Email: applications@waidc.govt.nz www.waikatodistrict.govt.nz Telephone (all hours) 07 824 8633 Call Free 0800 492 452 District Office 15 Galileo Street Private Bag 544 Ngaruawahia 3742 Application for Resource Consent (Subdivision) Section 88, Resource Management Act 1991 Form 9 If you are unsure of how to complete this form it is recommended that you engage the services of a suitably qualified planning consultant to help you with your application. It is important that you answer all questions in full otherwise your application may be returned to you as incomplete. Please note that all the information provided in this application is available to the public and for statistical purposes. A.1 APPLICANT DETAILS (the name of the consent holder who will be responsible for the consent and any associated costs, unless otherwise stated in Section A.11) Full Name (please write all names in full) OR Name of Company Trust/Organisation (Please note that if a Trust, all Trustee Names must be included) Electronic address for service Postal address Post Code Phone Mobile phone If you have an agent / spokesperson acting on your behalf, tick here and enter their details below in A.2 Please note: if you appoint an agent, the Council will contact only the agent regarding this application unless you specifically request otherwise. To request copies of all correspondence sent to the agent, please tick A.2 AGENT DETAILS Tick here if N/A Company Contact Person Electronic address for service Postal address Post Code Phone Mobile Phone A.3 APPLICATION SITE DETAILS Site/Street Address: Legal Description (from your Rates Notice or Certificate of Title) Town/Location Page 1 09/17
A.4 BRIEF DESCRIPTION OF PROPOSED ACTIVITY AND REASONS FOR APPLICATION. PLEASE SPECIFY ALL DISTRICT PLAN RULE NUMBERS THAT THE PROPOSAL BREACHES A.5 SITE VISIT REQUIREMENTS A site visit may be required by Council staff or authorised consultants to visit the application site for the purposes of assessing this application. Council staff will call or email the landowner or agent before going onto site. As landowner and with the consent of any occupiers or lessees, I agree to Council staff or authorised consultants visiting the application site for the purposes of assessing this application OR If applicant is not the landowner Landowner s full name: Landowners signature A signature is not required if the application is made by electronic means Date Signed Email Phone Is there a locked gate or security system restricting access by Council staff? Mobile Phone Yes No Do you have any dogs on the property? Yes No If so, will these be locked up during the site visit? Yes No Please provide details of any entry restrictions/hazards that the Council staff or authorised consultants should be aware of? E.g. health and safety matters, organic farm etc: A.6 RULE BOOK Waikato District Plan (Waikato Section) 2013 Waikato District Plan (Franklin Section) 2000 Proposed Plan Change(s) National Environmental Standard A.7 PREVIOUS ADVICE Have you had any previous advice and/or correspondence from Council in regards to your proposal? Yes No Duty Planner Building Consent/PIM Officer Pre application PRE / Name of person you received advice from Copy of advice and/or correspondence attached Page 2 09/17
A.8 DEVELOPMENT CONTRIBUTIONS In accordance with Council s Development Contributions Policy the Local Government Act 2002, please note that the creation of additional titles is likely to result in required development contributions at the time of issue of section 224(c) certificate. A.9 NATIONAL ENVIRONMENTAL STANDARD FOR ASSESSING AND MANAGING CONTAMINANTS IN SOIL TO PROTECT HUMAN HEALTH REGULATIONS 2011 (NES) In accordance with Regulation 6 of the NES every application for subdivision (unless it involves production land remaining as production land) must be accompanied by information determining whether or not any activities or industries that appear on the Ministry for the Environment Hazardous Activities and Industries List (HAIL) are being, have been or are more likely than not to have been undertaken on the land. One of two methods detailed within the NES MUST be adopted for determining whether any HAIL activities are likely to have been undertaken on a site. Please indicate the method used to support the information detailed within this application: 1. Council Records. Information may be sourced by using information that is the most up to date information about the area where the piece of land is located that the Territorial Authority holds on dangerous goods files, property files, or resource consent database or relevant registers; or has available to it from the regional council. Please note - Waikato District Council offers a HAIL reporting service in order to meet the requirements of Regulation 6(2)(a) if required. There is a ten working day turnaround for this report. Please also complete and attach a Site History Checklist with your application OR 2. Preliminary Site Investigation. This must be undertaken by a suitably qualified and experienced practitioner carried out in accordance with the current edition of the Ministry for the Environment s Contaminated Land Management Guidelines No. 1 Reporting on Contaminated Sites in New Zealand. All findings must be included in a written assessment within the application specifically addressing the provisions of the NES. If electing council records to determine if a HAIL activity has occurred the assessment should identify all records reviewed to support any conclusion. The assessment should take account of the records and site history information. If a HAIL activity is