Water and Sewer connections application form. Section 1. 1a. Applicant details

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Water and Sewer connections application form Application for new connections to the existing water and/or sewer network. Please use this application to apply for a new water connection(s) and/or sewer connection(s). You can apply for multiple connections on one form - just fill in the appropriate section for the type of connection you need. You can find more information at stwater.co.uk/newconnections or by calling us on 0800 707 6600. Please keep a copy of your completed application form for your records. Section 1 Contents Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Applicants details Site details Standard water connections Large diameter water connections Sewer connections Checklist and payment 1a. Applicant details It s important we know who to contact about the application, arrange a site visit and send correspondence to. Name Contact address Postcode Phone Mobile Email Registered company number 1b. Agent/consultant details (only complete if you use a agent or consultant) Agent/consultant name Address Postcode Phone Mobile Email Registered company number 1c. Correspondence Who would you prefer we send correspondence to? Applicant Agent Is there anyone else you re happy for us to discuss your application with? What method of correspondence would you prefer? Email Post

Section 2 2a. Site details What is the development? Site name Address Postcode 2b. Connection requirements So we can give you the right information we need to know exactly what you re applying for. What type of connections are you applying for? Water Sewer Both If applying for water connections, do you require a standard connection or large diameter connection? standard (upto 32mm) large (over 32mm) If you re not sure if you need a standard or large diameter connection you can use our connection type calculator at stwater.co.uk/newconnections If you re only making a new water connection, please tell us how the used water will be disposed of. This is so we can keep a record for network demand and billing purposes. How will foul water be removed from the properties? How will surface water be removed from the properties? 2c. Previous site usage Septic tank Soakaway or Watercourse Connection to public sewer Connection to public sewer If the site has been previously occupied, there may be a risk of the ground being contaminated. To make sure your supply and our network doesn t become contaminated, please confirm the following: What was the site previously used for? Housing Industry Greenfield/Agriculture Landfill Other (please specify) If greenfield you don t need to complete section 2d If you re applying for a water connection and the site was used for anything other than greenfield you need to include a soil analysis report of the site with your application OR you will be required to lay protective pipework (this may increase the cost of your application). Please tick which option is applicable. Soil report included Protective pipework to be laid

2d. Previous supplies Please give details of any premises that may have had a previous water or sewer connection that has been billed by Severn Trent Water within the last five years. If these premises have had a connection which won t be used as part of your development, we ll use this information to work out if we can apply credits to your infrastructure charges which may reduce the amount you need to pay. Address of previous premises Former Use (commercial or domestic) Demolition Date Water Account number If applying for standard water connections please complete section 3 If applying for a large diameter connection please complete section 4 If applying for just waste connection please complete section 5 If applying for both you will need to complete sections 3 or 4 AND 5

Section 3 - Standard water connections (Sections 45 and 55 of the Water Industry Act 1991) You only need to complete this section if you re applying for standard water connections (25mm or 32mm). If you require a larger connection please complete the large diameter connection page. A standard water connection is a connection up to 32mm in diameter. This will provide up to 1 litre per second and should be sufficient for all domestic properties (flats/terrace/semi/detached houses). It can also be used for commercial properties that don t require more than 1 litre per second, e.g. office block requiring water for kitchen and bathroom facilities only. If you re not sure you can use the flow type calculator at stwater.co.uk/newconnections to check. Please give as much information as you can. This will help us to log your application correctly and arrange a site visit/ quotation as soon as possible. 3a. Existing supplies Is there a existing Severn Trent Water supply on site? Are you intending to retain the live supply? If yes, which plot will it be used for? Will you be using an existing metered supply for construction? If yes, please provide the Severn Trent Water account number 3b. New connection requirements If the connection is not for domestic or commercial purpose please specify the reason for connection. Temporary Building Supply Process water only Agricultural trough Other Irrigation If process water please specify what it will be used for and flow rate required in litres per second On the following pages: For domestic properties you only need to complete table 1 For commercial properties you only need to complete table 2

Table 1 Domestic properties Property type Fire sprinkler branch Do you know the final billing address for this property? Connection number Flat Terraced Semi detached Detached New build Existing property Conversion Final billing address 1 a a a a 1a The Green, Leicester, LE1 1AA Total

