Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNM

DILG - NAPOLCOM Center, EDSA Corner Quezon Avenue, Quezon City
www.dilg.gov.ph

CHECKLIST FOR THE REVIEW OF SIMPLIFIED FEA

(FOR WATER PROJECTS)

PROJECT PROFILE:

REGION: SOURCE OF FUND:

PROVINCE: TYPE OF PROJECT:
CITY/MUNICIPALITY/BRGY.:
PROJECT TITLE:
PROJECT LOCATION: LEVEL OF SERVICE:
PROJECT YEAR:
NO. OF HHs TO BE SERVED:
POPULATION TO BE SERVED: TYPE OF SOURCE:
TOTAL PROJECT ALLOCATION:
a. National Subsidy
b. LGU Counterpart MANAGEMENT TYPE:
c. Others

INFORMATION YES NO
1 BASIC DATA INFORMATION
2 TECHNICAL DATA INFORMATION
3 PREPARATION OF SIMPLIFIED FEASIBILITY STUDY
3.1. MAP OF THE PROJECT AREA
3.2. SCHEMATIC DIAGRAM / SPOT MAP
3.3. SCHEMATIC DIAGRAM
3.4. CROSS SECTION OF WELL SOURCE / PLAN OD SPRING
SOURCE DEVELOPMENT
3.5. FINANCIAL INFORMATION
3.6. PROJECT COST ESTIMATES / INDICATIVE COST
3.7. COST SUMMARY
3.8. FINANCIAL ANALYSIS
4 INSTITUTIONAL INFORMATION /COMMUNITY CONSULTATION
INSPECTED BY:

_________________________________ __________________________ __________________

DATE: ___________________________ DATE: ___________________ DATE: ____________

blic of the Philippines
NTERIOR AND LOCAL GOVERNMENT
nter, EDSA Corner Quezon Avenue, Quezon City
www.dilg.gov.ph

W OF SIMPLIFIED FEASIBILITY STUDY

WATER PROJECTS)

SOURCE OF FUND: SALINTUBIG ADM /BUB-WATER SUPPLY

TYPE OF PROJECT: NEW CONSTRUCTION
EXPANSION / UPGRADING
REHABILITATION / IMPROVEMENT
LEVEL OF SERVICE: LEVEL I LEVEL II & III
LEVEL II FROM LEVEL II TO LEVEL III

LEVEL III
TYPE OF SOURCE: SPRING
GROUND WATER (WELL)

SURFACE WATER
MANAGEMENT TYPE: LGU-MANAGED BWSA-MANAGED
WATER DISTRICTS OTHERS

DATE REMARKS
_________________________________

DATE: ___________________________

Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GO
DILG - NAPOLCOM Center, EDSA Corner Quezon Avenue, Quezon C
www.dilg.gov.ph


CHECKLIST FOR THE REVIEW OF SIMPLIFIED

(FOR WATER PROJECTS)

PROJECTPROFILE:

REGION:
PROVINCE: SOURCE OF FUND
CITY/MUNICIPALITY/BRGY.: TYPE OF PROJECT
PROJECTTITLE:
PROJECTLOCATION:
PROJECTYEAR: LEVEL OF SERVIC
NO.OFHHsTOBESERVED:
POPULATIONTOBESERVED:
TOTALPROJECTALLOCATION: TYPE OF SOURCE
a.NationalSubsidy
b.LGUCounterpart
c.Others MANAGEMENT TY

SOCIO ECONOMIC, TECHNICAL AND FINANCIAL

1. BASIC DATA INFORMATION
AVAILABILITY OF ELECTRICITY: YES NO

AVAILABILITY OF PUBLIC TRANSPORTATION: YES NO

MAIN LIVELIHOOD OF RESIDENTS: FARMING NO GOV'T EMPLOYED

WATER RELATED DISEASES: CHOLERA HEPA A DIARRHEAL

HOUSEHOLDS W/ SANITARY TOILETS FLUSH POOR FLUSH VENTILATED IMPROVED PI

HOUSEHOLDS W/ INSANITARY TOILETS OVERHANG OPEN/CLOSED PIT WITHOUT TOILETS

AVERAGE DAILY SUPPLY PER PERSON(lpcd) 20 60 100

WATER QUALITY BACTERIOLOGICAL PHYSICAL

SPENDING ON WATER PER DAY PER HH (in pesos) ________________

2.TECHNICAL DATA INFORMATION

EXISTING SOURCE: WELL SURFACE WATER SPRING

DISCHARGE (LPS) _______ ________

UNUTILIZED
ELEVATION/DEPTH _______ ________
UTILIZED
YEAR CONSTRUCTED _______ ________

EXISTING RESERVOIR:
STEEL GROUND ELEVATED

REINFORCE CONCRETE GROUND ELEVATED

MAP OF THE PROJECT AREA:

