Design Verification Form

QES Management System Issue Date: 01/07/2014

Design verification form

This form must be lodged by the consultant and submitted at least ten days prior to construction starting

City West Water Email [email protected]

Service (please select)

Water supply Recycled water Sewerage Pump station

Development details

Location/estate name:

City West Water reference:

Developer:

Consultant:

Consultant nominated representative (name):

Consultant nominated representative email:

Key personnel – design:

Designer’s name:

1 Documentation to be submitted (please select):

1.1 electronic copy of final design drawings in PDF format

1.2 electronic copy of road and drainage drawings (detail plans) for the development in PDF format

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

1.4 hydraulic computations for main and branch sewerage designs

1.5 geotechnical report and project specific backfill specification

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

Document FOR-312 Rev 3 Page 1/2 QES Management System Issue Date: 01/07/2014

2 Consultant’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 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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