Application for
Resource Consent:
Onsite Wastewater
Form B: Activity Information and Assessment Form
A complete Administration Form (Form A) MUST accompany
the Resource Management Act 1991. These forms are to act as a
this Activity Information and Assessment Form (Form B) when
guide only, and Horizons Regional Council reserves the right to
lodging your application. The purpose of this form is to provide
request additional information.
the applicant with guidance on information that is required under
APPLICANT NAME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Te Pirangi Developments
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Limited
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Refer to Form A)
1
APPLICATION PURPOSE
What is the purpose of this application (select one)
New consent
Renewal of consent
Consent number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expiry date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is this an application for an existing, upgraded or new system?
Existing Upgrade New
What is the total area of the property . . . . . . .
10500 . . . . . . . . . . . . . . . . . . . . . . . m2
Consent term sought . . . .
35 . . . . . .
years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Max. 35 years)
Note: Resource consents are typical y aligned with the relevant common catchment expiry dates in Policy 12-5 of the One Plan.
2
LOCATION
Location of the proposed discharge . . . . .
158 . .
& . . . . .
164 . . . . . . .
Turitea . . . . . . .
Road, . . . . . . . . . . . .
Palmerston . . . . . .
North . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . .
158 . .
& . . . .
164 . . . . . . . .
Turitea . . . . . . .
Road, . . . . . . . . . . . .
Palmerston . . . . . .
North . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Map reference (NZTM 2000) E. . . . . . . . . .
1824375 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N. . . . . . . . . .
5524327 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Legal description . . . . .
Lot . .
3 . . .
DP . . . . . . .
67730 . . . . .
and . . .
Lot . .4 . . . .
DP . . . . . .
30170 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Certificate of Title and a detailed site map is required with this application, please see Section 14 - additional information required.
3
SITE CHARACTERISTICS
Provide descriptive details below.
Vegetation cover
Mostly pasture with some trees
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
Topography/slope
Lot 2, most of Lot 14 and the eastern half of Lot 16 are located on the relatively flat ground. The south-western perimeter of Lot 14 lies at the toe of a
~30 m high northeast-facing slope. The western half of Lot 16 reaches about halfway up the 30 m high slope.
General land stability of the property (including a description of any previous fill in the vicinity of the proposed soakage field)
The slope is stable under all conditions, with no previous fill observed in the vicinity of the proposed soakage fields.
Site constraints (e.g. gullies, retaining wal s, ponds, tile drains etc.)
None
Site clearances (which should be also shown on the site plan)
Separation distance from
Treatment plant separation
Disposal field separation distance
distance (m)
(m)
Boundaries
As per AEE 3.6.
Surface water (incl. drains etc.)
Stands of trees/shrubs
Wel s, water bores
Embankments/retaining wal s
Buildings
Other (specify)
YES NO
* (As defined in Schedule F of the One Plan)
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
4
SITE ASSESSMENT
All site assessments are to include a detailed assessment of the soils
distance between the case of the land application system and any
that underlay the proposed land application area. The assessment shall
groundwater table (see Table 2.2 in the Manual for On-site Wastewater
be by test pit or, where this is impractical, by hand auger borehole.
Systems Design and Management (Horizons Regional Council 2010).
The subsurface assessment should be to a depth of at least 1-2
Photographs are also needed of the soil profile.
metres, or at the minimum recommended groundwater separation
Who carried out the site assessment?
Resource Development Consultants Ltd (RDCL) and Lowe Environmental Impact Ltd (LEI)
Date and Time . . . .
17 . . .
& . . .
18 . . . . . . . . . .
January . . . . .
2024 . . . . . . . .
(RDCL . . . . .
and . . . .
13 . . . . . .
June . . . . . .
2024 . . . .
(LEI). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
What was the weather preceding and at time of assessment?. . . . . . . . .
Sunny . . . . .
and . . . .
dry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Describe the soils and subsoils of the land treatment field and their characteristics (e.g. depth of topsoil, colour, texture, structure,
comment on soakage ability)
Please provide photos of the soil profile with the application
Refer to Section 2.3.2 and Table 2.3 of the AEE.
Based on results of the subsoil investigation above, please indicate the disposal field soil category
Is topsoil present?
YES NO
Is so, what is the topsoil depth? . . . . . . . . . . . .
Between . . . .
0.2 . . . . .
and . . .
