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Design Templates Stormwater Calculation Summary
F4.1 Infrastructure Technical Specifications
Site Address:
Consent Number:
Application by:
Total Site Area Prior to Subdivision
Lot 1 Area
Lot 2 Area
Lot 1 C
Lot 2 C Design Storm Details
ARI
Soakage Viable Yes/No
Lot 1
Provide
number 900 mm soakholes
or
metres of 1.0 m*1.5 m*1.5 m rock filled soak trench
or
metres of 1.0 m*1.5 m*1.2 m proprietary trench
proprietary units
Lot 2
Provide
number 900 mm soakholes
or
metres of 1.0 m*1.5 m*1.5 m rock filled soak trench
or
metres of 1.0 m*1.5 m*1.2 m proprietary trench
proprietary units
Detention
Allowable runoff flow rate into HCC reticulation
litres/second
Lot 1 Share
%
Lot 2 Share
%
l/s
l/s
Lot 1 provide
Lot 2 provide minimum
litres detention
minimum
litres detention
orifice
mm diameter
orifice
mm diameter
Version: October 2012 Page 1 of 1
Design Templates
Worksheet 1 Falling Head Percolation Test
F4.2 Infrastructure Technical Specifications
Site Address:
Completed by: Date:
Qualification: Chartered Engineer Civil Engineer Engineering Technician Engineering Geologist Drain Layer Other _________________ Registration number ___________________ (tick one)
Date of test: Season:
The following procedure has been carried out
Hole kept full for 17 hrs. prior to test Hole kept full for 4 hrs. prior to test
Drop in water level recorded at intervals of 30 mins (or less)
Test continued for 4 hrs. Test continued until bore empty
Test stopped at 0.25 m above base Hole refilled at 0.25 m above base
(tick when complete) Signature:
Test Details
Bore hole reference ref:
Diameter of bore D= ____.____ mm
Depth of bore ____.____ mm
Time (min) Depth (mm) Time (min) Depth (mm)
Calculations
Soakage Rate Sr = Minimum Gradient * = 𝑌
𝑋
*a straight line interpolation between last points on graph 𝑦/𝑥 = = ____________mm/hr
Divide by 1000 for m/hr ____________m/hr
Version: October 2012 Page 1 of 1
Design Templates
Worksheet 2 Falling Head Percolation Graph
F4.3 Infrastructure Technical Specifications
Site Address:
Completed by: Date:
Bore ref:
1 2 3 4 0
2000
3000
1000
Wat
er D
epth
(mm
)
Time (hr)
Version: October 2012 Page 1 of 1
Design Templates
Worksheet 3 Stormwater Runoff Calculation Summary – 2 Lot Development
F4.4 Infrastructure Technical Specifications
Site Address:
Completed by: Date:
Pre-Development Site Runoff
Zone Residential Industrial Commercial
