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DESCRIPTION INPUT INFORMATION

Location

Google Earth or Google Maps

location

Number of Toilets in

Household

Number of occupants

Wastewater description Black water (soil line from WC)

Tick where appropriate

Grey Water (waste from Baths, Showers and Basins)

Both Black water and Grey water


DESCRIPTION INPUT INFORMATION

Soil Conditions

Tick where appropriate Sandy

Clayey

Loamy

None of the above. Please describe below:

Has a Percolation Test

been done at site Yes

Tick where appropriate

No
DESCRIPTION INPUT INFORMATION

Is there an existing

septic tank and or soak Septic Tank

away

Tick where appropriate Soak Away

Is there an existing

public drain Yes

Tick where appropriate

No

If yes, are the existing drainage pipes above or

below the invert level of the drain?

Is there a nearby well or Description Distance from House (m)

borehole or stream Well

Tick where appropriate Borehole

Stream
DESCRIPTION INPUT INFORMATION

Comment

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