0.4. . . . . . . . . .m
Soil Category
Description
Drainage
Tick
1
Gravel, coarse sand
Rapid draining
2
Coarse to medium sand
Free draining
3
Medium-fine and loamy sand
Good drainage
4
Sandy loam, loam and silt loam
Moderate drainage
5
Sandy clay-loam, clay loam and silty clay-loam
Moderate to slow drainage
6
Sandy slay, non-swelling clay and silty clay
Slow draining
7
Swel ing slay, grey clay. hardpan
Poorly or non-draining
Are surface water interception drains required?
YES NO
If ‘Yes’, please show in site plan
Please state the depth of the seasonal water table: Winter . . . . . . . . . . . . . . . .
Not confirmed . . . . . . . . . . . . . . . . . . . . .m Summer . . . . .
> 3.4. . . . . . . . . . . . . . . . . . . . . . . . . . m
Was this Measured Estimated
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
5
DESCRIPTION OF PROPOSED ACTIVITY
Volume of the discharge. Note: Horizons default calculation for discharge volume is 180 litres/person/day.
Activity type
Size
Maximum daily discharge (m3)
Private House
Number of bedrooms*
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Four
1.2
Motel/Hotel
Max. number of guests and staff
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Café/Restaurant/Winery
Max. number of patrons and staff
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
School
Max. number of pupils and staff
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Camping Ground
Max. number of campers and staff
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Community Hal /Marae/Golf Club
Max. number of patrons
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other
Max. number of staff, permanent or seasonal
residents/guests
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*Include offices, media rooms
Horizons Regional Council’s default calculation for discharge volume is 180 litres/person/day. If the volume stated in the above
table is based on more or less than this default calculation, please provide details of the volume calculation below.
See Section 3.3 of AEE.
What is the property’s primary water source?
Please select all applicable
Reticulated supply
Private supply from bore
Other
Trickle feed
Onsite roof tank supply
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
6
TREATMENT SYSTEM
What type of treatment system will be used?
Primary
Advanced secondary
Secondary
Tertiary
Who/what is the manufacturer, brand, and model:
See Section 3.4, Table 3.2 of AEE.
Who is the system instal er?
See Section 3.4, Table 3.2 of AEE.
Has the system been accredited by the Onsite Effluent Treatment National Testing Programme?
YES NO
If yes, please state date of accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To be provided by the WWTP designer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Primary Treatment (Only fill out this section if you are instal ing/have a primary treatment system)
Please indicate below the number and capacity (litres) of all septic tanks including type (single/dual/grease traps) to be instal ed or
currently existing.
Number of tanks
Type of tank
Capacity of tank (litres)
TOTAL CAPACITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is a septic tank effluent outlet filter to be instal ed?
YES NO
If ‘Yes’, please state the type
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
Secondary and Tertiary Treatment (Only fill out this section if you are instal ing/have a Secondary/Tertiary system)
Please indicate the type of additional treatment, if any, proposed to be instal ed in the system (please tick).
Secondary treatment
Please tick
Working capacity (litres)
Total capacity (litres)
Home aeration plant
Commercial aeration plant
Intermittent sand filter
Recirculating textile filter
Clarification tank
Tertiary treatment
Ultraviolet disinfection
Chlorination
Other (please specify)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
DISPOSAL METHOD
Please indicate the proposed loading method (Please select one)
Gravity
Pump
Dosing siphon
Ma
ke
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Capacity . . . . . . . . . . . . . . . . . . . . litres/minute
Is a high and low water level alarm being installed in all pump chambers?
YES NO
Please identify the type/s of disposal method proposed for this site.
Surface dripper irrigation
LPED shal ow trench
Other, please specify. . . . . . . . . . . . . . . . . . . . . .
Subsurface dripper irrigation
Wisconsin mound
Standard trench
Evapotranspiration beds
Define the dimensions of the land treatment field on the APPLICABLE SYSTEM DIAGRAM.
Dripline Field
Ground Level
a)
b)
a) Depth below ground level . . . . .
200 . . . . . . . . . . . . . . . . . . . . . . .mm
b) Spacing between distribution pipes . . . . . .
1000. . . . . . . . . . . . .mm
Lineal length of distribution pipes . . . .
50 . . . . . . . . . . . . . . . . . . .m
Make of emitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Emitter spacing . . . . . .
600 .- . . . . . .