OK FOR REVISION

SCHEMATIC DIAGRAM:
OK FOR REVISION

CROSS SECTION OF WELL SOURCE / SPRING SOURCE DEVELOPMENT:

OK FOR REVISION

CONTRACTORS/SKILLED WORKERS:
PLUMBER TANK FABRICATOR WELL DRILLERS
3. FINANCIAL INFORMATION

LOCAL COUNTERPART CONTRIBUTION

CASH IN-KIND
PROVICIAL

MUNICIPAL

BARANGAY

4. PROJECT COST ESTIMATE / INDICATIVE COST

SOURCE CONFIRMATION:
a. Well Drilling YES NO PUMP
b. Source Development YES NO TAPSTAND
PIPE AND FITTINGS: YES NO TREATMENT FACILITY
RESERVOIR: YES NO (chlorinator)
PUMPHOUSE: YES NO

GHANT CHART / BAR CHART : YES NO

5. COST SUMMARY

GEO-RESISTIVITY SURVEY YES NO

DETAILED ENGINEERING DESIGN (DED) YES NO

COST SHARING STRUCTURE

DILG (GAA Provision) YES NO

LGU Contribution (indicate if loan or equity)

Province LOAN EQUITY

Municipality / City LOAN EQUITY

Barangay LOAN EQUITY

6. FINANCIAL ANALYSIS

MONTHLY EXPENSES

1. OPERATIONS: 2. ASSET REPLACEMENT:

Salaries YES NO Source Confirmation
Power YES NO a. Well Drilling
Chemicals YES NO b. Source Developm
Office Supplies YES NO Pipe and Fittings
YES NO
 YES NO

Miscellaneous YES NO Reservoir

Pumphouse
3. MAINTENANCE: YES NO Pump
4. COMPUTATION OF WATER FEE: YES NO Tapstand
5. AFFORDABILITY OF WATER FEE: YES NO Treatment facilities (Chlorinato

7. INSTITUTIONAL INFORMATION

EXISTING WATER USER ASSOCIATION YES NONE

IF YES: ACTIVE INACTIVE

CONDUCTED COMMUNITY DIALOGUE?

YES NO

TARIFF CONSULTATION:
YES NO

REGISTERED WITH THE FOLLOWING:

LGU SEC LWUA

TYPE OF ORGANIZATION TO BE FORMED:

RWSA/BWSA COOPERATIVE WATER DISTR

DEED OF DONATION/RIGHT OF WAY:

YES NONE

INSPECTED BY:

_________________________________ _________________________________

DATE: ___________________________ DATE: ___________________________

 Republic of the Philippines
THE INTERIOR AND LOCAL GOVERNMENT
LCOM Center, EDSA Corner Quezon Avenue, Quezon City
www.dilg.gov.ph

IEW OF SIMPLIFIED FEASIBILITY STUDY

R WATER PROJECTS)

SOURCE OF FUND: SALINTUBIG ADM /BUB-WATER SUPPLY

TYPE OF PROJECT: NEW CONSTRUCTION

EXPANSION / UPGRADING

REHABILITATION / IMPROVEMENT

LEVEL I LEVEL II & III

LEVEL OF SERVICE:
LEVEL II FROM LEVEL II TO LEVEL III

LEVEL III

TYPE OF SOURCE: SPRING

GROUND WATER (WELL)

SURFACE WATER

MANAGEMENT TYPE: LGU-MANAGED BWSA-MANAGED

WATER DISTRICTS OTHERS

CHNICAL AND FINANCIAL INFORMATION

REMARKS: _________________
REMARKS: _________________
GOV'T EMPLOYED PRIVATE EMPLOYED REMARKS: _________________

DIARRHEAL SKIN DISEASES OTHERS REMARKS: _________________

VENTILATED IMPROVED PIT REMARKS: _________________
WITHOUT TOILETS REMARKS: _________________

CHEMICAL
 SPRING

UNUTILIZED

UTILIZED

ELEVATED

ELEVATED

WELL DRILLERS MASONRY

 IN-KIND

YES NO

YES NO

TREATMENT FACILITY YES NO

2. ASSET REPLACEMENT:
Source Confirmation
a. Well Drilling YES NO

b. Source Development YES NO

YES NO

YES NO
 YES NO

YES NO

YES NO

YES NO

YES NO

Treatment facilities (Chlorinator) YES NO

LWUA OTHERS: Please Specify __________________

WATER DISTRICT OTHERS: Please Specify __________________

______________________________ _________________________________

E: ___________________________ DATE: ___________________________

 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

CHECKLIST FOR THE REVIEW OF DETAILED ENGINEERI

REGION:

PROVINCE: SOURCE OF FUND:

CITY/MUNICIPALITY: TYPE OF PROJECT:

PROJECT TITLE: LEVEL OF SERVICE:

PROJECT YEAR: TYPE OF SOURCE:

NO. OF HOUSEHOLDS:

POPULATION:

PROJECT ALLOCATION:

v Design Criteria and Standard Used

DEMAND PROJECTION
Demand Projections:

1) Design Period : 5 10 years

2) Minimum Demand : 0.3 ADD

3) Average Day Demand :

-Design Population x per capita consumption/1-NW

4) Maximum Day Demand (MDD):

- 1.3 ADD

5) Peak Hour Demand (PHD):

- 3 x ADD for < 1,000 served population

- 2.5 x ADD for > 1,000 served population

6) Non-Revenue Water : 15% for New System; 20% for old sy

7) Household per Public Faucet: 4-6 HHs

Per Capita Water Consumption:

v Level II : 40 - 60 lpcd

v Level III :

Matino, Mahusay at Maasahan

[Page 13] DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
FORM 2: PMC DURING DED REVIEW
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

- Domestic : 80 100 lpcd

- Institutional : 1.0 cu.m. /day or actual

- Commercial : 0.80 cu.m. /day or actual

Design Pump:
v Pump TDH = Depth of Pumping Water Level
+ Maximum Reservoir High Water
Level + Friction Losses
v Pump Capacity = Maximum Day Demand/Operating

Design of Reservoirs

o Reservoir Capacity : 25% of ADD

Design of Distribution System (Distribution System Analysis)

1) Minimum Line Pressure = 3 meters

2) Maximum Line Pressure = 70 meters

3) Transmission Line = 3.0 m/s

4) Distribution Pipe = 1.5 m/s

Treatment

o Water Sampling/Testing (Critical Parameters)

o Biological, Microbial, Chemical, Physical Testing (

o Justification of any treatment process adopted

Matino, Mahusay at Maasahan

[Page 14] DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
FORM 2: PMC DURING DED REVIEW
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

Source Description

o Type of Water Source

o Estimated Yield or Capacity of Discharge = lps

o Justification

Soil Conditions

v Basis for foundation design (as needed)

1. General Lay-out (first page of the detailed Plan)

v Detailed plans showing the brgy/mun covered by the project

v CBO or agency in charge of the WS Facilities

v Location of major facilities (source, reservoirs,
filtration tanks, pump house, chlorination house, etc.)
v Coverage of the Pipe Network (Transmission Lines, Distribution

2. Detailed Plans

v Blueprints/Computer Aided/Generated Working Drawings

v Plans must include the locations, elevations,
schematics, spot details, dimensions of all facilities,
fittings & appurtenances
v Thrust Block Plans

v Trench Plans

3. Technical Specifications

v Types of materials to be used

v Installations and Disinfection procedures

v Quality of workmanship/performance required

Suggestion: LWUA has a complete set of specifications for water s

Matino, Mahusay at Maasahan

[Page 15] DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
FORM 2: PMC DURING DED REVIEW
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

4. Bill of Quantities & Cost Estimates

v Bill of Quantities DED phase

v Used as the bill of quantities in the bid documents

v Cost estimates will be used as basis of the agency estimate for

5. Construction Schedule

v Bar Chart

v S-Curve

6. Quantity Derivations

v Hydraulic Computations

v Area & Volumetric Computations

INSPECTED BY:

_________________________________ _________________________________

DATE: ___________________________ DATE: ___________________________

Matino, Mahusay at Maasahan

[Page 16] DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
FORM 2: PMC DURING DED REVIEW
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

