Dam safety assurance programme
The dam safety assurance programme consists of this form, the attached documents, and any other referenced documents.
Resource consent number or identification (if applicable):
Height of dam (in metres):
Reservoir maximum capacity (in cubic metres):
Description of spillway or flood control facility:
Flood capacity (in cubic metres per second):
Changes in design or operation since construction:
Potential impact classification:
Relevant regional authority:
Name of operator (if different from owner):
Summary of compliance with criteria and standards
Please attach a brief summary of how each of the criteria and standards set out in regulation 8 of the Building (Dam Safety) Regulations 2008 have been addressed and indicate where these are addressed in the dam safety assurance programme.
Describe briefly and/or reference how each of the following have been adequately addressed for the dam:
surveillance requirements, including accurate records detailing the safety performance of the dam and that appropriate actions are taken when potential deficiencies or adverse data trends are identified:
the frequency for routine visual inspections:
instrument monitoring and data evaluation:
reporting to the dam owner.
Describe and/or reference the requirements for annual dam safety reviews of the dam.
Describe and/or reference the requirements and frequency for comprehensive dam safety reviews of the dam.
Summarise and/or reference your emergency action plan including—
emergency identification procedures:
notification procedures and contact lists:
dam breach inundation maps.
Describe and/or reference the requirements to inspect appurtenant structures, including testing of gates and valves that contribute to reservoir safety.
Describe and/or reference the procedures for the investigation, assessment, and resolution of dam safety deficiencies.
Documentation of dam safety assurance programme
List the location of all documentation, manuals, and publications referred to in the dam safety assurance programme if applicable: [list]
State the location(s) of the dam safety assurance programme: [location(s)]
State the appropriate contact person with respect to the dam safety assurance programme and supporting referenced material—
The documents that form the dam safety assurance programme are attached as follows: [list documents]
Certificate of recognised engineer
I certify that the dam safety assurance programme prepared for the above dam meets the methodology for classifying a dam set out in regulation 4 of the Building (Dam Safety) Regulations 2008.
I am a category A recognised engineer in accordance with section 149 of the Building Act 2004.
I have attached evidence that I am a category A recognised engineer.
Signature of recognised engineer:
Full name of recognised engineer:
CPEng registration number: