Application for the diversion of a Severn Trent Connect sewerage asset under section 185 of the Water Industry Act Note Note. 1.

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Sewer diversion Application for the diversion of a Severn Trent Connect sewerage asset under section 185 of the Water Industry Act 1991 NOTE: Please ensure all relevant sections of the application are completed and refer to the attached support notes. Please ensure you save a completed copy of this application form for your own records. Office use only SDA Section 1A: Applicant s details Name of Applicant: Note. 1.1 Contact name: Address of Applicant: Note. 1.2 Mobile number: Registered company number: Note. 1.3 Section 1B: Agent/Consultant details (only to be completed if an agent/consultant is being used) Name of Agent/Consultant: Note. 1.4 Contact name: Address: Note. 1.2 Mobile number: Registered company number: 1

Section 1C: Site details Site name and address: Note. 1.5 Ordnance survey reference: Note. 1.6 x: Y: To whom should we send the correspondence? Applicant Agent/Consultant Related application reference: Note. 1.7 Section 2: Contractor details Name of Contractor: Note 2.1 Contact name: Address of Contractor: Note 1.2 Registered company number: Mobile number: Section 3: Construction and Design Management (CDM) Regulations 2007 NOTE: For information on the CDM Regulations 2007 please visit www.hse.gov.uk 1. Is your project notifiable? Note 3.1 Yes No If no, please move to the next section. Fax number: NOTE: Your project is notifiable if construction work lasts more than 30 working days or involves more than 500 person days 2. Has the Health and Safety Executive been notified that your project is notifiable? Note. 3.2 Yes No NOTE: If No, you need to contact the HSE at www.hse.gov.uk to advise that your project is notifiable before you submit this application form. 3. If yes to 2, have you appointed a CDM co-ordinator? Note 3.3 Yes No Name of CDM Co-ordinator: Name of Principal Contractor: Note. 3.4 Address: Address: 2

Contact name: Contact name: Section 4: Local Council details Name of local Council: Note. 4.1 Outline consent date: Note. 4.3 Local Council planning consent ref: Note. 4.2 Full consent date: Note. 4.4 NOTE: Please provide a copy of any conditions attached to the consent. 3

Section 5: Checklist / Required information and plans (please tick to indicate information is attached) General information required for all enquiries: Three copies of a location plan (scale 1:2500) showing: The proposed route of the diverted sewer(s) (coloured pink) The abandoned sewer(s) (coloured red) The site boundary (coloured green) The point at which the Applicant wishes to connect his drains or sewer(s) to the diverted sewer(s) (if applicable). A plan showing the location and value of the Ordnance Survey benchmark used to determine the invert levels A copy of the valid planning permission for the site (if proposed development). Evidence that the applicant owns or occupies the site or premises. (such as a copy of the title or deed for the land/property) Enclosed the correct payment as detailed in the Developer Charges Summary. Please make cheques payable to Severn Trent Services (Water & Sewerage) Ltd A copy of any conditions attached to the planning consent. If you have a proposed design and wish to construct the diversion yourself under agreement with Severn Trent Connect, please also include the following information: Note: Work cannot start until agreement is in place and all provisions have been complied with Details of other services in the vicinity of the diversion route. CCTV of the sewer to be diverted (a survey conducted using video footage to assess the structural condition of the pipe work). 3 Copies of a longitudinal section of the proposed sewers scale horizontal 1/500, vertical 1:100 showing: Existing and proposed levels Pipe materials and strengths Pipe diameters Pipe bedding classifications Pipe gradients Construction details of manholes and structures. Phase 1 Habitat Survey Report (a survey of flora and fauna in the vicinity of the asset and how the proposal work would impact this environment). Note: A Phase 1 habitat survey is required to demonstrate the affect any work undertaken may have on the site and adjoining land. The survey identifies the habitats that are contained within or make up a site and the key plant species for each of the habitat types. It also provides target notes on important aspects of the site such as the presence of rare plant or animal species or special features such as an ancient hedgerow. 4