5 min storm intensity 2 year 5 year 10 year
Pre-climate Change I= _____ mm/hr _____ mm/hr _____ mm/hr
Total Site Area A= ________m2
Allowable Runoff From Site 𝑄 = 𝐶𝐼𝐴3600000
m3/s
Qallow= ____𝑋____𝑋____3,600,000
=
_______________m3/s
Note: litres/second = [(m3/s)*1000] [_______________l/s]
Developed site Lot 1
Zone Residential Industrial Commercial
1 hr storm intensity _____ year _______ year _______ year
Post-climate Change I= _____ mm/hr _____ mm/hr _____ mm/hr
Lot 1 Area Alot1= ______________ m2
Equivalent Impervious Area
Cover Type Area (m2) Coefficient C Area x C
Roof Ar = 0.95
Paved Apv = 0.95
Pervious (lawn etc.) Ape = 0.3
Ae = ∑(𝐴𝑟𝑒𝑎 𝑥 𝐶)
Equivalent Runoff Coefficient Ceqv = 𝐴𝑒𝐴𝑙𝑜𝑡1
=
Runoff From Site𝑄 = 𝐶𝑒𝑞𝑣𝐼𝐴𝑙𝑜𝑡13600000
m3/s
Qlot1= ____𝑋____𝑋____3,600,000
=
_______________m3/s
Note: litres/second = [(m3/s)*1000] [_______________l/s]
Version: October 2012 Page 1 of 2
Design Templates
Worksheet 3 Stormwater Runoff Calculation Summary – 2 Lot Development
F4.4 Infrastructure Technical Specifications
Developed site Lot 2 Run-off
Zone Residential Industrial Commercial
____ min storm intensity _____ year _______ year _______ year
Value from manual I= _____ mm/hr _____ mm/hr _____ mm/hr
Lot 2 Area Alot2= ______________ m2
Equivalent Impervious Area
Cover Type Area (m2) Coefficient C Area x C
Roof Ar = 0.95
Paved Apv = 0.95
Pervious (lawn etc.) Ape = 0.3
Ae = ∑(𝐴𝑟𝑒𝑎 𝑥 𝐶)
Equivalent Runoff Coefficient Ceqv = 𝐴𝑒𝐴𝑙𝑜𝑡2
=
Runoff From Site𝑄 = 𝐶𝑒𝑞𝑣𝐼𝐴𝑙𝑜𝑡23600000
m3/s
Qlot2= ____𝑋____𝑋____3,600,000
=
_______________m3/s
Note: litres/second = [(m3/s)*1000] [_______________l/s]
Version: October 2012 Page 2 of 2
Design Templates
Worksheet 4 Nominal Soakage Design
F4.5 Infrastructure Technical Specifications
Site Address:
Completed by: Date:
Area of additional impervious surface _____ m2
Note this needs to be <= 20 m2
Describe the general soil type [excavate a 1.0 m square hole, 1.0 m deep in the general area of the proposed soak pit]
Fill the hole with water
Does the water soak away within 24 hours? Yes – Use nominal soak pit as detail available from the City Development Unit No – alternative method of disposal possibly required – refer to designer.
Version: October 2012 Page 1 of 5
Design Templates
Worksheet 5 Soakage Design
F4.5 Infrastructure Technical Specifications
Site Address:
Completed by: Date:
Area for lot number ___ from worksheet 3 Alot__ _____ m2
Equivalent Runoff Coefficient from worksheet 3 Ceqv
