DERM Man-Assess-Haz-Cat-Hyd-Perf-Dams-2012
DERM Man-Assess-Haz-Cat-Hyd-Perf-Dams-2012
DERM Man-Assess-Haz-Cat-Hyd-Perf-Dams-2012
2 ASSESSMENT REQUIREMENTS 3
DEFINITIONS 13
REFERENCES 13
Estimating the DSA using the method of deciles for volumetric containment 14
Estimating the DSA using the method of operational simulation for performance based containment 16
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1 Scope
This manual sets out the requirements of the administering authority, for hazard category assessment and
certification of the design of ‘regulated structures’, constructed as part of environmentally relevant
activities (ERAs) under the Environmental Protection Act 1994 (EP Act).
The term regulated structures includes land-based containment structures, levees, bunds and voids, but
not a tank or container designed and constructed to an Australian Standard that deals with strength and
structural integrity. Structures may be assessed using this manual as being in one of three hazard
categories: low, significant or high. Where categorised as a significant or high hazard, the structure is
referred to as a regulated structure. Notes on hazard assessment based on failure event scenarios are in
Appendix A of this document.
This manual does not provide a detailed methodology for the design of dams, spillways and levee
structures. The detailed design of a regulated structure is to be undertaken by a suitably qualified and
experienced person 1 with relevant professional experience, and requires appropriate documentation and
certification 2 .
The Manual for Assessing Hazard Categories and Hydraulic Performance of Dams does not limit, amend
or change in any way, any other requirements to be complied with under authority conditions and/or
regulations for the design and operation of a dam 3 . Further, it does not negate any lawful requirements of
the Environmental Protection Act 1994, other Commonwealth, state or local government laws or
requirements under relevant standards or agreements.
Related documents
This manual relates to, and should be read in conjunction with, Guideline: Structures which are dams or
levees constructed as part of environmentally relevant activities (EM634) published by the administering
authority, as both relate to environmental authority (EA) and development approval conditions.
Background
Good practice engineering for dams, spillways, and levee structures requires that they be assessed for the
hazards associated with ‘dam break’ and ‘failure to contain’ scenarios, and that the impacts of such
potential failures are identified and considered in their design and operation.
The early identification of the hazard potential of these structures is important in determining the standard
of reliability required for design, construction and operation of the structure. The default objective for any
structure containing substances (liquid and/or solid material) that could result in environmental harm is
that the substances be contained so as to prevent or otherwise minimise harm to the environment. In this
context the water management strategy for a site should minimise unnecessary accumulation of
contaminated waters by sufficient segregation of clean and contaminated waters. Hence regulated
structures also include flood protection levees to reduce risk of ingress of clean floodwaters into
operational areas where they may become contaminated with possible adverse impact on water
management operations and containment performance.
Structures that could have significant or high impacts need to be carefully designed and operated.
1
The term ‘suitably qualified and experienced person’ is defined in the definitions.
2
A copy of the certification required can be found at appendix B
3
An example of other legislative requirements that may be relevant are those relating to referrable dams under the Water Supply (Safety and
Reliability) Act 2008.
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Purpose
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2 Assessment requirements
Part 1—Hazard category assessment
This part provides guidance for undertaking a hazard category assessment for a structure which is a dam
or levee.
All structures which are dams or levees associated with the operation of an environmentally relevant
activity, must have their hazard category assessed based on the potential environmental harm that would
result from the failure event scenarios (Section 1.1) described in this manual.
The hazard category will determine whether the structure is a regulated structure. For some structures
there are minimum hazard categories (Section 1.2).
The hazard category of a structure is the highest hazard category determined under any of the assessment
criteria set out in this part. A structure is a regulated structure where the hazard category for the structure
is ‘significant’ or ‘high’.
1. Documentation of the assessment, in accordance with Appendix A, of each of the following failure
event scenarios:
(a) ‘Failure to contain’ – spills or releases from the structure due that may be due to any cause other
than a dam break; and
(b) ‘Dam break’ – collapse of the structure due to any possible cause.
In assessing each scenario under item 1, the types of impacts that may occur under the scenario must
be identified and considered, and must include any local and regional flooding that may lead to:
An assessment must also be made and documented under each scenario, of the potential for the
occurrence of things such as:
(a) the failure of a structure placing lives at risk due to dwellings or workplaces being in the failure
impact zone
(b) downstream consequences, including but not limited to failure of other structures that may be
affected by any flooding
(e) long term potential adverse effects due to release of contaminants to groundwater systems and
soil profiles
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(g) storage releases that may chemically interfere with waters used as sources of drinking water.
2. Assessment and documentation of the potential environmental harm, based on application of tables 1
and 2, that may result from each scenario assessed under this section.
(a) more than eight metres in height with a storage capacity of more than 500 Megalitres (ML); or
(b) more than eight metres in height with a storage capacity of more than 250 ML and a catchment
area that is, more than three times its maximum surface area at full supply level;
—then a dam break assessment must be included in the hazard category assessment, unless valid
justification is documented in the hazard category assessment for not doing so.
The overall hazard category for a structure is the highest hazard category determined by the application of
tables 1 and 2, under any of the failure event scenarios assessed under this section.
The hazard category of a structure based on failure event scenarios may be changed by relocation of the
structure relative to the environmental values affected. The hazard category of a structure cannot be
changed by adding a design element.
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(vi) broadcasting or telecommunications facilities other than low impact telecommunications facilities; or
(vii) regulated wastes facilities; and
(c) the term does not include minor utilities
6
Minor utility:
(a) means a utility (whether publicly or privately owned), which serves a broader purpose apart from the holder’s own sole
purposes, which is either of lesser significance to the broader community than the types of facilities listed in paragraph (b)
of the definition of important utility or is inherently unlikely to be damaged or interfered with in the event of a dam break or
failure to contain; and
(b) subject to paragraph (a), the term includes, but is not limited to:
(i) roads on private land such as mine roads or farm roads, but not private roads which are necessary to access important
utilities
(ii) local roads
(iii) a railway loop or spur or another part of a railway which solely serves the holder’s own purposes or which additionally
only serves another person who has agreed that the railway is to be treated as a ‘minor utility’
(iv) a general waste facility
(v) a low-impact telecommunications facility
(vi) electricity sub-stations, transmission grid works and supply network works under the Electricity Act 1994
(viii) storage depots or other minor ancillary facilities located on the holder’s land for important or minor utilities.
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Categories of harm
Loss of life or harm to Location such that people are Location such that people are Location such that people are
humans routinely present in the routinely present in the failure not routinely present in the
failure path and if present path and if present loss of life failure path. No
loss of life or harm is or harm is possible but not contamination of waters used
expected. Location such that expected. Location such that for human consumption
contamination of waters used contamination of waters used expected.
for human consumption for human consumption would
would occur, and occur, and consumption of
consumption of contaminated contaminated waters by
waters by humans with humans with consequent lesser
consequent loss of life or impact on human health is
serious impact on human expected.
health is expected or
possible.
General environmental Location such that harm to Location such that Location such that there will
harm significant environmental environmental values are of be no harm to environmental
values is expected. Such lesser significance or harm is values of significance, or
values might include the possible but not expected. only trivial harm is possible.
presence of protected areas,
protected or endangered flora
or fauna, the presence of
riverine environments, or
productive land used for
grazing or agricultural
cropping1.
Loss of stock2 Location of stock such that Location of stock such that loss Stock not in path of dam
loss of stock expected. of stock possible but not break flood. Contaminated
Consumption of expected. Consumption of water not available to stock
contaminated waters by stock contaminated waters by stock or no harm expected from
with consequent loss or harm with consequent loss or harm is consumption.
is expected. possible but not expected.
Location such that harm Location such that harm (other Location such that either:
General economic loss
(other than a different than a different category of (a) No harm or only trivial
or property damage
category of harm specified harm as specified above) in the harm in the failure path
above) 3 in the failure path failure path would be either: would be expected or
would be expected for any of (a) Possible, but not expected, possible in relation to
the following types of third for any of the items listed any of the items listed
party assets4: in the ‘High’ hazard in the ‘High’ hazard
(a) Urban development category for general category for general
assets of communities economic loss or property economic loss or
such as houses and damage; or property damage, or
offices (b) Expected, in relation to a (b) Harm would be possible
(b) Mine and gas production but not expected in
minor utility.6
(c) Industrial or commercial relation to a minor
assets utility.
(d) Significant agricultural
assets
(e) Water resources; or
(f) An important utility.5
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2. Selecting an appropriate AEP for setting a mandatory reporting level (MRL) from Table 4.
Note: It is the intent of this document that the Method of Deciles for Volumetric Containment
produce conservative estimates of DSA that are consistent with the simplified nature of the method.
