Item Code: 8923026308
STAS Code: 9318923025069
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
Application to Undertake Dam Works (Division 3 Permit)
(Constructing a New Dam)
Use this Application form to apply for an approval to undertake dam works (Division 3 Permit) under Section 144 of the
Water Management Act 1999.
In certain circumstances dam works may be exempt from the requirement to hold an approval. Before commencing any
work it is recommended you contact a Regional Water Management Officer at your local DPIPWE office to determine if
your proposed dam works is exempt or requires a permit.
If you intend to take water you must complete a different form to apply for a Water Licence/allocation.
For further information on Dam Works contact your local Regional Water Management Officer listed at
http://dpipwe.tas.gov.au/water/water-licences/water-management-regions.
Steps to Apply
1.
Complete the application form using the associated guide
2.
Submit the completed and signed application form
There are two options for submitting the completed application form;
• Post the completed application form, with the prescribed fee, in the form of a cheque or money order (made
payable to DPIPWE), to DPIPWE, Water Management & Assessment Branch, PO Box 44, Hobart TAS 7001, or
• Lodge the completed application form, with the prescribed fee, at any Service Tasmania outlet.
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
Item Code: 8923026308
STAS Code: 9318923025069
Application to Undertake Dam Works under a Division 3
Permit (Constructing a New Dam)
1. What is the name of the individual, company, partnership or joint venture making an application?
Complete the relevant section as an ‘individual’, ‘company’, or ‘partnership / joint venture’
Companies, Partnerships and Joint Ventures making an application complete this section:
Company, Partnership, Joint Venture name in full, as the name would appear on an ASIC Register.
NOTE FOR PARTNERSHIPS AND JOINT VENTURES: all members of any Partnership / Joint Venture must also complete a Membership
Details Form and attach it to this Notice. An application pertaining to Partnership / Joint Venture will not be accepted by the Department without a
fully completed Membership Details Form. A Membership Details Form is available at: http://dpipwe.tas.gov.au/Documents/Membership
DetailsForm
‘Individuals’ Making an application Complete this Section:
Please provide your full name as it would appear on a passport or drivers licence.
Title: Mr
Mrs
Miss
Ms
Dr
Family name
Full given name/s
Gender:
M
F
Date of Birth
2. If a company is making an application, what is the Company’s ACN?
ACN number (9 digits)
3. What is the ABN (if applicable) of the person or entity making an application?
Australian Business Number (ABN) is a unique 11 digit identifier issued to all entities registered in the Australian Business Register (ABR).
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
Item Code: 8923026308
STAS Code: 9318923025069
What is the street address of the person or entity making an application?
This must be a street address, for example, 9 SUNSHINE ROAD, RICHMOND TAS 7025. This cannot be a post office box number,
roadside mail bag, roadside delivery or other delivery point address.
Street
Suburb / town / locality
State/territory
Postcode
Country if other than Australia
4. What is the postal address of the person or entity making an application?
Enter the details as you would want it to appear on an envelope addressed to you.
Tick this box if Postal Address is same Street Address
If postal address is not the same as street address, complete following:
Street/PO Box
Suburb/town/locality
State/territory
Postcode
Country if other than Australia
6. What are the contact details of the person or entity making an application?
Contact Name
Daytime phone number
Mobile phone number
Email Address
(Remember to specify lower and upper case letters)
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Item Code: 8923026308
STAS Code: 9318923025069
7.
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
What are the coordinates, property address and property identifier of the proposed dam wall at the centre
of the crest of the dam?
Street
Easting
Northing
Suburb / town / locality
Property Identifier located on the Property Title (e.g. 147849/1)
8.
Is the proposed dam on a watercourse 1?
Yes
9.
No
If yes, what is the name of the watercourse?
What is the volume of the proposed dam at Full Supply Level?
ML at FSL (If over 100 ML a capacity survey must be attached)
10. What is the surface area of the proposed dam at Full Supply Level?
ha at FSL
11. What is the maximum height of the proposed dam wall? (i.e. height from point (a) to Point (b) on Figure 1)
m
1
watercourse means a river, creek or other natural stream of water (whether modified or not) flowing in a defined channel, or
between banks, notwithstanding that the flow may be intermittent or seasonal or the banks not clearly or sharply defined, and
includes –
(a) a dam that collects water flowing in any such stream; and
(b) a lake through which water flows; and
(c) a channel into which the water of any such stream has been diverted; and
(d) part of any such stream; and
(da) the floodplain of any such stream –
but does not include –
(e) a channel declared by the regulations to be excluded from this definition; or
(f) a drain or drainage depression in the contours on the land which only serves to relieve upper land of excess water in
times of major precipitation.
