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APPLICATION FOR MAINS

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                                                                                  Office use only
                                                                                    Job No:
APPLICATION FOR MAINS
Application notice to Bristol Water for the
provision of new water mains to a development site –
Sections 41, 51A and 55 of the Water Industry Act 1991
Please return this form with supporting documents.

  1. Requisitioner/Applicant (the applicant must be the owner and/or occupier of the site)
  Company name:                                              Contact name (if different from name given on left):


  Address:                                                   Telephone number (including dialling code):


                                                             Fax number (including dialling code):


                                                             E-mail address:
  Postcode:

  2. Site address details
  Site name or description of location:                      Site contact name:


  Road name:                                                 Site telephone number (including dialling code):


  Town/village:                                              Site fax number (including dialling code):


  County:                                                    E-mail address:


  Postcode:                                                  Site mobile telephone number:


  OS Ref at site entrance (6 figures each):
  X                            Y

  If you have made a previous development enquiry regarding this piece of land, please provide our reference:



  3. Consultant/Agent acting for requisitioner, if applicable
  Company name:                                              Contact name (if different from name given on left):


  Address:                                                   Telephone number (including dialling code):


                                                             To whom should we send our correspondence?
  Postcode:                                                      Requisitioner/Applicant            Consultant/Agent
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Application notice to Bristol Water for the provision of new water mains to a
development site – Sections 41, 51A and 55 of the Water Industry Act 1991

  4. Site history
  Details of the previous use of the site are required so that we can determine whether there may be any
  contaminants in the soil that will influence the pipe material to be laid or affect any personnel working on the
  mains installation. A soils analysis report must be submitted for all sites that have been developed in the past,
  together with any other site which we suspect is likely to be contaminated. If certain types of contamination
  are found to be present, connection may be refused until protective measures or remedial action has been
  undertaken by yourselves.

  Was the site previously used for:      greenfield/agricultural?     housing?         industry?          landfill?

  Other, please specify

  Is there any evidence that material (made ground) has been imported on to the site?               Yes         No

  Have any pollution events occurred at or near the site?                                           Yes         No
  If ‘yes’, please give brief details:




  Are any adjacent sites known to be contaminated?                                                  Yes         No
  If ‘yes’, please give brief details:




  5. Previous water usage
  Are there any ‘live’ water supplies on the site?                                                  Yes         No

  Have there been any other properties on this site (such as those that have now been
  demolished) that have had a ‘live’ water supply within the last five years?                       Yes         No
  Previous occupier of the site, and their current contact details:




  Please provide details of the total number of fittings in properties on the site that have had a water supply
  within the last five years:
  Bath                                   Shower cubicle                                  Sink
  Basin                                  Water heater                                    Bidet
  WC                                     Clothes washer                                  Hosetap
  Urinal                                 Dishwasher                                      Sprinkler

  Please provide details of the nature of any usage on the site in the last five years, ie restaurant, manufacturing,
  nursing home etc.
                                                                                                             Page 3 of 7




Application notice to Bristol Water for the provision of new water mains to a
development site – Sections 41, 51A and 55 of the Water Industry Act 1991

  6. Water mains construction details
  On what basis would you like the water mains to be installed?
  Lay only (developer to excavate and backfill on site)           Go to Section 7
  Bristol Water to excavate and backfill on site                  Go to Section 7
  Self-lay                                                        Go to Section 8

  7. Phasing
  Will all site roads be constructed to allow Bristol Water to complete mainlaying in one
  continuous installation?                                                                           Yes     No
  If ‘no’, please indicate the extent of each of the installations on your accompanying site plan.
  On what date do you envisage the site being ready for uninterrupted mainlaying?


  Go to Section 9


  8. Self-lay
  Please note that the details given here must refer to an installer accredited through the Water Industry
  Registration Scheme (which is administered by Lloyds Register).
  Accredited Self-Lay Organisation (SLO)                       Address:


  SLO contact name:


  Contact telephone number (including dialling code):
                                                               Postcode:

  Project Manager:                                             Address:


  Project Manager contact name:


  Contact telephone number (including dialling code):
                                                               Postcode:

  In making this application I am aware that:
  • the terms and conditions of the Bristol Water Self-Lay Policy will apply;
  • the developer and his self-lay contractor must comply with the terms and conditions of the self-lay policy;
  • the developer will be expected to make good any shortfall between the cost of providing the new main and
      the income from the properties that are to be connected;
  • the water mains/services cannot be connected until the work is accepted by Bristol Water;
  • where services are to be laid, the developer shall be responsible for all payments due when the connection
      is made. This will include an administration fee together with the infrastructure charges;
  • all work must comply with the current edition of the Code of Practice for the Self-Laying of Water Mains
      and Services - England and Wales, published by the Water Research Centre, and the Bristol Water
      Addendum to that Code of Practice.
                                                                                                             Page 4 of 7




Application notice to Bristol Water for the provision of new water mains to a
development site – Sections 41, 51A and 55 of the Water Industry Act 1991

  9. Occupation dates and dwelling types

  Domestic units
  Indicate the number of each property type to be built:
  Detached dwellings             2 bed                        3 bed                  4 bed (or more)
  Semi-detached dwellings        2 bed                        3 bed                  4 bed (or more)
  Terraced dwellings             2 bed                        3 bed                  4 bed (or more)
  Flats or apartments            1 bed                        2 bed                  3 bed (or more)

  Including the ground floor, what is the maximum number of floors within each individual building?

  Indicate the date the first property on this scheme will be occupied
  Indicate the date the last property on this scheme will be occupied

  Commercial units
  Please complete the details below for each connection required from the new water main:
                                                                           Annual water
                                                  Peak water flow in                            Domestic storage
  Property description                            litres/second
                                                                           consumption in
                                                                           cubic metres         capacity in litres
  eg Hotel                                        1.01 l/s                 4,800 m3             5000 l




  Including the ground floor, what is the maximum number of floors within each individual building?

  Indicate the date the first property will be supplied from this scheme
  Indicate the date the last property will be supplied from this scheme

  Is the ground floor of any property elevated more than five metres above the public
  highway?                                                                                       Yes       No
                                                                                                       Page 5 of 7




Application notice to Bristol Water for the provision of new water mains to a
development site – Sections 41, 51A and 55 of the Water Industry Act 1991

  10. CDM Regulations
  Is your project notifiable under sections 2(3) and 21 of the Construction (Design and
  Management) Regulations 2007?                                                                  Yes   No
  If yes, please provide details of the CDM Co-ordinator:
  Name:


  Address:




  Postcode:

  Telephone number (including dialling code):




  11. Land ownership
  Will you be the land owner when the water mains are laid?                                      Yes   No


  If no, please provide details of the land owner:
  Name:                                                        Address:


  Contact name (if different from name given above):


                                                               Postcode:

  Will any of the site roads, footpaths, verges or service strips by adopted by the
  Highway Authority?                                                                             Yes   No

  If yes, please indicate the extent of the area to be adopted on your accompanying site plan.


  12. Planning permission
  Do you have full finalised planning approval?
  Yes         No

  If yes, please give approval reference number:
                                                                                                               Page 6 of 7




Application notice to Bristol Water for the provision of new water mains to a
development site – Sections 41, 51A and 55 of the Water Industry Act 1991

  13. Further information
  Please give details of anything not covered elsewhere on this form that may affect the normal installation of
  water mains or services. This could include, but should not be limited to: details of non-standard drainage
  structures; details of surface levels (existing or alterations to); details of tree planting; any environmental
  considerations; and, where the layout is to deviate from the National Joint Utilities’ Group’s guidelines,
  details of how you propose to accommodate all services.




  14. Checklist
  Please note that incomplete submissions will be returned, which will delay the installation.
  To enable your application to be processed swiftly, please ensure that you have completed all the questions on
  the application form and use the checklist below to capture any supporting documentation we may require.
  Please check that you have:
  (a) enclosed a suitable location plan showing the site
  (b) enclosed a blank site layout plan at scale 1:500, 1:250, 1:200 or 1:100
  (c) enclosed a site layout plan (or plans) showing:
        • areas to be adopted as public highway
        • drainage details
        • service pipe layout showing boundary box/meter positions and point of entry to property
        • the phasing of the installation, if multiple visits are required
        • service strips, if applicable
        • other utilities’ apparatus (if known)
  (d) enclosed a soil analysis report, if applicable (Section 4 refers)
  (e) enclosed a schedule detailing plot numbers and pipe sizes, if other than 25 mm service pipes to be
        installed
  (f) enclosed the application fee – see Developers’ Charter
                                                                                                              Page 7 of 7




Application notice to Bristol Water for the provision of new water mains to a
development site – Sections 41, 51A and 55 of the Water Industry Act 1991

  15. Authorised signature (must be the applicant)

  Please create a proposal for installing new water mains for domestic and/or non-domestic purposes for the
  above named development and advise me of the scheme’s details and estimated cost together with the likely
  lead-in times. I have provided all relevant information detailed on this form and will provide any reasonable
  additional information if requested to do so by Bristol Water.

  I confirm that:

  •   I am the owner and/or occupier (delete as applicable) of the land or existing premises for which the mains
      are being requisitioned.
  •   I understand that the submission of this form does not commit me or Bristol Water in any way.
  •   I understand that my design fee may be taken into account when calculating the financial terms offered on
      any resulting mains scheme but that my fee will not be refunded if the mains requisition does not proceed.
  •   If, following the provision by Bristol Water of the proposed mains layout and associated estimated cost, I
      require revised or alternative layouts and estimates for the above named development, I will pay Bristol
      Water any costs they may reasonably require in advance of such work being undertaken.
  •   I understand that I will have to apply for the service connections on this site separately and that the
      relevant "Application for Supply" form or forms will be sent to me with the details of the mains scheme.
      I understand that following the completion and return of my "Application for Supply" form(s) I will be
      advised of the service connection and infrastructure charges that will be payable.
  •   I am aware that as the requisitioner of the mains for the above site, I may also have client responsibilities
      under the Construction (Design and Management) Regulations 2007 and that in respect of these
      regulations I have a responsibility to ensure that, amongst other things, I co-operate with Bristol Water,
      provide information that is sufficient, relevant and timely to Bristol Water and that, where applicable,
      I co-ordinate any work that Bristol Water may have to do with other works that may take place on the
      above site to ensure the safety of those involved with or affected by the works. I am aware that I can find
      out more information on this from the Approved Code of Practice to the CDM Regulations – Managing
      Health and Safety in Construction.


  Signed                                                                      Date
                                                                                         /           /
  Full name in capitals


  Company name


  Address



  Please return this form with supporting documents and appropriate fee to:

  Development Services, Bristol Water plc, PO Box 218, Bridgwater Road, Bristol BS99 7AU

				
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