Although the Method of Operational Simulation for Performance Based Containment has the
potential for greater accuracy, the extent to which this accuracy can be relied upon for the mitigation
of risk of harm must be substantiated and certified by the designer in the design plan for the dam.
4. All regulated dams must as a minimum provide for a volume called a design storage allowance
(DSA). DSA can be distributed across multiple regulated dams as described in Section 2.2.1. Note: If
a regulated dam was assessed in the low hazard category for the ‘failure to contain scenario’ the
volume of the DSA is not required.
5. All regulated dams must have a MRL marked in a clearly visible location.
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(b) take into consideration reasonably foreseeable scenarios including, but not limited to climatic
variability and pump and power failures during wet weather events.
(a) sufficient available storage is maintained to accommodate expected inputs and outputs during the
year; and
(b) the DSA is provided for at the 1 November for the coming wet season.
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(a) be designed with a floor and sides of material that will contain the wetting front and any entrained
contaminants within the bounds of the containment system during its operational life including any
period of decommissioning and rehabilitation; and
(b) have a system that will detect any passage of the wetting front or entrained contaminants through
either the floor or sides of the dam; and
(c) either, be capable of repair to rectify any passage of the wetting front through either the floor or sides
of the dam, or else be decommissioned and rehabilitated.
(a) be designed with a floor and sides of material that will contain the wetting front and any entrained
contaminants within the bounds of the containment system during its operational life including any
period of decommissioning and rehabilitation; and
(b) have a system that will detect any passage of the wetting front or entrained contaminants through
either the floor or sides of the dam; and
(c) have a system for the collection and proper disposal of any contaminants that move beyond the
bounds of the containment system; and
(d) either, be capable of repair to rectify any passage of the wetting front through the either the floor or
sides of the dam, or else be decommissioned and rehabilitated.
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Definitions
Note: Definitions of terms in this document are provided in the Guideline: Structures which are dams or
levees constructed as part of environmentally relevant activities (EM634).
References
1. Downstream Hazard Classification Guidelines, ACER Technical Memorandum No. 11, U.S.
Department of the Interior, Bureau of Reclamation 1988.
2. Guidelines on Dam Safety Management, Australian National Committee on Large Dams (ANCOLD)
August 2003.
3. Guidelines on Assessment of the Consequences of Dam Failure. Australian National Committee on
Large Dams (ANCOLD) 2000.
4. Guidelines on Tailings Dam Design, Construction and Operation. Australian National Committee on
Large Dams (ANCOLD) October 1999
5. Queensland Dam Safety Management Guidelines. Queensland Department of Natural Resources and
Mines February 2002
6. Guideline for Failure Impact Assessment of Water Dams. Queensland Department of Natural
Resources and Mines April 2002.
7. Guidelines on Acceptable Flood Capacity for Dams. Queensland Department of Natural Resources
and Water February 2007.
8. Technical Guidelines for the Environmental Management of Exploration and Mining in Queensland.
Queensland Department of Minerals and Energy January 1995.
9. Dam Safety Course Notes. Queensland Government Dam Safety Group DPI Water Resources March
1994.
10. Guidelines on Selection of Acceptable Flood Capacity for Dams, Australian National Committee on
Large Dams (ANCOLD) March 2000.
11. Guidelines on Prevention of Water Pollution from Cyanide Use in Gold Ore Processing, Queensland
Government Department of Environment and Heritage, January 1990.
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3 MONTHS
2 MONTHS
3 MONTHS
4 MONTHS
Method of calculation
This method of estimating DSA is based on rainfall deciles. It uses records from a Bureau of Meteorology
daily rainfall station with similar meteorology and sufficient length of record, at a location sufficiently
close to the site to enable conservative estimation of wet season rainfall runoff volume reporting to a dam.
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where relevant, assumptions, constraints, operations, and procedures relied upon to distribute
DSA allowance for an integrated containment system across a number of regulated dams.
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Modelling should be mass conservative for water volumes and, where relevant, mass of contaminants.
The checking of model results and documentation should demonstrate a net balance check of water (and
mass of contaminants where applied) for:
(a) every storage or significant conveyance element (e.g. upstream and downstream watercourse
reaches); and
(b) the system as a whole across the period of the model simulations.
Climate inputs to the model (rainfall and evaporation) must be representative of the historical variability
and sequences for the specific site. The period of climate data should be as long as possible to adequately
represent the extremes of climate and climate sequences that can occur at a site.