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
Item Code: 8923026308
STAS Code: 9318923025069
12. What is the length and width of the crest of the proposed dam wall? (location of crest is noted on Figure 1)
Length =
m
Width =
m (note: minimum permitted width is 3m)
13. What is the proposed upstream batter slope? (note: location of batter is noted on Figure 1)
to 1 (note: minimum permitted is 3:1, or as designed by engineer)
14. What is the proposed downstream batter slope? (note: location of batter is noted on Figure 1)
to 1 (note: minimum permitted is 3:1, or as designed by engineer)
15. What is the proposed spillway depth at the upper level spill point? (i.e. measurement from MFL to invert of
spillway)
m (note: minimum depth is 0.75 m, and must be in accordance with the Water Management
(Safety of Dams) Regulations 2015
16. What is the spillway width of the proposed dam?
m (note: minimum width is 3 m, and must be in accordance with the Water Management (Safety of
Dams) Regulations 2015
17. What is the freeboard 2 of the proposed dam?
m (note: minimum of 0.25 m is required)
18. What is the proposed outlet pipe diameter and material?
mm (note: minimum of nominal 150 mm is required)
material description:
2
Freeboard means the vertical distance between the stated water level of a reservoir and the crest of the dam when not affected
by floods.
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Item Code: 8923026308
STAS Code: 9318923025069
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
Figure 1. DAM CROSS SECTION
Crest of Dam
(a)
Invert of Spillway
Inlet
(c)
Downstream
Batter
Upstream
Batter
(b) Lowest point of Natural Ground Level
Keyway Cut-off into clay:
0.3m minimum
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
Item Code: 8923026308
STAS Code: 9318923025069
Supply information regarding the Height Datum Reference 3 and Reduced Levels:
a) Height Datum Reference:
Easting
Northing
Reduced Level (metres):
b) Crest of Dam (point (a) in Figure 1):
Reduced Level (metres):
c) Lowest point of lowest natural ground level (point (b) in Figure 1)
Reduced Level (metres):
d) Invert of Spillway (point (c) in Figure 1)
Reduced Level (metres):
19. What is the proposed valve diameter?
mm
20. Are the proposed dam works and inundation area (including Maximum Flood Level) entirely on land to which you
are the owner?
Yes
No
If ‘No’, the applicant must notify the owner of the land, in writing, of the intention to make the application.
21. Tick the dam’s Consequence Category
Very Low
Low
Significant
High C
High B
High A
Extreme
22. Will the dam be used to store treated effluent 4? (tick one)
Yes
No
3
A Height Datum Reference (Bench Mark) is to be established at a location nearby to the proposed dam site. The datum is
required to be in place throughout the life of the dam and is to be used to confirm height levels at (a), (b) and (c) in Figure 1.
4
treated effluent includes dairy effluent and water from a sewage treatment plant.
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Item Code: 8923026308
STAS Code: 9318923025069
23.
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
LIst the vegetation type(s), and their area in hectares, found within the dam works construction footprint 5, as
indicated by:
• a vegetation survey report conducted by a suitably qualified person and attached to this application; or
• if a vegetation survey has not been undertaken, TASVEG 3.0 mapping found on LISTmap at:
(http://maps.thelist.tas.gov.au/listmap/app/list/map);
TASVEG Vegetation Code (3 letters)
Area:
ha
TASVEG Vegetation Code (3 letters)
Area:
ha
TASVEG Vegetation Code (3 letters)
Area:
ha
TASVEG Vegetation Code (3 letters)
Area:
ha
TASVEG Vegetation Code (3 letters)
Area:
ha
TASVEG Vegetation Code (3 letters)
Area:
ha
TASVEG Vegetation Code (3 letters)
Area:
ha
TASVEG Vegetation Code (3 letters)
Area:
ha
TASVEG Vegetation Code (3 letters)
Area:
ha
TASVEG Vegetation Code (3 letters)
Area:
ha
5
dam works footprint means the area of land in and around the dam site, to be affected by inundation and construction activities
such as machinery movement, borrow pits, stockpiles, and vegetation clearance.