Soakage Rate (from worksheet 1) Sr _____ m/hr
Design storm
Duration I mm/hr
Depth (d) mm Q=CIequivAlot_/3600000 m3/s
Volume in Vin=(d/1000) x A m3
5 min
10 min
20 min
30 min
60 min – 1 hr
2 hr
6 hr
12 hr
24 hr
48 hr
72 hr
Note for soakage design initially use a one hour storm duration
Rainfall Runoff Volume 𝑅𝑐 = 10 𝑥 𝐶𝑒𝑞𝑖𝑣 𝑥 𝐼 𝑥 𝐴𝑙𝑜𝑡10000
= 10 x ___ x ___ x ___
Rc = _____m3
For a typical soakhole 900 mm diameter
Volume of runoff disposed of by 𝑉𝑠𝑜𝑎𝑘 = 𝐴𝑠 𝑥 𝑆𝑟 𝑥 𝑆𝑑
Version: October 2012 Page 2 of 5
Design Templates
Worksheet 5 Soakage Design
F4.5 Infrastructure Technical Specifications
soakage
𝐴𝑠 = 𝑆𝑜𝑎𝑘𝑎𝑔𝑒 𝐴𝑟𝑒𝑎
(for one 900 mm dia soakhole) = 0.636 m2
𝑆𝑟 = 𝑆𝑜𝑎𝑘𝑎𝑔𝑒 𝑅𝑎𝑡𝑒
____ m/hr
𝑆𝑑 = 𝑆𝑡𝑜𝑟𝑚 𝐷𝑢𝑟𝑎𝑡𝑖𝑜𝑛
1 hr
𝑉𝑠𝑜𝑎𝑘 = 0.636 𝑥 _____𝑥1 _______m3
Volume of runoff held in storage 𝑉𝑠𝑡𝑜𝑟𝑒 = 𝐴𝑠 𝑥 𝐷𝑠 𝑥 𝑉𝑟𝑓
𝐴𝑠 = 𝑆𝑜𝑎𝑘𝑎𝑔𝑒 𝐴𝑟𝑒𝑎
(for on 900 mm dia soakhole) = 0.636 m2
𝐷𝑠 = 𝐷𝑒𝑝𝑡ℎ 𝑜𝑓 𝑠𝑡𝑜𝑟𝑎𝑔𝑒 (ground water depth – 0.5 m or depth of soakhole - 0.5 m) Keep to 2.0 m max depth)
____m
𝑉𝑟𝑓 = 𝑉𝑜𝑙𝑢𝑚𝑒 𝑅𝑒𝑑𝑢𝑐𝑡𝑖𝑜𝑛 𝑓𝑎𝑐𝑡𝑜𝑟
0.38 for rock filled hole
𝑉𝑠𝑡𝑜𝑟𝑒 = 0.636 𝑥 __𝑥 0.38 _______m3
For 1 Soakhole Capacity = 𝑉𝑠𝑜𝑎𝑘 + 𝑉𝑠𝑡𝑜𝑟𝑒 _______m3
For the site Soakholes required - 𝑉𝑠𝑜𝑎𝑘 + 𝑉𝑠𝑡𝑜𝑟𝑒 > 𝑅𝑐
Therefore 𝑅𝑐𝑉𝑠𝑜𝑎𝑘+𝑉𝑠𝑡𝑜𝑟𝑒
=
_________ Soakholes
Version: October 2012 Page 3 of 5
Design Templates
Worksheet 5 Soakage Design
F4.5 Infrastructure Technical Specifications
For a typical soak trench (1.0 m wide by 1.5 m long)
Volume of runoff disposed of by soakage
𝑉𝑠𝑜𝑎𝑘 = 𝐴𝑠 𝑥 𝑆𝑟 𝑥 𝑆𝑑
𝐴𝑠 = 𝑆𝑜𝑎𝑘𝑎𝑔𝑒 𝐴𝑟𝑒𝑎
(1.0 m * 1.5 m) = 1.5 m2
𝑆𝑟 = 𝑆𝑜𝑎𝑘𝑎𝑔𝑒 𝑅𝑎𝑡𝑒
____ m/hr
𝑆𝑑 = 𝑆𝑡𝑜𝑟𝑚 𝐷𝑢𝑟𝑎𝑡𝑖𝑜𝑛
1 hr
𝑉𝑠𝑜𝑎𝑘 = 0.636 𝑥 _____𝑥1 _______m3
Volume of runoff held in storage 𝑉𝑠𝑡𝑜𝑟𝑒 = 𝐴𝑠 𝑥 𝐷𝑠 𝑥 𝑉𝑟𝑓
𝐴𝑠 = 𝑆𝑜𝑎𝑘𝑎𝑔𝑒 𝐴𝑟𝑒𝑎
(1.0 m * 1.5 m) = 1.5 m2
𝐷𝑠 = 𝐷𝑒𝑝𝑡ℎ 𝑜𝑓 𝑠𝑡𝑜𝑟𝑎𝑔𝑒 (ground water depth – 0.5 m or depth of trench - 0.5 m) Keep to 2.0 m max depth)
____m
𝑉𝑟𝑓 = 𝑉𝑜𝑙𝑢𝑚𝑒 𝑅𝑒𝑑𝑢𝑐𝑡𝑖𝑜𝑛 𝑓𝑎𝑐𝑡𝑜𝑟
0.38 for rock filled hole
𝑉𝑠𝑡𝑜𝑟𝑒 = 0.636 𝑥 __𝑥 0.38 _______m3
For 1 trench Capacity = 𝑉𝑠𝑜𝑎𝑘 + 𝑉𝑠𝑡𝑜𝑟𝑒 _______m3
For the site Metre of trench required - 𝑉𝑠𝑜𝑎𝑘 + 𝑉𝑠𝑡𝑜𝑟𝑒 > 𝑅𝑐
Therefore 𝑅𝑐𝑉𝑠𝑜𝑎𝑘+𝑉𝑠𝑡𝑜𝑟𝑒
=
_________ m
For proprietary system (dimensions and void figures from manufacturer) (use a 1.0 m length)
Volume of runoff disposed of by soakage
𝑉𝑠𝑜𝑎𝑘 = 𝐴𝑠 𝑥 𝑆𝑟 𝑥 𝑆𝑑
𝐴𝑠 = 𝑆𝑜𝑎𝑘𝑎𝑔𝑒 𝐴𝑟𝑒𝑎
= __________m2
𝑆𝑟 = 𝑆𝑜𝑎𝑘𝑎𝑔𝑒 𝑅𝑎𝑡𝑒
____ m/hr
𝑆𝑑 = 𝑆𝑡𝑜𝑟𝑚 𝐷𝑢𝑟𝑎𝑡𝑖𝑜𝑛 1 hr
Version: October 2012 Page 4 of 5
Design Templates
Worksheet 5 Soakage Design
F4.5 Infrastructure Technical Specifications
𝑉𝑠𝑜𝑎𝑘 = _____ 𝑥 _____𝑥1 _______m3