1,000 . . . . . . . . . . . . . . . . . . . . . . . . . .mm
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
Trench/Bed Field
Ground Level
d)
g)
c)
a)
e)
b)
Is it a trench or a bed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a) Depth of trench / bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
b) Width of trench / bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
c) Spacing between distribution pipes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
d) Depth of distribution pipes below ground level . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
e) Distance from pipe to bottom of trench / bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
f) Distance between adjacent trench wal s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
g) Size of pipe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
Length of trench / bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
Depth of aggregate in trench / bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
Number of trenches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of distribution pipes within bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Raised Bed Field
c)
a)
b)
d)
a) Height bed raised above ground level . . . . . . . . . . . . . . . . . mm
Ground Level
b) Space between distribution pipes and original ground level . . . . . . . . . . . . . . . . .mm
c) Distance between distribution pipes and top of bed . . . . . . . . . . . . . . . . . . . . . . . .mm
d) Spacing between distribution pipes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .mm
e) Number of distribution pipes within bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Please identify the loading rate you propose for the option selected above, stating the reasons for selecting this
loading rate.
Loading rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .litres/m2/day
Land application area: Basal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .m2
OR Areal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .m2
Explanation
Please refer to Chapter 6 of the Manual for On-site Wastewater Systems Design and Management (Horizons Regional Council 2010) for recommended
calculation methods
What is the proposed reserve wastewater disposal area? . . . . . . . . . . . . . . . . . . .m2
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
8
RULE 14-15 ASSESSMENT
Please ensure that your proposal is not a permitted activity under
14-13 or 14-14. To determine if your application will be assessed as
Rules 14-13 or 14-14. If you are applying for a consent for your activity
a Restricted Discretionary Activity (Rule 14-15) or a Discretionary
it is because the proposed on-site wastewater treatment and disposal
Activity (Rule 14-30) we need to understand if the discharge meets all
system does not comply with one or more of the conditions of Rules
of the conditions of Rule 14-15.
Rule 14-15
The discharge^ of domestic wastewater* onto or into land^ pursuant to ss15 (1) or 15(2A) RMA and any ancil ary discharge^ of
contaminants^ into air pursuant to ss15(1) or 15(2A) RMA from an on-site wastewater treatment and disposal system that does not
comply with one or more of the conditions^ of Rules 14-13 or 14-14.
Conditions/standards/terms
Yes/No/N/A
Explanation
The design flow must not exceed 6m3/d.
Yes
The flow al owance used to calculate the system
design flow must be no less than 145 litres per person
per day where the water^ supply is provided by roof
Yes
water^ col ection, or no less than 180 litres per person
per day for other sources of water^ supply.
The discharge^ must consist only of contaminants^
normal y associated with domestic sewage and
Yes
greywater.
The activity must not take place in any rare habitat*,
threatened habitat* or at-risk habitat*.
Yes
The activity must not be to any historic heritage^
identified in any district plan^ or regional plan^.
Yes
*If the area where you are considering works contains or is adjacent to an area containing indigenous plant species (which may include scattered exotic
species), coastal dunes, wetlands, tussock (unless red tussock regenerating through pasture dominated by exotic grass species), or a waterway, you may
need further assistance. Please contact the Horizons consents team in the first instance or obtain advice from your own qualified ecologist as to whether it is
considered an at-risk, rare or threatened habitat.
Further information on rare, threatened or at-risk habitats can also be found in Schedule F of the One Plan, which can be accessed via
http://www.horizons.govt.nz/publications-feedback/one-plan/part-3-annexes/schedules
Activity Status
• If you have met all of the above conditions/standards/terms your application is RESTRICTED DISCRETIONARY ACTIVITY, you can
proceed to fill out this form to complete your application, including an appropriate Assessment of Environmental Effects.
• If you have not met one or more of the conditions/standards/terms above your application is a DISCRETIONARY ACTIVITY. You
will need to ensure that the Assessment of Environmental Effects is appropriate to the scale of the non-compliance with the
rules above. For further assistance you can contact a member of the consents team.
• An assessment of cultural effects will be required. This should be informed by [written] feedback from the relevant iwi and/or
hapū. For indicative rohe and contact details of your local iwi and/or hapū please visit http://www.tkm.govt.nz/.
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
9
ASSESSMENT OF ENVIRONMENTAL EFFECTS
For your application to be considered, an assessment of effects must be included. Please answer all questions below. Additional
information may need to be provided depending on the scale and significance of your proposal.