Section 6: Declaration (To be signed by Applicant) Please advise me of the estimated cost and programme for diverting public sewers for the above named development. In this respect, I will provide any relevant information required by Severn Trent Connect. I understand that the submission of this form is to be treated as a preliminary enquiry and does not commit me or Severn Trent Connect, save as set out below. In particular, I understand that Severn Trent Connect does not authorise or hold itself responsible for the reimbursement of any expenses incurred in any design work undertaken by me without the express approval of Severn Trent Connect. I confirm that if following the provision by Severn Trent Connect of the agreement to the sewer diversion, the estimated cost and programme, I require further or revised estimates and programmes for diverting public sewers for the above named development, I will pay Severn Trent Connect s costs and will provide such advance payment as they may reasonably require. Upon my acceptance of the estimated cost and programme, I will enter into a formal written agreement with Severn Trent Connect for the diversion of a public sewer. I also confirm that if the diversion does not proceed I will reimburse Severn Trent Connect s reasonable abortive costs in preparing the estimated cost and programme. NOTE: Under no circumstances are alterations to the pipe/apparatus to be undertaken by any party other than Severn Trent Connect (or as agreed by Severn Trent Connect). If there is more than one applicant, please photocopy this declaration page and ensure that each applicant returns a signed copy. By signing this form I confirm: That the Applicant hereby gives notice to Severn Trent Connect in accordance with Section 185 of the Water Industry Act 1991 to alter/remove a relevant sewerage asset as shown in the attached plan That the Applicant is the owner/occupier of the land or has an interest in the land and have provided evidence accordingly The Applicant undertakes to pay the full reasonable costs incurred by Severn Trent Connect in implementing the diversion scheme and that such estimated reasonable costs shall be paid in advance of commencement of the diversion scheme That all statutory requirements, including without limitation the Water Industry Act 1991 and the CDM Regulations 2007 (as amended), shall be met That I have read the Sewer Diversions Guidance Note (if signing on behalf of a Company) I am a duly authorised representative of the Company and can bind the Company accordingly. Signed: Position: (If signing on behalf of a Company) Full name in capitals: Address: Company name: (If signing on behalf of a Company) Date: 5

The information you provide to us in this application will be used for the purposes of progressing your application for a sewerage diversion. Please note that we will only discuss this application with those parties identified on the application. Should you make any changes to this information you must inform us as soon as possible so as not to delay your application. Please return this form with supporting documents to: Severn Trent Connect Developer Services Severn Trent Centre 2 St.Johns Street Coventry, CV1 2LZ Email: developer@severntrentconnect.com 6

Support notes IMPORTANT NOTE: Insufficient or inaccurate information may result in delays in the processing of your application. Note 1: Applicants details 1.1 1.2 1.3 1.4 1.5 1.6 1.7 The Applicant is the owner/occupier of the site that requires the connection. It is this individual/company that is responsible for the content of the application form and accepting the conditions laid out in the application declaration. Please ensure that the complete address and contact details are provided. These address details may be used for future contact and correspondence. Registered Company Number: The registration number of the business as issued by Companies House www.companieshouse.gov.uk. We will accept an application form that has been completed by an Agent/Consultant, however, the Applicant remains responsible for the content of the application and must sign the application form. Please provide as much of the site address as is available at the time of the applications submission. This address MUST contain: Road name, Town/city, County. The Ordnance Survey reference is a 12 digit grid reference split into two 6 digit numbers (X and Y). This can be obtained from www.ordnancesurvey.co.uk If you have made a development enquiry or submitted any applications that are linked to this site please provide the reference numbers. This will help us process your application. Note 2: Contractor details 2.1 For sewer connections the contractor will be the company that will be making the actual connection. Note 3: Construction, Design and Management (CDM) Regulations 2007 3.1 3.2 3.3 3.4 Your project is notifiable if construction work lasts more than 30 working days or involves more then 500 person days. IMPORTANT NOTE If your project is notifiable you will have to appoint a CDM co-ordinator, if you have not Severn Trent Connect cannot process your application form. More information regarding the Health and Safety Executive (HSE) and how to contact them can be found at www.hse.gov.uk CDM Co-ordinator (Definition): The person appointed to advise and assist the client on how to comply with the CDM Regulations during the project, and to ensure that suitable arrangements are made and implemented for the co-ordination of health and safety measures during planning and preparation for the construction phase. Only appointed on notifiable contracts. 1 Principal Contractor (Definition): The duty holder who is required to ensure effective management of health and safety throughout the construction phase of the project. Their main duty is to properly plan, manage and co-ordinate work during the construction phase in order to ensure that hazards are identified and risks are properly controlled. 2 1 Definition taken from The HSE Industry guidance for CDM Co-ordinators 2 Definition taken from The HSE Industry guidance for Principal Contractors 7

Note 4: Local Council details 4.1 4.2 4.3 4.4 Please provide the name of the Council authority that has provided planning permission construction on the site. Please provide the unique reference number for the planning permission issued by the Council authority. Outline consent: A form of planning consent designed to test the principle of whether or not a development is acceptable. The planning authority can request any level of detail they think is necessary to reach a decision, although usually, only a minimal amount of information is supplied. Outline consent does not authorise construction, only that the site is suitable for development. Full consent: A detailed planning assessment that will provide consent for construction to start, as well as confirming the future use of the site. 8