FORM SSA/PDC/4

SEWERAGE SERVICES ACT 1993

SEWERAGE SYSTEMS AND SEPTIC TANKS
CERTIFICATE OF PROCESS DESIGN & DESIGN CALCULATIONS
(for endorsement on plans and calculations to be lodged with the Director General)
Date: __________________ 20 ____
To: The Director General of Sewerage Services
I hereby certify that the details in the process design and design calculations viz :

On Lot/s: _________________________________________________________________________

Section: __________________________________________________________________________

Jalan: ____________________________________________________________________________

for (Name of owner): ________________________________________________________________

I hereby certify that these works have been design by me in accordance with sound engineering
practice and are in accordance to the Guidelines For Developers, the MS1228 Codes of Practice for
Design and Installation of Sewerage System, and other regulatory agencies requirements and that I
take full responsibility for the design and performance of the same.

Signature of Qualified Person

Name of Qualified Person:
Discipline: Chemical/Civil/Environmental Engineer
Address:
I.C.No.:
Registration No:
Class:
FOR OFFICIAL USE ONLY
Date Received: ______________________ Checked By:_______________________
Ref.No._____________________________