Ventia Safety - Source Testing

• The version control will be maintained by the SHEQ team and is controlled via the Safety Equipment Inspections Document 2073838157-15.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Personnel

  Select Yes No N/A

  • Yes
  • No
  • N/A

The version control will be maintained by the SHEQ team and is controlled via the Safety Equipment Inspections Document 2073838157-15.

Lay-Out

• Location of Sewer Pot

  Same Property

  Adjacent Property

• Draw a Sketch of Property and House Service Line in relation with House

  Drawing

• Or Open Relevant property in Google Maps and download screenshot. Draw House Service Line on downloaded photo.

  Media

• Take Multiple Photos of Property Before Testing

  Media

Visual Inspection

V1 General Observation

• V1.1 Is stormwater drainage pipe system available in the street?

  Yes

  No

  N/A

• V1.2 Is there any stormwater outlet to street?

  Yes

  No

  N/A

• V1.3 Is there any stormwater pump used in Property?

  Yes

  No

  N/A

• V1.4 If not connected to stormwater system, stormwater discharges to "Soakage Pit"

  Yes

  No

  N/A

• V1.5 If not connected to stormwater system, stormwater discharges by "overland discharge"?

  Yes

  No

  N/A

• V1.6 Is property level lower than street level?

  No

  Yes

  N/A

• V1.7 Sewer service diagram appears to reflect the current arrangement

  Yes

  No

  N/A

• V1.8 Trees located in vicinity of House Service Line (HSL)

  No

  Yes

  N/A

• V1.9 Property likely to be impacted by local flooding

  No

  Yes

  N/A

• V1.10 Stormwater drainage to the street identified

  Yes

  No

  N/A

• V1.11 Is there a swimming pool

  No

  Yes

  N/A

• V1.12 Is the swimming pool connected to Wastewater system?

  No

  Yes

  N/A

• V1.13 Is there a rain water tank

  Yes

  No

  N/A

• V1.14 Approximate age of house

• V1.15 House Service Line (HSL) material

  PVC

  Vitrified Clay

  Other

V2 Down Pipe

• V2.1 Downpipe empties over gully

  No

  Yes

  N/A

• V2.2 Downpipe from shed entering gully

  No

  Yes

  N/A

• V2.3 Downpipe running into canal, then enters the gully

  No

  Yes

  N/A

• V2.4 Downpipe drains onto path and runoff enters Gully

  No

  Yes

  N/A

V3 Overflow Relief Gully (ORG)

• V3.1 Low gully, broken surrounds

  No

  Yes

  N/A

• V3.2 Low gully next to vent pipe

  No

  Yes

  N/A

• V3.3 Old cracked low gully

  No

  Yes

  N/A

• V3.4 Low gully near vent pipe on driveway

  No

  Yes

  N/A

• V3.5 Local flooding (less than 150 mm of the declared flood level)

  No

  Yes

  N/A

• V3.6 Is the rain water tank overflow pipe connected to gully

  No

  Yes

  N/A

V4 Boundary Trap

• V4.1 Boundary trap in the property

  Yes

  No

  N/A

• V4.3 Boundary trap cover broken & acting as drain

  No

  Yes

  N/A

• V4.2 Boundary trap location

  Front Yard

  Back Yard

• V4.4 Broken collar on boundary trap acting as drain

  No

  Yes

  N/A

• V4.5 Low boundary trap or damaged

  No

  Yes

  N/A

V5 Inspection Opening (I/O)

• V5.1 I/O visible

  Yes

  No

  N/A

• V5.2 Location of I/O likely to result in damage to HSL

  No

  Yes

  N/A

• V5.3 I/O Low & flush with ground

  No

  Yes

  N/A

• V5.4 Broken I/O acting as area drain

  No

  Yes

  N/A

V6 Outdoor Plumbing

• V6.1 Vent pipe broken at base

  No

  Yes

  N/A

• V6.2 Broken / open pipework, allowing water to enter

  No

  Yes

  N/A

• V6.3 Vent pipe cut off, acting as area drain

  No

  Yes

  N/A

• V6.4 Vent pipe rusted through at the base, water drains through

  No

  Yes

  N/A

V7 House Service Line (HSL)

• V7.1 Broken pipe exposed to surface, near gully

  No

  Yes

  N/A

• V7.2 Large hole in pipe next to footpath

  No

  Yes

  N/A

• V7.3 Hole in ground near boundary trap

  No

  Yes

  N/A

• V7.4 Open pipe visible through ground next to path

  No

  Yes

  N/A

V8 Other Observations

• V8.1 Comments (Other Observations)

• Take Photo/s Of Other Observations, If Required

  Media

Test Results

T1 Dye Testing

• T1.1 Downpipe connected to sewer

  No

  Yes

  N/A

• T1.2 Downpipe from shed connected to sewer

  No

  Yes

  N/A

• T1.3 Stormwater gullies/pits connected to sewer

  No

  Yes

  N/A

• T1.4 Property drains connected to sewer

  No

  Yes

  N/A

T2 Smoke Test

• T2.1 Has any smoke been witnessed escaping

  No

  Yes

  N/A

• T2.2 Downpipe connected to sewer

  No

  Yes

  N/A

• T2.3 Downpipe from shed connected to sewer

  No

  Yes

  N/A

• T2.4 Stormwater gullies/pits connected to sewer

  No

  Yes

  N/A

• T2.5 Property drains connected to sewer

  No

  Yes

  N/A

• T2.6 Broken HSL

  No

  Yes

  N/A

T3 Other Test/s

• T3.1 Comment (Other Test/s & Results)

• Take Photo/s Of Other Test/s Results, If Required

  Media

Recommended Defect Repair List

• Is there any Rectification To Do? (If ‘No’ don’t fill out rest of this section)

  No

  Yes

  N/A

D1 Overflow Relief Gully (ORG)

• D1.1 Raise ORG

  No

  Yes

  N/A

• D1.2 Repair ORG

  No

  Yes

  N/A

• D1.3 Cap ORG

  No

  Yes

  N/A

• D1.4 Construct concrete ring around ORG

  No

  Yes

  N/A

• D1.5 Re-grade surrounding surface

  No

  Yes

  N/A

• D1.6 Install one way flap valve

  No

  Yes

  N/A

• D1.7 Seal ORG & construct pump/pot

  No

  Yes

  N/A

D2 Inspection Opening (I/O)

• D2.1 Repair I/O defect

  No

  Yes

  N/A

• D2.2 Repair surface section of I/O

  No

  Yes

  N/A

• D2.3 Repair of HSL at I/O

  No

  Yes

  N/A

D3 Irregular Stormwater Connection

• D3.1 Disconnect irregular stormwater connection only

  No

  Yes

  N/A

• D3.2 Extend disconnected pipe to the stormwater main

  No

  Yes

  N/A

• D3.3 Construct property drain and discharge to street

  No

  Yes

  N/A

• D3.4 Construct extension of stormwater to street with detention tank and pump

  No

  Yes

  N/A

• D3.5 Install rainwater tank

  No

  Yes

  N/A

• D3.6 Construct stormwater line through properties to stormwater main

  No

  Yes

  N/A

• D3.7 No viable solution

  No

  Yes

  N/A

D4 House Service Line (HSL)

• D4.1 Repair/relining of HSL

  No

  Yes

  N/A

• D4.2 Dig and replace (Metres)

  No

  Yes

  N/A

D5 Other Defect/s Rectification or Restoration

• D5.1 Comment (Other Defect/s Rectification or Restoration)

• Take Photo/s Of Other Defect/s Rectification or Restoration, If Required

  Media

• Signature (Subcontractor Representative)

  Sign

• Signature (Ventia Representative)

  Sign