What is the expected quality of the discharged effluent?
Biochemical Oxygen Demand (BOD) . . . .
20 . . . . . . .mil igrams/Litre
Faecal coliforms . . . . . . .
10,000 . . . . . . . . . . . . . . . . . . . . . . .cfu/100 ml
Suspended solids . . .
30 . . . . . . . . . . . . . . . . . . . . . . . . . mil igrams/Litre
Total Nitrogen . . . .
60 . . . . . . . . . . . . . . . . . . . . . . .mil igrams/Litre
Other effluent quality information/comment
Proposed application rate of 4 mm/day.
How were the above results obtained?
Make use of secondary treatment systems that have been tested in trials and can meet these parameters. See Section 3.4 of AEE.
What effect will the discharge have on:
Soil
(Based on disposal system loading rate and proposed disposal method)
See Section 6.2 of AEE.
Groundwater
(Note separation distance between the base of the land application system and the highest seasonal groundwater level)
See Section 6.3 of AEE.
Surface water
(Note separation distances)
See Section 6.4 of AEE.
Neighbouring properties
(Note separation distances, management of potential odour)
See Section 6.5 of AEE PA proposed system.
Vegetation
See Section 6.2 of AEE.
Is the disposal system and discharge area prone to flooding? (If so, describe how often and to what degree)
NB: The disposal system needs to be above the 1: 200 year flood (0.5%) level. A flood risk assessment may not be required for all proposed systems and
Horizons Regional Council may have existing flood risk information.
The discharge location aligned with the 20 m setback from the 1 in 20 year event
required in the design manual.
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
10
EFFECT ON STATUTORY ACKNOWLEDGMENTS
Is the activity on, adjacent to, or may affect land that is subject of a statutory acknowledgment?
Yes
No
List of statutory acknowledgments:
Ngāti Tūwharetoa (Bay of Plenty) Claims Settlement Act 2005
Ngaa Rauru Ki tahi Claims Settlement Act 2005
Ngāti Apa (North Island) Claims Settlement Act 2010
Rangitāne o Manawatu Claims Settlement Act 2016
Rangitāne Tū Mai Rā (Wairarapa Tamaki nui-ā-Rua) Claims Settlement Act 2017
Ngāti Rangi Claims Settlement Act 2019
Information on statutory acknowledgments can be found on the Horizons website:
https://www.horizons.govt.nz/about-our-
region-and-council/iwi-and-hapu
If yes, Council must have regard to the statutory acknowledgments. We recommend that applicants considering undertaking
works that may affect a statutory acknowledgment make contact with local iwi and/or hapū before the lodgement of a consent
application to determine if there are any effects on the statutory acknowledgment.
11
TE AWA TUPUA (WHANGANUI RIVER CLAIMS SETTLEMENT) ACT 2017
Are the proposed works in the Whanganui catchment?
YES NO
Please note that this covers a large area. If you are unsure, please contact the consents team.
If yes, the Whanganui River and its wider catchment is the subject of the Te Awa Tupua (Whanganui River Claims Settlement) Act
2017. Council must have regard to the values of Te Awa Tupua when making a decision on any application we receive (regardless of
activity status). On that basis, we recommend that parties considering undertaking works within the Whanganui catchment make
contact with Ngā Tāngata Tiaki o Whanganui and local iwi and/or hapū before lodgement of a consent application to confirm any
requirements under Te Awa Tupua and obtain feedback on the proposed works.
12
TE WAIŪ-O-TE-IKA - WHANGAEHU RIVER (NGĀTI RANGI CLAIMS SETTLEMENT ACT 2019)
Are the proposed works in the Whanganui catchment?
YES NO
Please note that this covers a large area. If you are unsure, please contact the consents team.
If yes, the Whangaehu River and its wider catchment is the subject of Te Waiū-o-Te-Ika (Ngāti Rangi Claims Settlement Act 2019).
Council must have regard to the values (Te Mana Tupua and Ngā Toka Tupua) of Te Waiū-o-Te-Ika when making a decision on any
application we receive (regardless of activity status). On that basis, we recommend that parties considering undertaking works
within the Whangaehu catchment make contact with local iwi and/or hapū before lodgement of a consent application to confirm
any requirements under Te Waiū-o-Te-Ika and obtain feedback on the proposed works.