VIEW OF DETAILED ENGINEERING DESIGN

SOURCE OF FUND: SALINTUBIG BUB-WATER

TYPE OF PROJECT: NEW EXPANSION REHABILITATION

LEVEL OF SERVICE: LEVEL I LEVEL II LEVEL III LEVEL II & III

TYPE OF SOURCE: SPRING WELL SURFACE WATER

STATUS

PRESENT ABSENT REMARKS

__________________

__________________

__________________

__________________
on x per capita consumption/1-NWR

__________________

< 1,000 served population __________________

> 1,000 served population __________________
% for New System; 20% for old system __________________

__________________

__________________

Matino, Mahusay at Maasahan

[Page 17] DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
FORM 2: PMC DURING DED REVIEW
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

__________________

__________________
0.80 cu.m. /day or actual __________________

__________________
Maximum Day Demand/Operating Hours __________________

__________________

__________________

__________________

__________________

__________________

ng/Testing (Critical Parameters) __________________

robial, Chemical, Physical Testing (Results) __________________
any treatment process adopted __________________

Matino, Mahusay at Maasahan

[Page 18] DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
FORM 2: PMC DURING DED REVIEW
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

__________________
d or Capacity of Discharge = lps __________________

__________________

__________________

rgy/mun covered by the project __________________

__________________

__________________
k (Transmission Lines, Distribution Lines) __________________

enerated Working Drawings __________________

__________________

__________________

__________________

__________________

__________________

__________________
ete set of specifications for water system __________________

Matino, Mahusay at Maasahan

[Page 19] DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
FORM 2: PMC DURING DED REVIEW
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

__________________

__________________
s basis of the agency estimate for the bid __________________

__________________

__________________

__________________

__________________

_________________________________

DATE: ___________________________

Matino, Mahusay at Maasahan

[Page 20] DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
FORM 2: PMC DURING DED REVIEW
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

CHECKLIST FOR THE REVIEW OF DETAILED ENGINEERING DESIG

REGION:

PROVINCE: SOURCE OF FUND: SALINTUBIG BUB-WAT

CITY/MUNICIPALITY: TYPE OF PROJECT: NEW EXPANSION

PROJECT TITLE: LEVEL OF SERVICE: LEVEL I LEVEL II

PROJECT YEAR: TYPE OF SOURCE: SPRING WELL

NO. OF HOUSEHOLDS:

POPULATION:

PROJECT ALLOCATION:

PRESENT ABSENT REMAR

Water Supply Development Plan

Water Source(s) & Location(s) _______________________

Reservoir/Storage Locations _______________________

Transmission Line Route _______________________

Water Treatment Facility (if any) _______________________

Distribution Network _______________________

Location of Communal Faucets _______________________

Schematic Lay-out of the Proposed Water Supply System. _______________________

Plan/Lay-out of Existing Facilities (if any, in scale also

indicating elevations.) _______________________
Plan/Map of the proposed service area (showing relative
location of water source, land-use plan and/or zoning plan
of the LGU.) _______________________

Program of Works (POW) signed by the Municipal Engineer

and approved by the concerned LCE _______________________

Detailed Design Report

Water demand projection

Hydraulic analysis taking into account the network _______________________
diagram report and, if necessary, geo-resistivity
report _______________________

[Page 21]
Matino, Mahusay at Maasahan FORM 3: PMC DURING PROCUREMENT
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

Proof of Land Ownership _______________________

Proof that Environmental Compliance Certificate (ECC) or

Certificate of Non-Coverage (CNC) which is applicable, is
being secured _______________________

Application for the issuance of Water Permit of National

Water Resource Board (NWRB) _______________________

INSPECTED BY:

_________________________________ _________________________________ ____________________

DATE: ___________________________ DATE: ___________________________ DATE: _______________

[Page 22]
Matino, Mahusay at Maasahan FORM 3: PMC DURING PROCUREMENT
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

W OF DETAILED ENGINEERING DESIGN

SALINTUBIG BUB-WATER

NEW EXPANSION REHABILITATION

LEVEL I LEVEL II LEVEL III LEVEL II & III

SPRING WELL SURFACE WATER

REMARKS

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

_________________________________________

[Page 23]
Matino, Mahusay at Maasahan FORM 3: PMC DURING PROCUREMENT
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

_________________________________________

_________________________________________

_________________________________________

_________________________________

DATE: ___________________________

[Page 24]
Matino, Mahusay at Maasahan FORM 3: PMC DURING PROCUREMENT
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

PROJECT MONITORING CHECKLIST

REGION:

PROVINCE: SOURCE OF FUND:

CITY/MUNICIPALITY: TYPE OF PROJECT:

PROJECT TITLE: LEVEL OF SERVICE:

PROJECT YEAR: TYPE OF SOURCE:

NO. OF HOUSEHOLDS:

POPULATION:

PROJECT ALLOCATION:

INSTALLED/ NOT
DESCRIPTION ONGOING RE
DONE INSTALLED
I. WELL SOURCE
1. WELL DRILLING
1.1 GEORESISTIVITY ________________________
1.2 DRILLING ________________________
1.3 PRIMARY PUMPING TEST ________________________
1.4 INSTALLATION OF CASING W/ ________________________
PERFORATED PIPE ________________________
1.5 CHECK THE ALIGNMENT/ ________________________
PLUMBNESS OF PIPES ________________________
1.6 GROWTING OF ANNULAR BET ________________________
WELLHOLE AND CASING ________________________
1.7 CONCRETING OF APRON ________________________
1.8 INSTALLATION OF PUMPING ________________________
FACILITIES/ CAP ________________________
1.9 DISINFECTING OF WELL ________________________

2. TRANSMISSION LINE
2.1 EARTHWORK
EXCAVATION ________________________
BACKFILL ________________________
2.2 PLUMBING WORKS ________________________
PIPE LAYING ________________________
2.3 CONCRETING THRUST BLOCK ________________________

3. RESERVOIR

Matino, Mahusay at Maasahan

[Page 25] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

INSTALLED/ NOT
DESCRIPTION ONGOING RE
DONE INSTALLED
3.1 EARTHWORK
EXCAVATION ________________________
BACKFILL ________________________
3.2 STRUCTURAL ________________________
CONCRETING ________________________
FORM WORKS ________________________
REBARS ________________________
3.3 MASONRY ________________________
PLASTERING ________________________
WATER PROOFING ________________________
3.4 PLUMBING WORKS ________________________
OVERFLOW PIPES ________________________
INLETPIPES/RISER PIPE ________________________
SLEEVE/DISTRIBUTION PIPES ________________________
DRAIN PIPES ________________________

4. PUMP HOUSE/CHLORINATOR
4.1 EARTHWORK
EXCAVATION ________________________

Matino, Mahusay at Maasahan

[Page 26] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

INSTALLED/ NOT
DESCRIPTION ONGOING RE
DONE INSTALLED
BACKFILL ________________________
4.2 STRUCTURAL ________________________
CONCRETING ________________________
FORM WORKS ________________________
REBARS ________________________
4.3 MASONRY ________________________
PLASTERING ________________________
4.4 ROOFING ________________________
4.5 CARPENTRY ________________________
DOOR ________________________
WINDOW ________________________

5. DISTRIBUTION LINES
5.1 EARTHWORK
EXCAVATION ________________________
BACKFILL ________________________
5.2 PLUMBING WORKS ________________________
PIPE LAYING ________________________
5.3 CONCRETING THRUST BLOCK ________________________
5.4 TAPSTANDS ________________________
5.5 WATER METER ________________________
5.6 HYDROTESTING ________________________

6. CONCRETE RESTORATION

6.1 PAVEMENT ________________________

7. TREATMENT FACILITIES
7.1 CHLOLRINATOR ________________________
GAS ________________________
GRANULAR ________________________

8. PUMP AND MOTOR

8.1 PUMP
BOOSTER PUMP ________________________
SUBMERSIBLE PUMP ________________________

Matino, Mahusay at Maasahan

[Page 27] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

INSTALLED/ NOT
DESCRIPTION ONGOING RE
DONE INSTALLED

9. ELECTRICAL WORKS
9.1 POWERLINES ________________________
9.2 CONTROLS ________________________
________________________
10. BILLBOARD ________________________
________________________
9. COMMISSIONING ________________________
________________________

INSPECTED BY:

_________________________________ _________________________________

DATE: ___________________________ DATE: ___________________________

Matino, Mahusay at Maasahan

[Page 28] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

MONITORING CHECKLIST

SALINTUBIG BUB-WATER

TYPE OF PROJECT: NEW EXPANSION REHABILITATION

LEVEL OF SERVICE: LEVEL I LEVEL II LEVEL III LEVEL II & III

SPRING WELL SURFACE WATER

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

Matino, Mahusay at Maasahan

[Page 29] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

_____________________________________________________

Matino, Mahusay at Maasahan

[Page 30] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

_____________________________________________________

_____________________________________________________
_____________________________________________________
_____________________________________________________

