IDAS form 16—Particular dams (Sustainable Planning Act 2009 version 3.1 effective 3 August 2015) This form must be used for development applications where the proposed operational work requires a dam to be failure impact assessed. You MUST complete ALL questions that are stated to be a mandatory requirement unless otherwise identified on this form. For all development applications you must: complete IDAS form 1—Application details complete any other forms relevant to your application provide any mandatory supporting information identified on the forms as being required to accompany your application. Attach extra pages if there is insufficient space on this form. All terms used on this form have the meaning given in the Sustainable Planning Act 2009 (SPA), the Sustainable Planning Regulation 2009 or the Water Supply (Safety and Reliability) Act 2008. Mandatory requirements 1. What is the nature of the proposed work? Construction of a new dam Works carried out in relation to an existing dam 2. What are the details of the proposed work? Type of construction Storage capacity to full supply (megalitres) Maximum embankment height (metres) If the works relate to an existing dam, provide the following information for that dam: Height of the dam metres Note: See the definition of height for a dam in s.343(7) of the Water Supply (Safety and Reliability) Act 2008 Storage capacity Was this dam failure impact assessed? megalitres Yes No Unknown 3. 4. Has a failure impact assessment for the proposed works been accepted by the chief executive administering the Water Supply (Safety and Reliability) Act 2008? Yes A copy of the ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the Water Supply (Safety and Reliability) Act 2008 must accompany this application. No An application cannot be made without a ‘Notice Accepting a Failure Impact Assessment’ from the chief executive administering the Water Supply (Safety and Reliability) Act 2008. Please seek acceptance from the Department of Energy and Water Supply prior to submitting this application. What is the failure impact rating given for the proposed works? No failure impact rating (less than 2 people at risk) Category 1 (2-100 people at risk) Category 2 (more than 100 people at risk) If the failure impact rating for the proposed dam is category 1 or category 2 it will be a referable dam and additional information on the design and construction of the dam must be provided as supporting information. Mandatory supporting information 5. Confirm that the following mandatory supporting information accompanies this application Mandatory supporting information Confirmation of lodgement Method of lodgement Plan showing: the location of the proposed works including the storage area and any existing works Confirmed lot boundaries and descriptions Confirmed the position of any watercourses or water bodies Confirmed Not applicable the position of any roads. Confirmed Not applicable Written documentation A statement addressing the relevant part(s) of the State Development Assessment Provisions (SDAP). Confirmed Not applicable Notes for completing this form For determining when a dam must be failure impact assessed, refer to section 343 of the Water Supply (Safety and Reliability) Act 2008. Privacy—Please refer to your assessment manager, referral agency and/or building certifier for further details on the use of information recorded in this form. OFFICE USE ONLY Date received Reference numbers The Sustainable Planning Act 2009 is administered by the Department of Infrastructure, Local Government and Planning. This form and all other required application materials should be sent to your assessment manager and any referral agency. IDAS form 16—Particular dams Version 3.1—3 August 2015