Rainfall inputs to modelling must include a sequence of at least 100 years of real data (infilled as
necessary from nearby stations) to deliver output for performance analysis and benchmarking against
other model inputs. Such a rainfall sequence can be produced from, in order of preference:
(b) ‘datadrill’ (both from silo enhanced meteorological data, published on the web); or
(c) independently created using nearby Bureau of Meteorology rainfall stations in the region—where this
can be demonstrated to be robust and consistent with conditions on the site.
Stochastically derived rainfall data may only be used for modelling of containment systems where it is
demonstrated that application of the data to continuous time-series simulation of rainfall-runoff processes
satisfactorily replicates observed runoff characteristics. For modelling of containment systems where
there is reasonable possibility of substantial carry-over water volumes from a wet season well into the
next year’s wet season, care is required to ensure that the possibility of sequential wet seasons evident in
historical climate records is properly represented by the applied climate data.
Evaporation estimates used may need to be adjusted for any local limitations due to expected water
quality (e.g. salinity, low pH), and location (e.g. water surface below surrounding land and low surface air
flow) where relevant to ensure reasonably conservative outcomes of the assessment.
The suitably qualified and experienced person must document the basis upon which it is expected that the
climate data has been used conservatively for the purpose of the assessment.
The use of annual averages of rainfall and evaporation in modelling storage volume outcomes is not
acceptable.
An assessment of system performance risks to the environment (particularly overflows from dams and
adequacy of storage capacity), must assume that there are no seepage losses from dams and no
transmission losses from open channel systems used to transfer water. This assumption is intended to be
conservative from the perspective of containment performance but may not be conservative for other
outcomes of operational simulation modelling (such as water supply reliability).
F. Runoff processes
The processes represented to transform rainfall onto a catchment to runoff rates/volumes must replicate
the catchment responses to a full range of climatic conditions including, but not limited to, conditions
during wet seasons.
As a minimum requirement, an established and properly calibrated 'watershed' element of the water
balance model that accounts for antecedent catchment conditions must be used.
Where outcomes going into a wet season are being assessed using a water balance model, the watershed
calibration must be demonstrated to be appropriate for wet season conditions.
For existing operations where historical operations and/or monitoring data is available, that data must be
used to calibrate and validate the models based on comparison of simulated and historical water inventory
(storage volumes) over time sequences of wet and dry climate periods (seasonal fluctuations).
Professional care and judgement must be applied to ensure the accuracy of storage curves for dams in
making these comparisons. Discrepancies between simulated and historical observed data may be
acceptable providing that the differences can be adequately explained and justification made that the
model representation maintains conservative assumptions relative to the specific purpose of the
assessment.
A best estimate approach shall be applied to those situations where there is insufficient historical data for
calibration, including:
substantiating that runoff parameters are appropriate for catchment conditions including runoff
estimates for disturbed lands
For combined water and contaminant balance models, validation needs to extend to validating the water
quality results from the model against historical water quality data. Professional care and judgement must
be exercised in the validation methods used and adequate substantiation and explanation provided on the
significance of the validation results relative to the specific purpose of the assessment.
Estimates of potential contaminant concentrations on any release must be based on a validated water
balance model together with conservative estimates of contaminant concentrations likely to be in relevant
dams at the time of any release.
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A properly constructed and calibrated operational simulation water balance model will provide a best
estimate time series site water balance, without undue imposed bias.
However, the application of simulation outcomes to containment system design and operation requires the
addition of appropriate margins to conservatively compensate for observed deficiencies in simulation
accuracy or lack of calibration data.
For the purposes of this manual, model accuracy may be defined with respect to the seasonal simulation
margin (SSM), which is to be derived when adequate calibration data is available. SSM is calculated as
the numerical difference between recorded and simulated storage inventory maxima for each water year
of simulation, for the particular storage under consideration. SSM is a positive value when recorded
inventory volumes are greater than simulated containment system inventory volumes and set to zero
otherwise. SSM can never be a negative value.
where: i ranges from 1 to number of annual SSM values, and Vi is the associated simulation
volume,
When there is inadequate data for model calibration a minimum DSM value of not less than 50% shall be
applied
The required conservative margin is then calculated by multiplying the volume of interest by the DSM.
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Levees may differ from most dams containing hazardous contents, where the hazard category can be
readily determined for a ‘failure to contain’ and ‘dam break’ scenario in accordance with tables 1 and 2,
and this appendix.