identified on the site, please also refer to section C.7.a of this application form for information that may be required. For any further information regarding the interpretation and/or application of the NES please refer to the Ministry for the Environment Users Guide for the National Environmental Standard for Assessing and Managing Contaminants in Soil to Protect Human Health, 2012, available at http://www.mfe.govt.nz/laws/standards/contaminants-in-soil/. The subdivision proposal involves production land remaining as production land and therefore the NES not apply to this application. A.10 OTHER CONSENTS Additional consents required from Waikato Regional Council Is a Building Consent required? Yes No Discharge consent If Yes, has it been applied for? Yes No Regional land use consent Building Consent Application Reference BLD Coastal consent Water take consent Other Are these being sought at the same time? Yes No Page 3 09/17
A.12 BILLING DETAILS This identifies who will be receiving any invoices associated with processing this resource consent. By signing Section A.14 you agree that you are responsible for all outstanding fees incurred during consent processing Full Name (please write all names in full) Postal Address Email Phone Mobile phone Post Code The deposit applicable for your application can be found under fees and charges on the Council website Payment Options Please tick - NB: Council s preferred method of payment is internet banking Please note: your application will not be processed until the required deposit is received Internet Banking Date of Payment Cheque Payment made via Internet Banking Use the Bill Payment option for your bank, select Waikato DC Resource Consents, quote the property address of the activity, your name/client(s) name and the application number if known Payment Advice Information attached Council Offices Payment made at Council Office Receipt Number Date of Payment Invoice Payment NB your application will not be processed until payment is received A.13 NUMBER OF COPIES Please provide ONE (1) complete electronic version of the application on CD or memory stick or by emailing it to applications@waidc.govt.nz and/or TWO (2) complete hard copies. It is recommended that you separate your resource consent application/s from any other type of application you may be submitting to Council (e.g. building consent applications). In some instances a combined land use consent and subdivision is acceptable. Please discuss with a Planner prior to lodgement. Page 4 09/17
A.14 SIGNATURE Note to Applicant I/We understand that the Council may charge me/us all costs that are actually and reasonably incurred in processing this application. I/we undertake to pay all actual and reasonable processing costs incurred by the Council subject to my/our rights under sections 357B and 358 of the RMA to object to such costs. Without limiting Waikato District Council s legal rights, if any actions are necessary to recover unpaid processing costs or fees associated with the resource consent(s), including debt recovery fees, I/we agree to pay all costs of recovering those costs. If this application is made on behalf of a company, society (incorporated or unincorporated) or trust, in signing this application I/we acknowledge that: I am/we are authorised to make this application on behalf of that company, society or trust; and The company, society or trust will pay the actual and reasonable costs of processing the application, including any debt recovery costs. By signing this form, I hereby certify that, to the best of my knowledge and belief, the information given in this application is true and correct. Signed by Applicant/s Dated A signature is not required if the application is made by electronic means Note to Agent By signing this form, I hereby certify that: To the best of my knowledge and belief, the information given in this application is true and correct; I am authorised to submit this application on behalf of the applicant/s; and I have explained to the applicant/s their obligation to pay all actual and reasonable processing costs incurred by Council under Section 36 of the RMA Signed by Agent Dated Name and Role (Please print) A signature is not required if the application is made by electronic means. Please email draft conditions to me (applicant) or my agent. I also understand that the opportunity to review the draft conditions is an act of good faith by the Council and is intended to assist with identifying errors, not to encourage debate over conditions. I further understand that the Council has the right to continue processing the consent if too much time is taken with the circulation of draft conditions. By requesting draft conditions and signing below you agree to an extension of time under section 37 of the RMA for the time it takes to resolve draft conditions. Signed by Applicant/s or Agent: Dated A signature is not required if the application is made by electronic means Note to Applicant It is advisable to lodge all the consent applications that you need at the same time. If the application is lodged with the Environmental Protection Authority you must also lodge form 16A (under the RMA regulations) at the same time. You must pay the charge payable to the consent authority for the resource consent application under the RMA (if any). If your application is to the Environmental Protection Authority, you may be required to pay actual and reasonable costs incurred in dealing with this matter (see section149zd of the RMA.) Important Privacy Information The information you provided in your application (including personal information) is official information. Your application documents, the details of this consent and any ongoing communications between you and Council will be held at Council s offices and maybe accessed upon request by a third party. Access to information held by Council is administered in accordance with the Local Government Official Information and Meetings Act 1987 and the Privacy Act 1993. Your information may be disclosed in accordance with the terms of these Acts. If you have any concerns about this, please discuss with a Council Planner prior to lodging your consent Page 5 09/17