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Item Code: 8923026308
STAS Code: 9318923025069
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
24. Assessment under the Dam Works Assessment Decision Framework
To complete this section, you must refer to The Dam Works Assessment Decision Framework available at:
http://dpipwe.tas.gov.au/DamWorksAssessmentDecisionFramework
Do the Proposed Dam Works meet
Elements of the Dam Works Assessment Decision
Framework
5.1 Public Safety
Yes
No
5.2 Landslide
Yes
No
5.3 Sediment and Erosion Control
Yes
No
5.4 Acid Sulfate Soils
Yes
No
5.5 Saline Soils
Yes
No
5.6 Coastal Zone
Yes
No
5.7 Capacity to Pass Flows
Yes
No
5.8 Dam Works in a Floodplain
Yes
No
5.9 Storage of Treated Effluent for Reuse
Yes
No
5.10 Harvesting Timber or Clearing Trees
5.11 Native Vegetation Communities and Threatened Flora and
Fauna Species
Yes
No
Yes
No
Yes
No
Yes
No
5.12 Protected Areas
5.13 High
Ecosystems
•
•
the Circumstances of Box A?
(tick "Yes" or "No" for each)
Conservation
Value
Freshwater-Dependant
If ‘No’ is ticked in the above table, then this application must also:
Address the additional matters or information to be provided in the application, as set out in Box B of each
element of the Framework; or
Otherwise show how the dam works could meet the statutory requirements of the Water Management Act
1999.
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Item Code: 8923026308
STAS Code: 9318923025069
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
25. To complete this application, you must attach:
(a) a Consequence Category Assessment of the proposed dam works satisfying the requirements of the Water
Management (Safety of Dams) Regulations 2015.
(b) a spillway design and calculation or a preconstruction and design report prepared in accordance with the
Water Management (Safety of Dams) Regulations 2011.
(c) a full copy of all land titles affected by the proposed dam works or the resulting dam and inundation area
including plan and text reports and provide details on any restrictions, easements, covenants or Part 5
Agreements (Section 71 of LUPAA) on the title.
(d) photographs of the full extent of the location of the proposed dam works and inundation area.
(e) a current (less than 3 months old) Natural Values Report for the proposed dam works site, produced by the
Natural Values Atlas.
(f) a Conservation of Freshwater Ecosystem Values (CFEV) database report covering the dam’s potential zone
of influence6.
(g) a capacity survey if the dam is over 100 ML.
(h) a dam works site plan in accordance with the Division 3 Permit Dam Works Code 2015.
6
potential zone of influence for an off-stream dam includes:
• the dam’s construction footprint; and
• the area extending 100 m from the maximum flood level (MFL)
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division
Item Code: 8923026308
STAS Code: 9318923025069
Form no 027 v1a
valid from 1 July 2016 to 30 June 2017
26. I, the Applicant, declare that:
•
•
•
the information given in this application is true and correct.
If I am not the owner of the land on which the proposed dam works and inundation (including Maximum Flood
Level) would be undertaken, I have notified the owner of the land, in writing, of the intention to make this
application.
that I have paid the prescribed fees of $910.35.
Full name of person making this declaration
Signature
Date
Declared at (place)
Declared before (must be Justice of the Peace, Commissioner for Declarations or Authorised Person)
Personal Information and Privacy Statement
Personal information will be collected from you for the purpose of managing Tasmania’s water resource and will be used by DPIPWE for purposes permitted
by the Water Management Act 1999 and regulations made under this Act. Under the Water Management Act 1999, a person must not furnish information
to the Minister, a water entity or an authorised officer that is false or misleading in a material particular. Your personal information will be used for the primary
purpose for which it is collected, and may be disclosed to contractors and agents of the Water & Marine Resources Division, law enforcement agencies, courts
and other organisations authorised to collect it. Your basic personal information may be disclosed to other public sector bodies where necessary, for the
efficient storage and use of the information. Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may
be accessed by the individual to whom it relates on request to DPIPWE.
Department of Primary Industries, Parks, Water and Environment
Water and Marine Resources Division