For flood protection levees or diversion levees, the suitably qualified and experienced person conducting
and certifying the assessment needs to consider the function of the levee in relation to the broader
operations and management of contaminants at the site, including functions to protect the integrity of
contaminant storages. The following situations should be considered for hazard assessment of levees.
Where a levee is designed to divert contaminated waters into a containment dam (which also means
designed to prevent release of contaminants), or as part of the protection of the structural integrity of a
containment dam, the levee should be considered a key design element of the relevant dam. The hazard
assessment is then to be undertaken for ‘failure to contain’ and ‘dam break scenarios’ (as outlined in
tables 1 and 2, and this appendix) from the perspective that the levee is an integral part of the dam
performance and failure of the levee could result in either failure to contain contaminants, and/or result in
dam break failure of the dam.
Where a levee is designed to prevent ingress of clean flood water into an operational area, or catchment of
a containment system, the suitably qualified and experienced person conducting and certifying the
assessment needs to determine the relevant application of the ‘failure to contain’ and/or ‘dam break’
hazard scenarios.
For flood protection levees designed to prevent ingress of clean flood water, it is possible that ‘failure to
contain’ or ‘dam break’ hazard scenarios will need to be formulated and documented as part of the
assessment.
Where failure of the structure would cause ingress of floodwater volumes with reasonable possibility of
overloading the containment system and diminishing the containment performance, or more generally
contributing to excessive accumulation of contaminated waters on the site, the structure is to be deemed
to be at least a significant hazard regulated structure.
Where the levee is intended to protect from ingress of flood waters originating from a waterway large
enough to be declared a watercourse under the Water Act 2000, the levee is to be classified as a
regulated structure.
Notwithstanding the above, even if the source of floodwater is not a declared watercourse (under the
Water Act 2000), but failure of the levee would substantially increase the effective catchment area
draining into a containment system and result in diminished containment performance or excessive
accumulation of contaminated waters, the levee is to be classified as a regulated structure.
The hazard assessment must include sufficient documentation of the context of the levee in relation to
site containment systems and surrounding waterways and catchments (with maps and quantified data
on catchments within and outside the containment system) to substantiate the classification
determined to be appropriate by the suitably qualified and experienced person conducting and
certifying the assessment.
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For levees determined to be regulated structures based on their function primarily to exclude flood water,
design criteria are defined in Table 4 of this manual.
The degree of immunity to regional and local flooding, the upstream and downstream effects of the dam
on such flood events, and potential erosion of the dam or the general environment; must be addressed in
the hazard assessment, design, operation and decommissioning of dams.
‘Failure to contain’ hazards are those potential dam failures that are typically non-flood producing, but
the release of contaminants could endanger environmental values including human life. Examples of
events include:
releases due to pipe bursts in tailings or process water circuits associated with the dam
inundation by floodwaters
erosion of containment structures around mining waste (decommissioned tailings dams, waste heaps
etc); and
Evaluation of the hazard potential on release requires information on the probable chemical nature of the
stored material, including rates, volume and concentrations at the time of a possible release. Acidity and
metal ions in solutions due to prolonged contact with ore bodies or stored material must be considered.
Contaminant concentrations at discharge must be estimated based on the contaminant concentration in the
dam, and design parameters such as available storage volume. Operational water balance models may
also be used to estimate likely instances of volumes and concentrations at discharge.
Conservative assumptions should be made to estimate outcomes of the worst case contaminant release or
collapse of the structure. Assessments must always consider the potential interaction of failure of one dam
with any other dams on site.
Assessment of progress of wetting fronts through dams with liners must be informed by proper materials
testing (note: in-situ testing is not required as part of this assessment), knowledge of the design sizing and
likely driving head during operation, the underlying hydrogeological conditions, and the potential impacts
on underlying land and groundwater.
The prerequisites for a dam break hazard are the existence, either permanently or temporarily, of a large
body of water or other flowable substances (slimes, tailings, etc); and environmental values, including
stock, human life or property, that are susceptible to harm should a dam break occur. The presence of
human life must also consider employees and persons associated with the operations for which the holder
of an authority is responsible (i.e. should not be limited only to third parties).
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The estimated extent of the flood at a particular probability level is called the ‘failure impact zone’. The
potential for losses to humans and stock must be considered. A high hazard for humans on a flood plain
or elsewhere is associated with water depths occurring in excess of 300 millimetres (0.3 metre).