Volume of runoff held in storage 𝑉𝑠𝑡𝑜𝑟𝑒 = 𝐴𝑠 𝑥 𝐷𝑠 𝑥 𝑉𝑟𝑓
𝐴𝑠 = 𝑆𝑜𝑎𝑘𝑎𝑔𝑒 𝐴𝑟𝑒𝑎
______m2
𝐷𝑠 = 𝐷𝑒𝑝𝑡ℎ 𝑜𝑓 𝑠𝑡𝑜𝑟𝑎𝑔𝑒 (ground water depth – 0.5 m or depth of unit - 0.5 m) Keep to 2.0 m max depth)
____m
𝑉𝑟𝑓 = 𝑉𝑜𝑙𝑢𝑚𝑒 𝑅𝑒𝑑𝑢𝑐𝑡𝑖𝑜𝑛 𝑓𝑎𝑐𝑡𝑜𝑟
0.__________
𝑉𝑠𝑡𝑜𝑟𝑒 = ______ 𝑥 _____𝑥 _____ _______m3
For 1 trench Capacity = 𝑉𝑠𝑜𝑎𝑘 + 𝑉𝑠𝑡𝑜𝑟𝑒 _______m3
For the site Metre of product required - 𝑉𝑠𝑜𝑎𝑘 + 𝑉𝑠𝑡𝑜𝑟𝑒 > 𝑅𝑐
Therefore 𝑅𝑐𝑉𝑠𝑜𝑎𝑘+𝑉𝑠𝑡𝑜𝑟𝑒
=
_________ m
Summary of Calculations Soakhole ____m deep = ______ Soakholes 1.0 m x 1.5 m Soak trench _____deep = ______ metres of trench Proprietary system ______ deep = ______ metres of product
Version: October 2012 Page 5 of 5
Design Templates
Worksheet 6 Detention Tank Design
W4.6 Infrastructure Technical Specifications
Site Address:
Completed by: Date:
Area for lot number ___ from worksheet 3 Alot__ _____ m2
Equivalent Runoff Coefficient from worksheet 3 Ceqv
Soakage Rate (from worksheet 1) Sr _____ m/hr
Design storm
Duration I mm/hr
Depth (d) mm
Q=CIequivAl
ot_/
3600000 m3/s
Volume in Vin=(d/
1000) x A m3
Volume Out Vout = Qallow x
duration in secs m3
Volume store
Vin – Vout
m3
5min
10min
20min
30min
60min
2hr
6hr
12hr
24hr
48hr
72hr
Select the largest volume store value and provide at least this sized detention tank. Orifice Plate Design
1. Determine the size and dimensions of the proposed detention tank. 2. Based on the tank dimensions, calculate the height (h) of detained stormwater above the location of the orifice
outlet. 3. Calculate the size of the orifice required for the detention tank from the following formula:
Version: October 2012 Page 1 of 2
Design Templates
Worksheet 6 Detention Tank Design
W4.6 Infrastructure Technical Specifications
𝑄 = 𝐶𝐴√2𝑔ℎ
Where Q= allowable flow into HCC reticulation C= 0.98 [orifice coefficient] A=area of orifice g=acceleration due to gravity h=height of water above orifice opening
Therefore area of orifice required 𝐴 = 𝑄𝐶√2𝑔ℎ
And for a round drilled hole the diameter (D) of orifice required is calculated by 𝐴 = 𝜋𝑟2 thus 𝑟 = √𝐴
𝜋 and 𝐷 = 2𝑟
Where D= diameter of circle r = radius of circle 𝜋 = 𝑃𝐼 A = area of orifice
Version: October 2012 Page 2 of 2
Design Templates
Worksheet 7 Combined Detention / Retention Tank
Design
W4.7 Infrastructure Technical Specifications
Site Address:
Completed by:
For single dwellings detention tanks shall provide a minimum of _______ storage for re-use and the volume determined above for detention.
