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 : 26 MARCH 2011

I / We (the undersigned) KEMENTERIAN PELAJARAN MALAYSIA

hereby apply to undertake the following sewerage works:

PROPOSED CONSTRUCTION OF SEWER LINES, SEWER MANHOLES AND SEWER MANHOLES AND
SEWERAGE TREATMENT PLANT FOR PROPOSED REDEVELOPMENT OF THE EXISTING SCHOOL ON
LOT 5844, SEKOLAH KEBANGSAAN (SK) CONVENT, JALAN CHAMBERLAIN, IPOH CITY, MUKIM KINTA,
DAERAH KINTA, PERAK DARUL RIDZUAN – PRIVATELY MAINTAINED SEWERAGE TREATMENT PLANT

and submit the following particulars (see reverse of form):

1) Location and Layout Plan – 4 copies.

2) Details of Land Title , Lot Number and Area of Land.

3) Engineering Report.

As required by 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.

Signature of Owner

Name of Owner : KEMENTERIAN PELAJARAN MALAYSIA

(in block letters)

I.C No :

Address : Bahagian Pembangunan dan Perolehan,

Kementerian Pelajaran Malaysia,
Aras 1, 5 & 6, Blok E2,
Kompleks Kerajaan Parcel E,
62602 Putrajaya,
Wilayah Persekutuan Malaysia

Telephone No : 03-88849045

Fax No : 03-88886649

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DECLARATION FOR SEWERAGE WORKS DESIGN APPROVAL
SSD Regional Office : Perak Date : 26 March 2011

File No. :
Project Title : Proposed Redevelopment of the Existing School on Lot 5844, Sekolah
Kebangsaan (SK) Convent, Jalan Chamberlain, Ipoh City , Mukim Kinta,
Daerah Kinta, Perak Darul Ridzuan.
License Land Surveyor : M/S Juruukur Staff

Address : No 33 A, Rumah Kedai, Persiaran Halaman Ampang, Halaman Ampang Mewah,

31350 Ipoh, Perak Darul Ridzuan.
Telephone / Fax : 05- 3115769 ; Fax No : 05- 3135161
Lot No. / PT : Lot 5844
Mukim / Village / Town
: Kinta / Ipoh City
District : Kinta

State : Perak Darul Ridzuan

Land Title No. : Lot 5844

Area of STPs / NPS : N/A – 200 Metres Square

Land Status of STP : Privately Maintained Sewerage Treatment Plant

Developer : Kementerian Pelajaran Malaysia

Consultant : M/S Perunding Azizi

Proposed Treatment : Extended Aeration

System

Development Type : School

Population Equivalent : 72 PE
(PE)

Catchment :N/A
STP NPS N/W IST
 Declaration by Engineer

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 'Guidelines for Developers' and the MS 1228
Codes of Practice for Design and Installation of Sewerage System and I accept full responsibility accordingly.

Date : 26 March 2011

Qualified Person by Lead Consultant
Name : IR AZIZI BIN ABU BAKAR
Discipline : Civil Engineer

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Declaration by Qualified Person

I hereby certify that the details in the plans and design calculation are in accordance with the Sewerage
System and Septic Tanks (Planning, Design and Construction) Regulations 1996 and with MS 1228

"Code of Practice for Design and Installation of Sewerage System" and I accept full responsibility accordingly.

Signature of Qualified Person

(by Lead Consultant)

Name of Qualified : IR AZIZI BIN ABU BAKAR

Person (in block letters)
Discipline : Civil Engineer
I.C No. : 630101-08-6963
Address : M/S Perunding Azizi,
No.3, Tingkat 2, Taman Arasu,
Jalan Raja Omar,
32000 Sitiawan,
Perak Darul Ridzuan.
Telephone No : 05 - 6923843
Fax No : 05 - 6923953
Qualifications and Registration particulars: Professional Engineer No 8989
FOR OFFICE USE ONLY

Date received : Checked By :

Date replied : Ref. No. :

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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 plan of the sewerage works.

2) Plans and longitudinal sections of proposed sewers.

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

4) Detailed plans and sections of sewer appurtenances.

5) Detailed plans and sections of pumping stations (where applicable).

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

7) Specifications of materials, equipment and plant.

2) Detalied calculations of the components of the sewerage system.

3) Detalied calculations of the treatment process and hydraulic design (where applicable).

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

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

6) Standard of final effluent to be achieved (where applicable).

7) Details of security, screening and access arrangement to plants (where applicable).

BORANG PDC 2