_____________________________________________________
_____________________________________________________

Matino, Mahusay at Maasahan

[Page 31] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

_________________________________

DATE: ___________________________

Matino, Mahusay at Maasahan

[Page 32] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

PROJECT MONITORING CHECKLIST

REGION:

PROVINCE: SOURCE OF FUND:

CITY/MUNICIPALITY: TYPE OF PROJECT:

PROJECT TITLE: LEVEL OF SERVICE:

PROJECT YEAR: TYPE OF SOURCE:

NO. OF HOUSEHOLDS:

POPULATION:

PROJECT ALLOCATION:

INSTALLED/ NOT
DESCRIPTION ONGOING
DONE INSTALLED
I. SURFACE SOURCE
1. INTAKE BOX
1.1 EARTHWORK
EXCAVATION _________________
BACKFILL _________________
1.2 STRUCTURAL _________________
CONCRETING _________________
FORM WORKS _________________
REBARS _________________
1.3 MASONRY _________________
PLASTERING _________________
1.4 PLUMBING WORKS _________________
OVERFLOW PIPES _________________
INLETPIPES _________________
SLEEVE/DISTRIBUTION PIPES _________________
DRAIN PIPES _________________

2. TRANSMISSION LINE
2.1 EARTHWORK
EXCAVATION _________________
BACKFILL _________________
2.2 PLUMBING WORKS _________________
PIPE LAYING _________________
2.3 CONCRETING THRUST BLOCK _________________

Matino, Mahusay at Maasahan

[Page 33] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

INSTALLED/ NOT
DESCRIPTION ONGOING
DONE INSTALLED
3. RESERVOIR
3.1 EARTHWORK
EXCAVATION _________________
BACKFILL _________________
3.2 STRUCTURAL _________________
CONCRETING _________________
FORM WORKS _________________
REBARS _________________
3.3 MASONRY _________________
PLASTERING _________________
WATER PROOFING _________________
3.4 PLUMBING WORKS _________________
OVERFLOW PIPES _________________
INLETPIPES/RISER PIPE _________________
SLEEVE/DISTRIBUTION PIPES _________________
DRAIN PIPES _________________

4. FILTRATION TANK
4.1 EARTHWORK _________________
EXCAVATION _________________
BACKFILL _________________
4.2 STRUCTURAL _________________
CONCRETING _________________
FORM WORKS _________________
REBARS _________________
4.3 MASONRY _________________
PLASTERING _________________
WATER PROOFING _________________
4.4 PLUMBING WORKS _________________
OVERFLOW PIPES _________________
INLETPIPES/RISER PIPE _________________
SLEEVE/DISTRIBUTION PIPES _________________

DRAIN PIPES

Matino, Mahusay at Maasahan

[Page 34] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

INSTALLED/ NOT
DESCRIPTION ONGOING
DONE INSTALLED
5. PUMP HOUSE/CHLORINATOR
5.1 EARTHWORK
EXCAVATION _________________
BACKFILL _________________
5.2 STRUCTURAL _________________
CONCRETING _________________
FORM WORKS _________________
REBARS _________________
5.3 MASONRY _________________
PLASTERING _________________
5.4 ROOFING _________________
5.5 CARPENTRY _________________
DOOR _________________
WINDOW _________________

6. DISTRIBUTION LINES
6.1 EARTHWORK
EXCAVATION _________________
BACKFILL _________________
6.2 PLUMBING WORKS _________________
PIPE LAYING _________________
6.3 CONCRETING THRUST BLOCK _________________
6.4 TAPSTANDS _________________
6.5 WATER METER _________________
6.6 HYDROTESTING _________________

7. CONCRETE RESTORATION

7.1 PAVEMENT _________________

_________________
8. TREATMENT FACILITIES _________________
8.1 CHLOLRINATOR _________________
GAS _________________
GRANULAR _________________
_________________

Matino, Mahusay at Maasahan

[Page 35] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

INSTALLED/ NOT
DESCRIPTION ONGOING
DONE INSTALLED
9. ELECTRICAL WORKS _________________
9.1 POWERLINES _________________
9.2 CONTROLS _________________
_________________
10. COMMISSIONING _________________

