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INTERNATIONAL NAVAL SURVEYS BUREAU

REPORT OF SURVEY OF PREVENTION OF POLLUTION BY SEWAGE


(ALL SHIPS)
To meet Regulations of ANNEX IV of the International Convention for the
Prevention of Pollution from Ships, 1973 and its 1978 Protocol, as amended.

Name of Ship : Distinctive Letters : Port of Registry:

Gross Tonnage: Year of Build: Number of crew:

Managers (or agents) :

Place of survey: in dry-dock on slipway afloat Survey Commenced :

At: Survey Completed :

Notes:
1) i. Fields should be filled with YES, NO or N/A as required.
ii. All negative entries (NO) should be clarified under “Surveyor’s Notes” with reference by item number.
2) This survey will only be applied to the following ships engaged in international voyages:
i. ships of 400 gross tonnage and above; and
ii. ships of less than 400 gross tonnage which are certified to carry more than 15 persons.
3) New ship means a ship:
i. for which the building contract is placed, or in the absence of a building contract, the keel of which is laid, or
which is at a similar stage of construction, on or after 27 September 2003; or
ii. The delivery of which is on or after 27 September 2006.
4) Existing ship means a ship which is not a new ship.

Status of ship
1. New ship as per reg.1(1) or Existing ship as per reg.1(2)

Sewage treatment plant


2. Type:
(Type approval certificate to be attached to this report)
3. Name of manufacturer:
4. Effluent Standards:

5 Sewage treatment plant was tested and found in good order


Comminuter
6. Type:
(Type approval certificate to be attached to this report)
7. Name of manufacturer:
8. Standard of Sewage after disinfection:

9. The system to comminute and disinfect the sewage examined and found satisfactory.
Holding tank equipment
10. Capacity: Location:

11. Holding tank installation is in good condition.


12. Holding tank has a means to indicate visually the amount of its contents
13. Holding tank has sufficient openings for cleaning / maintenance.
14. Transfer pump of Sewage content tested and found in good order

Form 1215225-SW/01-2014 Page 1 of 2


Others
15. Standard Sewage connection along with the pipeline for the discharge of sewage to reception facilities according to
Regulation 10 is in good order.
16. Approved calculations for the maximum rate(s) of discharge of untreated sewage sighted on board.
17. Sewage installation / piping diagram verified on board, being in compliance with the actual arrangement
(copy to be attached to this report)

SURVEYOR'S NOTES
18. Alterations or modifications:
18.1 Describe in detail system and equipment or parts which have been altered or modified.

18.2 Verification of the type approval certificate of the installed equipment carried out :

19 Describe in detail parts which remain to be examined, and deficiencies, if any

20. A Short Term I.S.P.P. Certificate with No. was issued on


21. It is recommended that:
A full term I.S.P.P.Certificate valid until to be issued by the Head Office of the Society, or
No Full Term I.S.P.P.Certificate is to be issued before the survey is completed.

Date:
Surveyor to International Naval Surveys Bureau - I.N.S.B.

Form 1215225-SW/01-2014 Page 2 of 2

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