FORM SSD/PDC/2

SEWERAGE SERVICES ACT 1993

SEWERAGE SYSTEMS AND SEPTIC TANKS

(PLANNING, DESIGN AND CONSTRUCTION) REGULATIONS 1996

(Regulation 7)

APPLICATION FOR APPROVAL OF SEWERAGE WORKS

Date: ___________________ 20____

I/we (the undersigned) ____________________________________________________________

hereby apply to undertake the following sewerage works:

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and submit the following particulars:

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As required by the Federal Government, all land sites for sewerage shall be reserved. Therefore,

I/We as the owner of the sewerage land sites, hereby agree to surrender the above sewerage land

site to the State Authority under Section 195 of the National Land Code 1965 to enable it to be

vested to the Federal Government

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Signature of Owner

Name of Owner (in block letters):

I.C.No.:

Address:

Telephone No.:

Fax No.:

Declaration for Sewerage Works Design Approval

SSD Regional Office: ________________________ Date:______________

File No. : ________________________________________________________

Project Title : _____________________________________________________________

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License Land Surveyor : __________________________________________________

Address : ______________________________________________

________________________________________

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Telephone/Fax : ________________________________________

Lot No/PT : _____________________________________

Mukim/Village/Town : _____________________________________

District : _____________________________________

State : _____________________________________

Land Title No : ________________________________________

Area of STPs/NPS : __________________________sq meter.

Land Status of STP : __________State Land/ Alienated Land/ Reserved Land

Developer : _____________________________________________________

Consultant : _____________________________________________________

Proposed Treatment System : _____________________________________________________

Development Type : ________________________________________________

Population Equivalent (PE) : ______________________________________

Catchment : ______________________________________

Declaration by Qualified Person

I hereby certify that all written information provided in this declaration and the attachment document are completed,

true and correct and are in accordance to the ‘Malaysia Sewerage Industry Guidelines’ and the MS1228 ‘Codes of

Practice for Design and Installation of Sewerage Systems and I accept full responsibility accordingly

Date: …………..…….. ..……………………………………….

Qualified Person by Lead Consultant

Name: ………………………………………

Discipline: Civil Engineer

STP NPS N/W IST

Declaration by Qualified Person

I hereby certify that the details in the plans and design calculations are in accordance with the Sewerage System

and Septic Tanks (Planning, Design and Construction) Regulation 1996 and with MS 1228 “Code of Practice

fro Design and Installation of Sewerage System and I accept full responsibility accordingly.

Signature of Qualified Person

(by Lead Consultant)

Name of Qualified Person (in block letters):

Discipline:Civil Engineer

I.C.No.:

Address:

Telephone No.:

Telefax No.:

Qualifications and Registration particulars:

FOR OFFICIAL USE ONLY

Date received: Checked By:

Date Replied: Ref. No:

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__________________________ __________________________

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Particulars

The following particulars are to be submitted with each application for sewerage works

approval:

1) Sewerage Planning Approval letter issued by the Sewerage Services Department.

2) A site layout plan as approved.

3) A location p lan of the sewerage works.

4) Plans and longitudinal sections of proposed sewers.

5) Detailed plans and sections of sewage treatment works (where applicable).

6) Detailed plans and sections of sewer appurtenances.

7) Detailed plans and sect ions of pumping stations (where applicable).

8) Detailed plans of proposed septic tanks (where applicable).

9) Specifications of materials, equipment and plant.

10) Detailed calculations for the components of the sewerage system.

11) Detai led calculations of the treatment process and hydraulic design (where applicable).

12) Details of phasing of development and numbers of properties served.

13) Details of population equivalent to be served by the proposed sewerage works.

14) Sta ndard of final effluent to be achieved (where applicable).

15) Details of security, screening and access arrangements to plants (where applicable).