FORM SSD / PDC / 2 SEWERAGE SERVICES ACT 1993 SEWERAGE SYSTEMS AND SEPTIC TANKS (PLANNING, DESIGN AND

CONSTRUCTION) REGULATIONS 1996 (Regulation 7) APPLICATION FOR APPROVAL OF SEWERAGE WORKS Date :

I / We (the undersigned) hereby apply to undertake the following sewerage works:

and submit the following particulars (see re erse of form):

!) ')

"ocation and "ayout #lan $ % copies& Details of "and (itle) "ot *umber and +rea of "and&

+s re,uired by -ederal .o ernment) all land sites for sewerage shall be reser ed& (herefore) I / We as the owner of the sewerage land sites) hereby agree to surrender the abo e sewerage land site to the /tate +uthority under /ection !01 of the *ational "and 2ode !031 to enable it to be ested to the -ederal .o ernment&

Signature of Owner *ame of 4wner (in block letters) I&2 *o +ddress : : :

(elephone *o -a5 *o

: 6!37%83'0!' :

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DECLARATION FOR SEWERAGE WORKS DESIGN APPROVAL //D Regional 4ffice -ile *o& #ro>ect (itle : : : : 7 "icense "and /ur eyor +ddress (elephone / -a5 "ot *o& / #( 9ukim / :illage / (own District /tate "and (itle *o& +rea of /(#s / *#/ "and /tatus of /(# De eloper 2onsultant #roposed (reatment /ystem De elopment (ype #opulation <,ui alent (#<) 2atchment : : : : : : : : : /(# *#/ Declaration by Engineer I hereby certify that all written information pro ided in this declaration and the attachment document are completed) true and correct and are in accordance to the =.uidelines for De elopers= and the 9/ !''8 2odes of #ractice for Design and Installation of /ewerage /ystem and I accept full responsibility accordingly& Date : */W I/( : 7 Date :

: : : : :

; -a5 *o : 7

?ualified #erson by "ead 2onsultant *ame : Discipline :

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Declaration by Qualified Person I hereby certify that the details in the plans and design calculation are in accordance with the /ewerage /ystem and /eptic (anks (#lanning) Design and 2onstruction) Regulations !003 and with 9/ !''8 @2ode of #ractice for Design and Installation of /ewerage /ystem@ and I accept full responsibility accordingly&

Signature of Qualified Person (by Lead Consultant

*ame of ?ualified #erson (in block letters) Discipline I&2 *o& +ddress

: : : :

(elephone *o -a5 *o

: :

?ualifications and Registration particulars: #rofessional <ngineer *o 8080

FOR OFFICE USE ONLY Date recei ed Date replied : : 2hecked Ay : Ref& *o& :

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PARTICULARS (he following particulars are to be submitted with each application for sewerage works appro al:

!) /ewerage #lanning +ppro al letter issued by the /ewerage /er ices Department& ') + site layout plan as appro ed& B) + location plan of the sewerage works& ') #lans and longitudinal sections of proposed sewers& B) Detailed plans and sections of sewage treatment works (where applicable)& %) Detailed plans and sections of sewer appurtenances& 1) Detailed plans and sections of pumping stations (where applicable)& 3) Detailed plans of proposed septic tanks (where applicable)& 7) /pecifications of materials) e,uipment and plant& ') B) %) 1) 3) 7) Detailed calculations of the components of the sewerage system& Detailed calculations of the treatment process and hydraulic design (where applicable)& Details of phasing of de elopment and numbers of properties ser ed& Details of population e,ui alent to be ser ed by the proposed sewerage works& /tandard of final effluent to be achie ed (where applicable)& Details of security) screening and access arrangement to plants (where applicable)&

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