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
13
GOOD MANAGEMENT PRACTICES AND MITIGATION MEASURES
Please include a description of the monitoring or good management practices to be undertaken to help avoid, reduce, remedy or mitigate the
actual and potential effects on the environment.
Describe routine maintenance and inspections that will be carried out concerning the treatment and disposal system.
To be carried out in line with manufacturer's requirements.
How will the treatment and disposal system be managed to ensure the maximum treatment efficiency?
To be managed in line with manufacturer's requirements.
Is any monitoring of the discharge, and its impact upon groundwater (or nearby surface water) carried out (or intended to be
carried out). If yes, please outline the programme (for example, what measured, where, how often).
No
What procedures/methods (other than treatment) have been adopted/put in place, to minimise the volume of discharge (for
example, dual flush toilets, water saving devices)?
These are becoming common in construction but we have addressed the
worest-case-senario.
14
CONSIDERATION OF ALTERNATIVES
What alternative methods of treating and/or discharging the effluent were considered?
See Section 5 of AEE.
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
15
NATIONAL ENVIRONMENTAL STANDARDS
NATIONAL ENVIRONMENTAL STANDARD FOR SOURCES OF HUMAN DRINKING WATER (NES-DW)
Are there any public water supplies that could be affected by your proposal?
YES NO
An assessment under the NES-DW will need to identify any sources of human drinking water that supply more than 25 people who
might be affected by the activity. Horizons Regional Council holds a list of such water supplies within its region and will be able to
provide assistance when identifying water supplies within the vicinity of the activity.
Discussion with the water supply operator may also be beneficial in determining whether the supply could be affected and what measures can be taken to
ensure the quality of the water supply is maintained.
Section 2.5 and 8 of the AEE.
Please state any other NES that you consider may be relevant to your activity and provide an assessment against that NES.
N/A
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
16
RELEVANT STATUTORY PROVISIONS
The Resource Management Act 1991 requires this application to include an assessment of the proposed activity against the One
Plan. Answering the fol owing questions will satisfy this requirement. If you are unable to answer the questions below, or you
believe your proposal is inconsistent with the relevant policies and documents discussed, it is recommended you seek professional
planning assistance to help you with your application.
For a complete copy of the One Plan visit http://www.horizons.govt.nz/publications-feedback/one-plan
REGIONAL POLICY ASSESSMENT
The objectives and policies of Chapter 5 (Water) are relevant to this application.
Is the activity consistent with the relevant provisions of the Regional Policy Statement?
YES NO
Please provide reasons for your answer above
See Section 8.2 of AEE.
Please list any other relevant objectives and/or policies of the Regional Policy Statement and provide an assessment of
the activity against those objectives and/or policies.
N/A
REGIONAL PLAN ASSESSMENT
Objective 14-1 and Policy 14-2, 14-3, 14-4 and 14-9 of Chapter 14 of the Regional Plan are relevant to this application.
Is the activity consistent with the relevant provisions of the Regional Plan?
YES NO
Please provide reasons for your answer above
See Section 8.3 of AEE.
If there are any other sections of the One Plan or any national planning documents (e.g. NZ Coastal Policy Statement) that
you consider relevant, please provide an assessment of the activity against those relevant objectives/policies of the One
Plan and/or national document.
N/A
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
17
ADDITIONAL INFORMATION REQUIRED WITH THIS FORM
Completed administration form (Form A)
A SITE plan to scale showing:
• Property
Boundary dimensions, basic house floor plan and any other structures, driveways, retaining wal s, stands of trees, slope,
angle and direction and slope breaks.
• Treatment plant
Location, distance from land treatment field, distance from dwelling/s.
• Land treatment field
Location, area, dimensions, distance from boundaries, location of effluent lines, distance between effluent lines and
location of all investigation boreholes or testpits.
• Reserve area
Location, area, dimensions, distance from boundaries
• Stormwater
Location of discharge, distance from land treatment field, distance from reserve area
• Bore (if relevant)
Location, distance to land treatment field and distance to reserve area
• Surface water body (if relevant)
Name & location, distance to land treatment field, distance to reserve area
• Rare, threatened or at-risk habitats (if relevant)
Location, distance to land treatment field and reserve area.
A signed copy of the contract with the service provider
Certificate of title
Photographs of the soil profile from the site assessment
Please contact the consents team on freephone
0508 800 800 if you require assistance with your application.
Application for Resource Consent: Onsite Wastewater
Form B: Activity Information and Assessment Form
