QES Management System

Issue Date: 01/07/2014

As-constructed verification form

This form must be lodged by the consultant and submitted
with the Construction Verification Form

City West Water

Email

Service(please select)

Water supply Recycled water Sewerage Pump station

Development details

Location/estate name:
City West Water reference:
Developer:
Consultant:
Consultant nominated representative:

1Documentation to be submitted (please select):

1.1electronic copy of the asset information in PDF format

1.2all information supplied is labelled with the supplier’s name and the City West Water reference number for the works

1.3specific identification of file is required, ie .DGN, .DXF, linked or unlinked in accordance with the WITS Survey Manual. If the development is less than 10 lots, City West Water will accept the as-constructed information in field note format

1.4the name of the survey company used to supply the information

1.5Verification Attachment Sheet, if any of the items on this form are not applicable.

2Consultant’s assurance

As the Consultant’s nominated representative responsible for the design of the development works detailed in the Development Deed, City West Water reference:

I verify that:

  • the survey is in accordance with the Development Deed and its referred documents and standards
  • the survey is in accordance with the WITS Survey Manual
  • the survey is in accordance with all relevant City West Water specifications and relevant Australian Standards
  • the digital information is supplied virus free and in accordance with the Consultant’s Responsibilities as set out in the
    WITS Survey Manual
  • the source documents have been filed in a manner that can be readily accessed for audit purposes.

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

Consultant’s nominated representative

Name: / Company position:
Signature: / Date:

Important privacy notice

City West Water is a state owned company which provides retail water, sewerage and trade waste services to Melbourne’s central business district, inner and western suburbs.

By completing this form you are providing personal information to City West Water for the primary purpose of City West Water providing you with a water or sewerage supply. To read City West Water’s complete privacy statement, please visit citywestwater.com.au

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