intermittent waterways, drainage channels)
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Comments
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Add media
Inspection Summary
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Satisfactory?
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Risk rating
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Fees
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Comment
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Date of reinspection if applicable