For multi-unit development detention tanks shall provide a minimum of _______ storage for re-use and the volume determined above for detention.
Version: October 2012 Page 1 of 1
Inspection Templates
Wetlands and Ponds Checklist F4.8
Infrastructure Technical Specifications Location: ________________________________________________________________________________________
Developer Council Comments Tick if correct Tick if correct
Administration Details
Developer name and contact details
Detention facility location – street address
Detention facility type (wetland, dry detention basin)
NZ map reference
Site plan No
Resource consent number (HCC and WRC)
Catchment name
Contributing catchment area
Coordinates for detention facility centre
Levels Levels to LINZ datum
Top of dam (RL)
Top of spillway (RL)
Toe of dam (RL)
2 yr ARI water level 10 yr ARI water level 100 yr ARI water level
Dimensions
Max pond length
Max pond width
Height of dam in metres to 0.1 m
Approx. max water depth to 0.1 m
Normal water depth to 0.1 m
Operating surface area (m2)
Normal storage volume (m3)
Spillway details Type Width or diameter
Inlet details Type Width or diameter
Outlet details Type Width or diameter
Flow Design 2 yr return period design m3/s 10 yr storm controlled at high level weir (m3/s) 100 yr storm at spillway (m3/s) Sediment Treatment Estimated suspended solids removal %
Estimated sediment accumulation rate in tonnes/year
Version: October 2012 Page 1 of 2
Inspection Templates
Wetlands and Ponds Checklist F4.8
Infrastructure Technical Specifications
Developer Council Comments
Tick if correct Tick if correct
Safety Features
Planting details Date of planting Plants source Maintenance Requirements Methodology for the on-going and long-term maintenance Estimated cleaning frequency in years
• Forebay • Main pond
Details for permanently wet areas Details for surrounding areas How facility should be dewatered and desilted Attachments Location map Legal description of site Detailed scale plan of total contributing catchment Construction detail plans of the pond including all structures
Approved As-built plan showing truck maintenance access, working and storage areas
WRC resource consent Geotechnical report if applicable Design calculations As-built planting plan Consent compliance reports from WRC All information included in required format
Further information required
…………………………………………….. …………………………………………….. Developer Council …………………………………………….. …………………………………………….. Date Date
Version: October 2012 Page 2 of 2
Inspection Templates
Wetland and Ponds Inspection/Signoff Checklist
F4.9 Infrastructure Technical Specifications
For completion by Developer prior to requesting:
1. 224c approval 2. First defects liability inspection 3. Final defects liability inspection 4. Remedial works completion inspection
Location: _________________________________________________________________________________________
Plan No. : __________________________
Date
Date Date Date
Type of Inspection (record 1,2,3 or 4)
Tick if satisfactory Tick if satisfactory Tick if satisfactory Tick if satisfactory
Pre-inspection 1) Final as-built plans sent to Council 2) Checklists completed for all pipelines and manholes 3) Planting Plan approved by Council Site Meeting 1) Forebay accessible and has all weather access 2) Forebay clear of sludge 3) Boundary pegs sighted 4) Works align with as built plans 5) Spillway/s clear of obstruction 6) Erosion and soil stability 7) Inlet and outlet has structural integrity 8) Plants at least 2.0 m clear of inlet and outlet 9) Planting done to approved planting plan 10) Plant density (approx. 1 per m2) 11) Plants in good condition 12) No plant pests 13) Weed (%) compliant with ITS 14) No notifiable weeds 15) Plants sourced from Waikato Ecological District
16) Safety Features All works satisfactory Remedial work required ………………………………….. …………………………………. Developer Council Date ……………………………
Date…………………………….
Version: October 2012 Page 1 of 1
Quality Assurance Design Certificate
F4.10 Infrastructure Technical Specifications WATER/WASTEWATER/STORMWATER – QUALITY ASSURANCE DESIGN CERTIFICATE
Site Address/Project Name
Consent Number if known
Name of Designer
Designers relevant qualifications
I hereby confirm that the design of the water reticulation / wastewater provision / Stormwater provision for the above site has been designed in accordance with the following standard _________________________________
Engineering Exception Decisions
The following aspects of the design do not meet the requirements of the above standard. (Where standards are not met, please detail the alternative standard achieved).
