AF PS3.5 Page 1 of 1 Last Updated: 10/01/2018
Revision:2
All sections of this form must be completed
TO BE COMPLETED BY THE INSTALLER/DRAINLAYER WHO COMPLETED THE WORK
Author name:
Building consent
No:
Author company:
Author
registration No:
Description of
work:
Site address:
Legal description:
Name of System
installed:
I confirm that I have sighted the above building consent and read the attached conditions of consent for the on-site wastewater treatment
and disposal system contained therein; and that
the on-site wastewater treatment and disposal system specified above has been constructed to the extent required by the building
consent
all work has been carried out in accordance with clauses G12 and G13 of the NZ Building Code; and
meets the requirements of the Air, Land and Water Plan of the Otago Regional Council
I attach copies of the following:
Drainage as-built plan
Manufacturer’s warranty
I understand that Queenstown Lakes District Council is reliant on this producer statement in order to establish compliance with
the requirements of the Building Act 2004, Building Code and the consented plans and will use this statement in order to issue the
code compliance certificate for this application.
Producer statements are accepted solely at Queenstown Lakes District Council discretion
Signature: Date:
Certifying drainlayer’s registration N
o
:
Drainlayer’s contact details:
Address:
Business phone: Fax:
Mobile phone:
Email:
Producer Statement Construction (PS3)
On-site Wastewater Disposal
click to sign
signature
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