HW39 - Point Moore Septic Inspection Form These forms are used to submit your biennial septic or effluent system certification. This online form will need to be completed by a licensed plumber and submitted to the City. Either send your plumber this link (insert link) or complete the form, print it out and send it to your plumber for signature/completion. If you require any further information or clarification regarding the certification of the septic or effluent system, please contact the Land and Leasing Team on 9956 6600 or via email: landandleasing@cgg.wa.gov.au Applicant Details Residential Address Lesse Name Plumber/Drainer Name Plumbing Licence No. Plumber Contact Details: Phone Plumber Contact Details: Email * Please enter a valid email address. Does the septic system service an additional property YesNo If yes, provide property address: Please tick all boxes Type of effluent system on site: Select an Option Aerobic Treatment Unit (ATU) Grey Water System Septic System Other If you selected "Other," please provide more detail: Does the toilet flush efficiently by removing waste into the septic system? YesNo Reason: Is there any evidence of effluent overflowing back-up into the drains inside the house? YesNo How many septic tanks are on-site? Select an Option Yes No Other If selected "Other," please provide more detail What is the septic tank made out of? Select an Option Bricks Concrete Septic Tank Visible Other If you selected "Other," please provide more details: Is all waste water being received to the septic tank from the property? YesNo Does the septic tank have a cover? Select an Option Yes No Septic Tank not visible Other: If selected "Other" please provide more details When was last time the septic tank was pumped out? Does the septic tank require pumping out? YesNo Is the septic tank structurally sound? Select an Option Yes No (see below) Septic Tank not visible If selected No (see below) - select from the following. Select an Option MINOR: broken lid MAJOR: Structurally damaged but not leaking into groundwater CRITICAL: Tank damaged and leaking into groundwater Does the system have? Select an Option Leach Drains Soak Wells Unknown How many leach drains? Select an Option 1 2 Other If "Other," how many? Leach Drain sizes, if known: If soak wells, how many? Select an Option 1 2 Other If "Other," how many? Soak Wells sizes, if known: Is there evidence of pooling effluent on or around the property? YesNo Is there any evidence of a damaged leach drain or soak well on the property? Select an Option Yes No Not Visible Other If "Other," please provide further information If YES, please provide further information Further Comments: I have agreed to submit this application by electronic means. I can confirm that the information given in this application is true, complete and accurate. By checking this box and typing my name below, I am electronically signing my application YesNo Plumber's Signature * Required Field. The City of Greater Geraldton collects the personal information you provide in relation to the Point Moore Septic Inspection Form so we can deliver the service, process your request, and meet our legal obligations under the Local Government Act 1995 and any other related legislation. Your information may be shared with government agencies, contractors, or others where authorised by law or with your consent. Where required by law, your personal information will be made publicly available, e.g. public registers. The City manages personal information in accordance with relevant privacy legislation and takes reasonable steps to protect it from unauthorised access or disclosure. You may request access to, or correction of, your personal information by contacting the City at pris@cgg.wa.gov.au. Type the code from the image: The code you entered is not valid. Get Audio CodeType the code from the image Was this page helpful? How can we improve this page? Email Address*This field is required. * Required Field.* Please enter a valid Email Address Type the code from the image: Do not fill this textbox.