FORM – C

Design verification form

(To be lodged by the Consultant 10 days prior to commencement of construction)

Service: Water supply Recycled water Sewerage

Details of Development

Estate name:
Municipality:
Developer: (owner)
Consultant:
Designed by:
Key Design Personnel – Authorisation by:
Consultant Senior Management Representative:
Consultant ref:
South East Water ref: / File number: ......
Case number: ......
Number of lots serviced
Does this project have an ‘abandonment of asset’ component / Yes / No

1  Documentation to be submitted (Please cross out where not applicable)

1.1  Digital copy of final design drawings to be issued for construction

1.2  Road and drainage civil drawings for the development.

1.3  Details of existing and proposed services, if not indicated on the submitted plans.

1.4  Hydraulic computations for non reticulation assets (shared assets)

1.5  Project specification if applicable.

1.6  Form G – Verification Form Attachment Sheet, if any of the items on this form are not applicable.

2  Consultant's Assurance

As the Consultant’s Senior Management Representative responsible for the design of the works detailed in South East Water’s Development Agreement, File No ......

I verify that:

The design is in accordance with the Development Agreement and its referred documents and standards.

Consultant’s Senior Management Representative

Name / Company Position
Signature / Date

Important Privacy Notice

South East Water Corporation ABN 89 066 902 547 (SEWC) is a Statutory Corporation created as a Water Authority under the Water Act, which provides retail water, recycled water, sewerage and trade waste services to Melbourne’s South Eastern suburbs.

By completing this form you are providing personal information to SEWC for the primary purpose of SEWC providing you with water, recycled water and/or sewerage supply.

Additionally, SEWC may share your personal information with service providers and other external organisations in limited circumstances, such as to:

·  government or regulatory authorities;

·  mail houses and other companies for the purposes of distributing statements of account and handling mail; and

·  information technology companies for the purposes of maintaining information technology and security systems.

If you do not provide the information requested by this form, then we may not be able to process your application for the provision of water supply, recycled water or sewerage facilities.

You may request access to your personal information which SEWC holds about you. You can make such a request by writing to the Privacy Officer at PO Box 2268 Seaford VIC 3198. Additionally, South East Water’s Privacy Policy is available on the company’s web site at southeastwater.com.au or contact 131 694.

South East Water Corporation 25/09/2015 Page 1 of 2