R A Dalton Template - July 2022

• Conducted on

  Date

• Prepared by

• Location

• Customer name

• Customer address

• Customer Email

• Customer Contact number

Site Details (if different to above)

• Site address

• Site contact name

• Site contact number

• Site/ Quotation details

• Proposed system/ works

• How many Properties are connected to the plant

• Are there any surface water connections?

  Yes

  No

• Do these require disconnecting by us?

  Yes

  No

• How much work is required to disconnect

• Where is the point of discharge

  Watercourse

  Drainage field

  Other

• Please specify

• Has percolation tests been carried out?

  Yes

  No

• Meterage of drainage field required?

• Height of inlet drainage

• Meterage of inlet drainage (Soft dig)

• Meterage of inlet drainage (Hard dig)

• Meterage of outlet drainage (Soft dig)

• Meterage of outlet drainage (Hard dig)

• Any reinstatement required (If so please specify what)

• How many inspection chambers required

• How many outlet chambers required

• Where is the power supply on site?

• Is an RCD Available on site? If so please include photos.

• How much/ what cable is required?

Site information

• Are there access issues? (please include the lead up to site and site itself)

  Yes

  No

• What size vehicle is required?

• What ground conditions are anticipated

• Will shoring/ a hydrainer/ a breaker be required?

  Select Breaker Shoring Hydrainer None

  • Breaker
  • Shoring
  • Hydrainer
  • None

• Is there a requirement for any fencing?

  Select Orange barrier mesh Pedestrian Barrier Heras Fencing Signage None Other

  • Orange barrier mesh
  • Pedestrian Barrier
  • Heras Fencing
  • Signage
  • None
  • Other

• How many are required?

• How many are required?

• What signage is required?

• Is there a requirement for welfare?

  Portable toilet

  Welfare unit

  Site Providing services

• Will any ground protection be required?

  Yes

  No

• Is there any significant site traffic?

  Yes

  No

• Please clarify

  Public

  Other contractors

  Other

• Is there a storage/ compound area?

  Yes

  No

• Are there any overhead cables or underground cables in the working area?

  Yes

  No

• Can the customer provide service plans?

• Are there any other notable risks on site?

Additional information

• Is a Building Notice required?

  Yes

  No

• Is an EA permit required?

  Yes

  No

• Who is this point of contact

• Contact Email

• Contact Number

• Who is the application for?

  Charity

  Company/ Corporate Body

• Name of the Charity

• Charity Commission Number

• Date Registered

• Contact (must be named on the company's house)

• Full name of the company

• Company Registration number

• Date Registered

• Is the discharge new or existing?

  New

  Existing

• When did it start?

  Yes

  No

• When do we want the permit to start? (Bearing in mind the delays in approving permits)

• Are we discharging to ground or surface water?

  Watercourse

  Drainage field

  Other

• Have percolation tests been carried out as these will be required if not

  Yes

  No

• Please confirm results

• Please supply site plan and up to date sizing sheet.

  Media

• Is a connection Mains sewer required?

  Yes

  No

• What size is the proposed connection?

• What is the method of connection?

• Is there an existing supply to the premises?

  Yes

  No

• What is the account number?

• Has planning permission been applied for?

  Yes

  No

• What type of site is it from?

  Commercial premises

  Caravan Site/ Holiday Park

  Residential

  Other

• Please confirm more details

• How many caravans/ lodges are on site and their occupation?

• How many properties are to be connected and how many bedrooms?

• Estimated duration of works

• Will directional drilling be required?

  Yes

  No

• Have we had any quotations for the works?

  Yes

  No

• Will we require a Section 50?

  Yes

  No

• Please describe the works being done.

• Where is the work taking place

  Verge

  Carriageway

  Footway

• Average depth of excavation

• Average length of the excavation

  Yes

  No

• Has routine maintenance been discussed?

  Yes

  No

• Does site require an Environmental Management System file?

  Yes

  No

• What machinery is required?

• How much gravel is required?

• Any additional works required before installation? (e.g. CCTV works, access etc)

• Any additional information.

• Photos of the site (please include pictures of access)

  Media