Dam location address: Nearest town : Grid reference: E: _ _ _ _ _ N: _ _ _ _ _ _ Maximum dam storage capacity (megalitres): Wall height (metres): Wall length (metres): Crest width (metres): Type of dam (tick box): Earthen Concrete Other □ □ □ Provide description if ‘other’: *ANCOLD consequence V low Low Significant Assessment Date: □ □ □ category (tick box): * The owner will need to verify the Australian National Committee on Large Dams (ANCOLD) Guidelines consequence category through a suitably qualified engineer. Department of Environment Land Water and Planning has also developed a Screening Tool for Small Dams” to assist to perform an initial level “Consequence assessment Appendix 2 Intermediate Dam Safety Inspection Template for very low, low and significant consequence category dams Owner: Licence Number: ------------------------------ Date: ------------------------------ Dam Name: Dam location: E: _ _ _ _ _ N: _ _ _ _ _ _ Water level ----------------------------------- metres (dam level from top) Full Supply Level(if known) ----------------------------------- metres Overflowing □ □ Yes No Dam Depressions, cracks/changes □ □ Yes No Deformation of □ □ Yes No
Dam location address: Nearest town : Grid reference: E: _ _ _ _ _ N: _ _ _ _ _ _ Maximum dam storage capacity (megalitres): Wall height (metres): Wall length (metres): Crest width (metres): Type of dam (tick box): Earthen □ Concrete □ Other □ Provide description if ‘other’: *ANCOLD consequence category (tick box): V low □ Low □ Significant □ Assessment Date: * The owner will need to verify the Australian National Committee on Large Dams (ANCOLD) Guidelines consequence category through a suitably qualified engineer. Department of Environment Land Water and Planning has also developed a “Consequence Screening Tool for Small Dams” to assist to perform an initial level assessment Appendix 2 Intermediate Dam Safety Inspection Template for very low, low and significant consequence category dams Owner: Dam Name: Licence Number: ------------------------------ Date: ------------------------------ Dam location: E: _ _ _ _ _ N: _ _ _ _ _ _ Water level Full Supply Level(if known) Overflowing ----------------------------------- metres (dam level from top) ----------------------------------- metres □ Yes □ No Dam Depressions, cracks/changes Deformation of □ Yes □ No □ Yes □ No
CST_Dams_rcedits.docx