Accepted Y N
Signed: Date:
Version : October 2012 Page 1 of 1
Pipe Laying Checklist F4.11 Infrastructure Technical
Specifications WASTEWATER PIPE LAYING CHECKLIST
Location:
to
to
to
to
to
Pipe Laying Checks Pipe length (MH To MH)
• Trench Safety (a) Shield (b) Batter (c) Other
• Pipe size, quality, approved materials confirmed
• Set out checked • Surveyors name ________________ • Control points identified
• Foundation support • penetrometer results available • if under cutting required, note
chainage and CBR results.
• Record daily level check and confirm on grade
• Bedding type and surround material _______________________________
• Bulk Backfill material _______________________________
• Bulk backfill compaction (CBR results from pipe to ground level attached)
• Alignment – control points identified
Service connections
• All service connections in place, taped and staked
• Connections correctly located horizontally and vertically
• Connections to main correctly formed
• As-built measurements taken
• CCTV pipe inspection
________________________________________ ________________________________________
Developer Date
Version : October 2012 Page 1 of 1 For further information about this form, email [email protected]
Manhole Checklist F4.12 Infrastructure Technical
Specifications MANHOLE CHECKLIST
Location:
to
to
to
to
to
Manhole Construction Checklist
MH number
• Manhole size, quality, approved materials checked
• Set out /orientation
• Sealing strip between risers
• Benching • Height • alignment and cross section • half pipe lining (wastewater only) • Step recesses (if applicable)
• Flexible joints
• Cutting and plastering of connections
• Access details per drawings
• Step irons including epoxy to outside recesses
• Bedding type and surround
• Bulk backfill compaction (CBR results attached)
• No debris in pipelines
• Invert of pipes in and out
________________________________________ ________________________________________
Developer Date
Version : October 2012 Page 1 of 1 For further information about this form, email [email protected]
Trench Backfill Compaction Test
Summary Checklist
F4.13 Infrastructure Technical Specifications TRENCH BACKFILL COMPACTION TEST SUMMARY (attach individual test reports)
Location: __________________________________________________________________________________
Plan No: __________________________________________________________________________________
From MH ______________________________ to MH ___________________________________
Acceptance Criteria: _______________________________________________________________________
Tests by: ______________________________________________________________ (attached)
Analysis of Results
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Trench backfill completed satisfactorily
Trench backfill requires remedial work
________________________________________ ________________________________________
Developer Date
Version: October 2012 Page 1 of 1 For further information about this form, email [email protected]
Stormwater and Wastewater
Catchpit Checklist Checklist
F4.14 Infrastructure Technical Specifications CATCHPIT CHECKLIST
Location:
Catchpit Construction Checklist
Catchpit Number
• Catchpit , type, size, quality, approved material checked
• Set out /orientation
• Location checked
• Depth of sump below outlet correct
• Cutting and plastering of outlet connection
• Floating debris baffle installed correctly
• Backfill compaction around pit checked
• Seating and plastering of surround and grate to sump barrel
• All silt and debris removed from sump
________________________________________ ________________________________________
Developer Date
Version : October 2010 Page 1 of 1 For further information about this form, email [email protected]
Final Inspection Pipe Network Checklist F4.15 Infrastructure Technical
Specifications FINAL INSPECTION FOR STORMWATER AND WASTEWATER NETWORKS
Location: _________________________________________ Plan No: _________________________
Pre-Meeting Tasks
Developer Checklist Council Pass Developer to verify prior to meeting: SW WW
1. All checklists completed
2. All lines flushed out 3. All required CCTV inspections carried out, reviewed and any re-work
completed.
4. All manholes checked (eg.infiltration, plastering)
5. Catchpits checked
6. All backfilling complete and tidied up
7. Pressure test completed and witnessed
8. Final as-built plans attached for approval
9. Inspection arranged with Council
Site Meeting
1. Inspect all lines
2. Inspect all manholes and catchpits
3. All manholes and catchpits set to level
4. Inspect SW inlet and outlet structures
5. Secondary flowpaths and detention ponds
6. Works on third party land completed to satisfaction of owner
7. Wastewater pumping station
8. Overland flow from adjoining properties not effected
9. All works satisfactorily
10. Remedial work required ________________________________________ ________________________________________
Developer Council
________________________________________ ________________________________________
Date Date
Version : October 2012 Page 1 of 1 For further information about this form, email [email protected]