INSPECTED BY:
_________________________________ _________________________________

DATE: ___________________________ DATE: ___________________________

Matino, Mahusay at Maasahan

[Page 36] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

MONITORING CHECKLIST

SALINTUBIG BUB-WATER

TYPE OF PROJECT: NEW EXPANSION REHABILITATION

LEVEL OF SERVICE: LEVEL I LEVEL II LEVEL III LEVEL II & III

SPRING WELL SURFACE WATER

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
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Matino, Mahusay at Maasahan

[Page 37] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

REMARKS

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Matino, Mahusay at Maasahan

[Page 38] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

REMARKS

_____________________________________________________
_____________________________________________________
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Matino, Mahusay at Maasahan

[Page 39] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

_________________________________

DATE: ___________________________

Matino, Mahusay at Maasahan

[Page 40] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

PROJECT MONITORING CHECKLIST

REGION:

PROVINCE: SOURCE OF FUND:

CITY/MUNICIPALITY: TYPE OF PROJECT:

PROJECT TITLE: LEVEL OF SERVICE:

PROJECT YEAR: TYPE OF SOURCE:

NO. OF HOUSEHOLDS:

POPULATION:

PROJECT ALLOCATION:

INSTALLED/ NOT
DESCRIPTION ONGOING RE
DONE INSTALLED
I. SPRING SOURCE
1. INTAKE BOX
1.1 EARTHWORK
EXCAVATION ________________________
BACKFILL ________________________
1.2 STRUCTURAL ________________________
CONCRETING ________________________
FORM WORKS ________________________
REBARS ________________________
1.3 MASONRY ________________________
PLASTERING ________________________
1.4 PLUMBING WORKS ________________________
OVERFLOW PIPES ________________________
INLETPIPES ________________________
SLEEVE/DISTRIBUTION PIPES ________________________
DRAIN PIPES ________________________

2. TRANSMISSION LINE
2.1 EARTHWORK
EXCAVATION ________________________
BACKFILL ________________________
2.2 PLUMBING WORKS ________________________
PIPE LAYING ________________________
2.3 CONCRETING THRUST BLOCK ________________________

Matino, Mahusay at Maasahan

[Page 41] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

INSTALLED/ NOT
DESCRIPTION ONGOING RE
DONE INSTALLED
3. RESERVOIR
3.1 EARTHWORK
EXCAVATION ________________________
BACKFILL ________________________
3.2 STRUCTURAL ________________________
CONCRETING ________________________
FORM WORKS ________________________
REBARS ________________________
3.3 MASONRY ________________________
PLASTERING ________________________
WATER PROOFING ________________________
3.4 PLUMBING WORKS ________________________
OVERFLOW PIPES ________________________
INLETPIPES/RISER PIPE ________________________
SLEEVE/DISTRIBUTION PIPES ________________________
DRAIN PIPES ________________________

Matino, Mahusay at Maasahan

[Page 42] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

INSTALLED/ NOT
DESCRIPTION ONGOING RE
DONE INSTALLED
4. PUMP HOUSE/CHLORINATOR
4.1 EARTHWORK
EXCAVATION ________________________
BACKFILL ________________________
4.2 STRUCTURAL ________________________
CONCRETING ________________________
FORM WORKS ________________________
REBARS ________________________
4.3 MASONRY ________________________
PLASTERING ________________________
4.4 ROOFING ________________________
4.5 CARPENTRY ________________________
DOOR ________________________
WINDOW ________________________

5. DISTRIBUTION LINES
5.1 EARTHWORK
EXCAVATION ________________________
BACKFILL ________________________
5.2 PLUMBING WORKS ________________________
PIPE LAYING ________________________
5.3 CONCRETING THRUST BLOCK ________________________
5.4 TAPSTANDS ________________________
5.5 WATER METER ________________________
5.6 HYDROTESTING ________________________

6. CONCRETE RESTORATION

6.1 PAVEMENT ________________________

________________________
7. TREATMENT FACILITIES ________________________
7.1 CHLOLRINATOR ________________________
GAS ________________________
GRANULAR ________________________
________________________

Matino, Mahusay at Maasahan

[Page 43] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

INSTALLED/ NOT
DESCRIPTION ONGOING RE
DONE INSTALLED
8. ELECTRICAL WORKS ________________________
8.1 POWERLINES ________________________
8.2 CONTROLS ________________________
________________________
9. COMMISSIONING ________________________
________________________