Table 2 Commercial properties Property type Fire sprinkler branch? Do you require a dual pulse water meter? Do you know the final billing address for this property? Water usage Water fittings to be used in property Tick as appropriate State number being used Property name/number Connection number New build Existing property Conversion Estimated peak flow (litres per second) Storage capacity WC flushing cisterns Auto flushing cisterns Basins household Basins elsewhere Baths (taps upto 20mm) Baths (taps over 20mm) Showers Sinks (taps up to 15mm) Sinks (taps over 15mm) Single spray taps Bidets Dishwasher Clothes washer Hose taps Drinks vending machines Office 1 1 a a a a 2 4 1 17 1 1 1 2 Total

Section 4 - Large diameter water connections (Sections 45 and 55 of the Water Industry Act 1991) You only need to complete this section if you re applying for large diameter water connections (50mm or above). If you re building a block of flats (usually more than 5) you may choose to have 1 large connection onto our main and then split the pipework internally to allow each water meter to be fitted for each flat. If you have a commercial property that will use a large amount of water, e.g. leisure centre/hotel/hospital, you may apply for a large diameter connection. If the commercial property will use water for process reasons, e.g. food processing/dye factory, you re likely to need a large diameter connection. If there are any fire hydrants or sprinkler supplies the large diameter connection can be sized to accommodate them. If you re not sure if you need a standard or large diameter connection you can use our connection type calculator at stwater.co.uk/newconnections Please give as much information as you can. This will help us to log your application correctly and arrange a site visit/ quotation as soon as possible. 4a. Connection requirements For individually metered flats/apartments in a block please complete table 1 and section 4b For commercial properties please complete table 2 and section 4b Table 1 Domestic Properties/blocks of flats Block name Will there be any domestic storage? (if please complete section 4b) Service pipe details Will rainwater be recycled or grey water plumbing be used? Do you know the final billing address for this property? Do you require a landlord supply? Total Number of Flats Size Material Block A 20 a 63mm MDPE a a a

Table 2 Commercial Properties Property type Do you know the final billing address for this property? Tick as appropriate Do you require a dual pulse water meter Water usage and fittings to be used in property Domestic use State number being used Property name/number Connection number New build Existing property Conversion WC flushing cisterns Auto flushing cisterns Basins household Basins elsewhere Baths (taps upto 20mm) Baths (taps over 20mm) Showers Sinks (taps up to 15mm) Sinks (taps over 15mm) Single spray taps Bidets Commercial use Dishwasher Clothes washer Hose taps Drinks vending machines Average daily usage (litres per second) Duration of usage per day (hours) Estimated peak flow (litres per second) Volume of process water required (l/s) 1a 1 a a a 2 2 10 15 1 17 1 1 8 3 What size pipe will you install to the boundary? 50mm 63mm 90mm 125mm 4b. Fire supplies and storage requirements Fire supply requirements are usually detailed at planning permission stage. If you re not sure of the requirements, please contact your planning officer. It s important this information is correct so we can assess our network and make sure we can meet your requirements. Where off-site reinforcement works are required, we ll let you know about it and the associated costs at quotation stage. We can t guarantee water for fire fighting purposes and it s advisable any fire supplies are not direct fed. Do you require a fire sprinkler supply? If yes, will this be supplied by a full capacity storage tank? We ll aim to fill this tank in 36 hours. If yes, what is the: Do you require a fire hydrant? Storage capacity Infill rate (l/s) If yes, what is the required flow? (l/s) We ll usually aim to provide 8l/s. If more is required please specify. Are you installing storage? (for anything other than fire supplies) If yes, what is the: Storage capacity Infill rate (l/s)

