Preamble

Pursuant to the Regulation respecting the application of section 32 of the Environment Quality Act, no person may undertake work scheduled in a five-year plan without having an engineer certify that the works detailed in the said construction drawings and specifications comply with the five-year plan authorized by the Minister.
The certification of compliance that is required before works begin must be presented on the form supplied by the Minister. The engineer may attach additional pages of information to the form as an appendix if not enough space is available on the form.
The municipality or, as the case may be, the borough must conserve the certification of compliance for a period of at least 10 years following the completion of works and must produce it upon requestof the Minister.

1 –General information

Name of municipality and, if applicable, borough in which the project is located:
Name of the regional county municipality (MRC) in which the project is located:
Name and date of authorization of the five-year plan:
File number of authorization of the five-year plan:
Official address of the municipality (number, street, cityand postal code):
Name of engineer commissioned:
Address (number, street, cityand postal code):
Telephone no. office:
( ) - ext. / Fax no. office:
( ) - / Email:
If the engineer was not commissioned by a municipality (that is, if the works in question are carried out by someone other than a municipality), indicate the official name of the promoter (legal entity as registered in the Centre informatisé du registre des entreprises du Québec [CIDREQ]):

2 – Works covered by the certification of compliance

Description of the workscovered by the certification of compliance
Construction drawings and specifications
List of the constructiondrawings and specificationsthat are covered by this certification. Indicate the date of the last revision, if any, for each document:

3 –Works requiring another type of authorization

List the projects that are covered by this certification that require another type of authorization prescribed under a law or regulation (authorization, authorization certificate, permission, occupation permit, etc.). Indicate the subject matter and date the authorizations are obtained. If works relate to a contaminated site, complete section 5.
YES / NO
I certify that all of the necessary authorizations for projects related to this certification have been obtained.

4 – Environmental clauses

YES / NOYES / N/A
The specifications contain environmental clauses that have a bearing on work methods and procedures to stabilize and restore shorelines, in compliance with the authorization certificate issued under section 22 of the Environment Quality Act for these works, if applicable.

5 – Contaminated sites

YES / NO / N/A
5.1 / The five-year plan (preliminary characterization study) indicates that soil in the location where workscovered bythis certificationare carried out orland being serviced is likely to be contaminated.
IfYES, the location must be specified:
5.1.1Project (infrastructures)
5.1.2Land serviced
5.2 / If the answer to question 5.1 isYES, I confirm that a Phase II characterization has been conducted in accordance with Phase I characterization recommendations. (Attach the certification report)
5.3 / The Phase II characterization report recommended that a Phase II characterization be conducted.
5.4 / If the answer to question 5.3 isYES, I confirm that a Phase III characterization has been conducted in accordance with Phase II characterization recommendations. (Attach the certification report)
5.5 / Phase II or III characterization studies conclude that soil at the location where workscovered by this certification (infrastructures) are carried out must be rehabilitated.
5.6 / If the answer to question 5.5 isYES, soil at the location where workscovered by this certification (infrastructures) are carried out must be rehabilitated in accordance with the Soil Protection and Rehabilitation of Contaminated Sites Policypublished by the Ministère du Développement durable, de l’Environnement et des Parcs (last version available),to ensure that the level of contamination is consistent with use of the site.
5.7 / The sites where works covered by this certification (infrastructures) are located come under Division IV.2.1 of the Environment Quality Act and the Land Protection and Rehabilitation Regulation.
IfYES, you mustspecify the location and attach a copy of the required documents (contamination notice and, where applicable, use restriction notice) to this certification.

6 – Works related to drinking water

General / YES / NO / N/A
6.1 / Except for special cases detailed in the authorization of the five-year plan, the waterworks work described in drawings and specificationsare in compliance with directive 001 and the requirements of the most recent edition of the standardized specification NQ 1809-300.
If NO, there is no compliance with the five-year plan.
The standardized specification must be used as the minimum baseline. A specification other than the standardized specification may be used provided the stipulations of this specification do notdiminish the requirements of the standardized specification. It is important to note that there is no obligation to comply with Chapter 12 of the standardized specification which deals with payment according to sections of the bid.
6.2 / The projected waterworks work will supply water to current and proposed users and distribute an adequatewater supply, in compliance with the conditions listed below.
6.2.1 Respect minimum pressure criteria (section 5.4.4 of directive 001)
6.2.2 Respect minimum diameterscriteria (section 5.4.5.2 of directive 001)
6.2.3 Respect fire protection criteria (section 5.4.6 of directive 001
regarding fire protection networks)
If NO, there is no compliance with the five-year plan.

7 – Works related to wastewater and rainwater

General / YES / NO / N/A
7.1 / Except for special cases listed in the authorization of the five-year plan, the sanitary and storm sewer works described in drawings and specifications comply with Chapter 5 of directive 004 and with the requirements of the most recent edition of standardized specification NQ 1809-300.
If NO, there is no compliance with the five-year plan.
The standardized specification must be used as the minimum baseline. A specification other than the standardized specification may be used provided the stipulations of this specification do not diminish the requirements of the standardized specification. It is important to note that there is no obligation to comply with Chapter 12 of the standardized specification which deals with payment according to sections of the bid.
Compliance with discharge and overflow requirements / YES / NO / N/A
7.2 / The overflow requirements of overflow discharge works located along the flow configuration for the works covered by this certification of compliance and requirements for discharge from treatment plants, published by the Minister, have been respected over the last two years.
If NO, there is no compliance with the five-year plan, unless one of the following situations applies.
a) Failure to comply with requirements is due solely to one or more unusual incidents. Where this is the case, the engineer must indicate the causes:
b) Remedial action has been implemented and this has reestablished compliance with discharge and overflow requirements.
Ifa orbapply, there is compliance with the five-year plan for fulfillment of requirements.
7.3 / The project includes adding a flow that is in excess of 5% of the capacity of the first overflow discharge works downstream from the connection point or the addition of a load in excess of 5% of the capacity of the treatment plant.
7.4 / If the answer to question 7.3 isYES, the overflow discharge works and treatment plant have the capability to handle the additional flows and loads of wastewater in compliance with the overflow discharge works and treatment plant discharge requirements published by the Minister and detailed in the five-year plan.
If NO, there is no compliance with the five-year plan.

8 – Compliance with the five-year plan

YES / NO
Changes may be made to a development project detailed in the five-year plan without the project being deemed non-compliant with the authorization, provided all the following conditions are respected:
a) the changes do not increase water needs or the inflow of wastewater or rainwater from levels determined in the initial project;
b) the changes do not affect the project’s compliance with a wetlands conservation agreement between the Ministère and the municipality;
c) the changes do not include works that come under section 22 of the Environment Quality Act;
d) the changes do not affect the project’s compliance with an urban planning program that is in effect.
Based on the information and confirmations provided, I certify that the work projects contained in the construction drawings and specifications, listed in section 2, comply with the five-year waterworks and sewer plan authorized by the Minister.

9 – Signature of the engineer

I declare that the information and confirmations provided in this form are complete and accurate.
First and last name: ______
Signature: ______/ Date:
NB – The signatory is required to initial each page of this form in the space provided.
Ministère du Développement durable, de l’Environnement et des Parcs 2008-06-03 / Initiales

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