If the ‘failure impact zone’ is contaminated by the dam break flood, the environmental harm and potential
for consequent harm from contaminants including access by stock or humans to the contaminants, must
also be fully considered. Clean up in the general environment can involve substantial costs that would fall
within the meaning of ‘environmental harm’ in the Act.
Applications that involve the construction and operation of any containment structure, must include
relevant information on which an initial hazard assessment by the applicant has been undertaken.
Dam owners are likely to have much of the information already available. The minimum information is:
maps showing the location of the proposed project in relation to surrounding land use and
watercourses—including the general topography and contours at a suitable scale
details of environmentally sensitive areas, rare and endangered species and human habitation and
infrastructure developments in the near vicinity or general area and particularly downstream
details of watercourses and groundwater aquifers that are or might be used as water resources
engineering sketch drawings, in accordance with good professional practice and sufficient to fully
define the layout, structure, volume and proposed means of construction of all aspects of operations
associated with the proposal
details of quantities and concentrations of all raw materials, products, by-products and waste products
produced in operations associated with the proposal; and
details of all studies conducted to assess requirements for storage and strength of all structures
associated with the project—such as hydrological and geotechnical data.
Whether or not a site inspection is required for a particular dam as part of a hazard assessment is a matter
for consideration by the suitably qualified and experienced person concerned. However, that person must
be satisfied that all relevant aspects have been otherwise researched and documented to enable a reliable
hazard assessment in each case.
Any assessment must include areas in the potential failure path or downstream of the dam that could be
impacted by collapse or failure of the dam. Relevant matters include (but are not limited to):
infrastructure including human habitation, worker accommodation and site offices, road crossings
recreation facilities (parks and known local camping spots, etc) along watercourses
presence of stock, irrigation and domestic water supply pumps, and water holes
mine adits (entrances to underground mining) and/or open cuts (voids)—current or proposed
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In the case of tailings dams and other waste disposal facilities, a site inspection should also note points of
impact above the level of the dam. Typical impacts from such facilities include:
gas emissions (e.g. cyanide, hydrogen fluoride, hydrogen sulphide, sulphur dioxide)
offensive odours
visual amenity (in cases where such is critical to a significant environmental value)
A hazard category based on ‘dam break’ or ‘failure to contain’ scenarios, must be assessed based on the
most adverse environmental harm that can arise from the range of all possible scenarios. The hazard
category is based on the consequences of failure, not on the perceived probability of the failure occurring.
A suitable range of rainfall scenarios will need to be considered in order to cover all potential harm
and the required performance contained in tables 4 and 5.
Where potential harm is by release of a contaminant, account should be taken of the potential dilution
by clean runoff entering the dam prior to release and potential dilution in receiving waters.
For an earth dam or bund wall, a ‘sunny day’ failure can also occur due to loss of structural integrity
of the wall, such as piping failure or weakness in zones of the wall (various causes).
Of course, the probability of piping and similar mechanisms occurring are reduced by good design and
construction practices, and regular inspections by informed operators and qualified professionals. The
purpose of a hazard assessment, is to identify dams that require more care and attention in that regard.
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____________________________________________________________________________________
____________________________________________________________________________________
I hereby state that I am a Registered Professional Engineer of Queensland and meet the requirements of
the definition of ‘suitably qualified and experienced person’.
Statement of certification
All relevant material relied upon by me, including subsidiary certifications of specialist components, where
required by the environmental authority, is provided in the attached report(s) <report name/ref> dated
<date>.
Refer to the manual for guidance on the nature of the certification statements that should be included
here.
Note: the following is a guide to the minimum information required. Further information may be necessary
as part of the certification to comply with all conditions of the environmental authority.
<identify which regulated structure(s) is the subject of the certification>
<identify the relevant condition which is the subject of the certification>
<identify, where appropriate, what is not included in the certification—including information about
any limitations, restrictions or exclusions that apply to the certification>
<identify where the certification relates to an inspection or design>
<identify if the certification was under supervision, the extent of the supervision>.
I <full name of person making the declaration>, declare that the information provided as part of this
certification is true to the best of my knowledge. I acknowledge that it is an offence under section 480 of
the Environmental Protection Act 1994 to give the administering authority a document containing
information that I know is false, misleading or incomplete in a material particular.
Signed: ____________________________________
Date: _______________________________________
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