INSPECTED BY:
_________________________________ _________________________________

DATE: ___________________________ DATE: ___________________________

Matino, Mahusay at Maasahan

[Page 44] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

MONITORING CHECKLIST

SALINTUBIG BUB-WATER

TYPE OF PROJECT: NEW EXPANSION REHABILITATION

LEVEL OF SERVICE: LEVEL I LEVEL II LEVEL III LEVEL II & III

SPRING WELL SURFACE WATER

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

Matino, Mahusay at Maasahan

[Page 45] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

Matino, Mahusay at Maasahan

[Page 46] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
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_____________________________________________________
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Matino, Mahusay at Maasahan

[Page 47] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

REMARKS

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

_________________________________

DATE: ___________________________

Matino, Mahusay at Maasahan

[Page 48] FORM
DILG NAPOLCOM Center EDSA corner, Quezon Avenue, 4: PMC
Quezon City DURING CONSTRUCTION
 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
OFFICE OF PROJECT DEVELOPMENT SERVICES

PUNCHLIST OF CORRECTIVE WORKS

REGION:
SALINT
PROVINCE: SOURCE OF FUND: BUB-WATER
UBIG
NE EXPAN REHABILITA
CITY/MUNICIPALITY: TYPE OF PROJECT: LEV
W SION
LEVE TIONLEVEL II &
PROJECT TITLE: LEVEL OF SERVICE: EL LEVEL III
SPRI L II SURFACEIII
PROJECT YEAR: TYPE OF SOURCE: I WELL
NGAD WATERDESIGN &
NO. OF HOUSEHOLDS: TYPE OF IMPLEMENTATION: CONTRACT
MIN BUILD
POPULATION: FUNCTIONALITY OF THE PROJECT: YES NO
RWSA/B COOPER LG WATER
PROJECT ALLOCATION: TURN-OVER ENTITY:
WSA ATIVE U DISTRICT
NAME OF CONTRACTOR:

TOTAL CONTRACT COST:

COMPONENTS OF WATER SUPPLY SYSTEM SPECIFICATION INSTALLED

N/
INTAKE BOX DIMENSIONS (m): L = _____________ W = _____________ H = _____________ YES NO
A
N/
COLLECTION BOX DIMENSIONS (m): L = _____________ W = _____________ H = _____________ YES NO
A
N/
FILTRATION TANK DIMENSIONS (m): L = _____________ W = _____________ H = _____________ YES NO
A
N/
WELL SOURCE CASING DIAMETER (mm): ________________ DEPTH (mm): ________________ YES NO
A
N/
SUBMERSIBLE PUMP CAPACITY (hp): ________________ YES NO
A
N/
ELECT. CONTROL PANEL YES NO
A
N/
PUMP HOUSE YES NO
A
TRANSMISSION PIPELINES SIZES (mm): ________ ________ ________ ________ TOTAL LENGTH: ___________ YES NO
BOOSTER PUMP CAPACITY (hp): ________________ REINFO YES NO
GROU ELEVATE STE RCE
RESERVOIR/TANK CAPACITY(m^3): ________________ YES NO
ND D EL CONCRE
GRANU
CHLORINATION EQUIPMENT CAPACITY: ________________ GAS TE YES NO
LAR
DISTRIBUTION PIPELINES SIZES (mm): ________ ________ ________ ________ TOTAL LENGTH: ___________ YES NO
VALVES & FITTINGS SIZES (mm): ________ ________ ________ ________ TYPE: ____________________ YES NO
BARRE SIAMES OTHERS (specify)
FIRE HYDRANT SIZES (mm): ________ ________ ________ YES NO
L E _________________
TAP STANDS/COMMUNAL FAUCET SIZES (mm): ________ ________ ________ ________ NO. OF T.S./C.F.: __________ YES NO
STUB-OUTS SIZES (mm): ________ ________ ________ ________ NO. OF CONN.: ____________ YES NO
WATER METER SIZES (mm): ________ ________ ________ ________ YES NO

INITIAL INSPECTION FINAL INSPECTION

DATE: _______________ DATE: _______________

ITEM OF WORK DESCRIPTION OF CORRECTIVE WORK REMARKS/RECOMMENDATIONS DATE RECTIFIED

INSPECTED BY:

_________________________________ _________________________________ _________________________________

DATE: ___________________________ DATE: ___________________________ DATE: ___________________________

[Page 49] Matino, Mahusay at Maasahan

DILG NAPOLCOM Center EDSA corner, Quezon Avenue, Quezon City FORM 5: PMC DURING PUNCHLISTING