Section 5 - Sewer connections (Section 106 of the Water Industry Act 1991) You only need to complete this section if you re applying for approval to connect to our sewer network. Sewer connections are on a self lay basis (i.e. you or your contractor carry out the connection works). We will approve, inspect and sign off the works. It s important we assess our network and understand additional demand to help us identify where future upgrades to our network may be needed. You may find it easier to complete this section with your contractor as they ll be able to provide the required information. A site specific method statement and risk assessment will be required which your contractor must give you to submit with the application. This is required for any connection being made directly onto the public sewer. If applying for a surface water or combined sewer connection, you ll need to provide evidence that it isn t feasible to use a soakaway. This evidence can be either an extract from the ground investigation report, results from a percolation test or an email/letter from building control. 5a. Connection details Please complete table 1 below, ticking the appropriate box for the connection type and sewerage flows. For each direct connection please also complete table 2. A separate fee and approval is required for each connection onto the existing sewer. Table 1 Connection Sewerage flows Connection number Indirect Direct Foul Anticipated peak flow (l/s) or number of properties Surface water Anticipated peak flow or surface area in M2 Combined Anticipated peak flow (l/s) Surface area in M2 1 a a 0.046 Total Table 2 Please complete a line for each direct sewer connection Connection number Where and how you are connecting Location Private Highway Connection method (please state) Sewer pipe you're laying Size Depth Material Size Existing pipe that you're connecting to Depth Material Gravity or Pumped G or P Demarcation chamber Size Depth Material 1 a Existing manhole 150m 0.9m Polysewer 150m 1.4m Clay G 450m 0.9m Plastic If you re installing a pump station you need you to give us the details of the pump station with your application form.

5b. Contractor details Please confirm who will be carrying out the sewer connection(s). For direct sewer connections, the person carrying out the works will also need to provide a site specific method statement and risk assessment covering the sewer connection works. You ll need to submit this with the application. We ll also need to check their Health and Safety policy to ensure they are safe to work on the sewer network. If they ve given us this in the last 12 months then you don t need to send it again. Contractor name Address Postcode Phone Mobile Email Registered company number

Section 6 - Checklist and payment Please make sure you submit all the required information so that we can process your application and get back to you as soon as possible. There s a fee for each type of application which is outlined in this form. You can find more information on the charges at stwater.co.uk/newconnections or by calling us on 0800 707 6600. The payment options can be found on the next page, but if you re paying by cheque, please make sure it s securely attached to the application form and that all items are posted together. 6a. Standard water connection Please make sure you provide the relevant information in the checklist below before submitting your application. Item Included t required Location plan identifying the property requiring connection (i.e. ordnance survey plan) Soil analysis report if necessary (see section 2) Site plan indicating the route of the customer service pipe to the highway boundary For commercial premises a scaled site plan showing the total site area and the area occupied by each unit Initial payment ( 114.90 plus VAT) (one payment for all standard water connections on this request) 6b. Large diameter water connection Please make sure you provide the relevant information in the checklist below before submitting your application. Item Included t required Location plan identifying the property requiring connection (i.e. ordnance survey plan) Soil analysis report if necessary (see section 2) Site plan indicating the route of the customer service pipe to the highway boundary For commercial premises a scaled site plan showing the total site area and the area occupied by each unit Initial payment ( 245.39 plus VAT) (one payment for all large diameter water connections on this request) 6c. Sewer connection Please make sure you provide the relevant information in the checklist below before submitting your application. Item Included t required Location plan showing the site and point of connection Site plan showing location of chamber, pipework and public sewer Contractor s Health and Safety policy (for direct connections only) Site specific risk assessment and method statement (for direct connections only) Evidence of why soakaways can t be used Approval fee payment(s) (see below table) A payment is required for each sewer connection you ll be making. Please state the number of connections you re applying for and the total payment enclosed. Direct Connections to a public sewer in the highway ( 455.67 each) Direct Connections to a public sewer in private land ( 224.98 each) Indirect connections (to a private drain that outfalls to a public sewer) ( 96.41 each) Total Total number Total payment

6d. Payment Details Please make sure you provide details of payment for your applications Cheque Debit/credit card BACS For debit/credit card payments, we ll contact you on receipt of the application to take payment. Please make all cheques payable to Severn Trent Water Ltd. Please attach your cheque to the completed application form and post together. It you re making a BACS payment, please confirm the date it was made, who made it and the reference number so we can match your application to the payment. Please make sure BACS payments are made before you submit your application. BACS Ref: Payer: Date: Amount: Please send all completed applications and supporting information to: Severn Trent Water Ltd PO Box 5311 Coventry CV3 9FL Or email them to new.connections@severntrent.co.uk If you email your application, we ll contact you for payment.