B B: Information needed for lodging your application Your application must meet the requirements of both Schedule 4 of the Resource Management Act and Chapter 19 (Waikato Section) or Chapter 52 (Franklin Section) of the relevant District Plan. To assist you with this we have developed a checklist below with Schedule 4 matters and some of the more common matters to be addressed under the District Plan. B1: Schedule 4 - General Requirements Applicant B1.1 A description of the activity Council Check B1.2 A description of the site at which the activity is to occur B1.3 The full name and address of each owner or occupier of the site B1.4 A description of any other activities that are part of the proposal to which the application relates: B1.5 A description of any other resource consents required for the proposal to which the application relates: B1.6 An assessment of the activity against the matters set out in Part 2 of the RMA B1.7 An assessment of the activity against any relevant provisions of a document referred to in section 104(1)(b) of the RMA. The assessment under B1.7 must include an assessment of the activity against: (i) (ii) (iii) any relevant objectives, policies, or rules in a document; and any relevant requirements, conditions, or permissions in any rules in a document; and any other relevant requirements in a document (for example, in a national environmental standard or other regulations). Page 6 09/17
B2: Schedule 4 Assessment of Environmental Effects Applicant Council Check An application must also include an assessment of the activity's actual or potential environmental effects on the environment that includes the information required by clause 6 and clause 7 of Schedule 4 of the RMA; A requirement to include information in the assessment of environmental effects is subject to the provisions of any policy statement or plan. Your AEE is required to include such detail as corresponds with the scale and significance of the effects that the activity may have on the environment. B2.1 If it is likely that the activity will result in any significant adverse effect on the environment, a description of any possible alternative locations or methods for undertaking the activity B2.2 An assessment of the actual or potential effect on the environment of the activity SEE APPENDIX A FOR A GUIDE ON WHAT TO INCLUDE FOR THIS SECTION. B2.3 If the activity includes the use of hazardous substances and installations, an assessment of any risks to the environment that are likely to arise from such use B2.4 If the activity includes the discharge of any contaminant, a description of (i) (ii) the nature of the discharge and the sensitivity of the receiving environment to adverse effects; and any possible alternative methods of discharge, including discharge into any other receiving environment B2.5 A description of the mitigation measures (including safeguards and contingency plans where relevant) to be undertaken to help prevent or reduce the actual or potential effect B2.6 Identification of the persons affected by the activity, any consultation undertaken, and any response to the views of any person consulted: To avoid doubt, subclause (M) obliges an applicant to report as to the persons identified as being affected by the proposal, but does not (a) oblige the applicant to consult any person; or (b) create any ground for expecting that the applicant will consult any person. B2.7 If the scale and significance of the activity's effects are such that monitoring is required, a description of how and by whom the effects will be monitored if the activity is approved: B2.8 If the activity will, or is likely to, have adverse effects that are more than minor on the exercise of a protected customary right, a description of possible alternative locations or methods for the exercise of the activity (unless written approval for the activity is given by the protected customary rights group). B2.9 Any effect on those in the neighbourhood and, where relevant, the wider community, including any social, economic, or cultural effects: Page 7 09/17
B2.10 Any physical effect on the locality, including any landscape and visual effects: B2.11 Any effect on ecosystems, including effects on plants or animals and any physical disturbance of habitats in the vicinity B2.12 Any effect on natural and physical resources having aesthetic, recreational, scientific, historical, spiritual, or cultural value, or other special value, for present or future generations B2.13 Any discharge of contaminants into the environment, including any unreasonable emission of noise, and options for the treatment and disposal of contaminants: B2.14 Any risk to the neighbourhood, the wider community, or the environment through natural hazards or the use of hazardous substances or hazardous installations. B3: Schedule 4 - Additional information required for subdivision consent Applicant Council Check An application for a subdivision consent must also include information that adequately defines the following: B3.1 B3.2 B3.3 B3.4 B3.5 B3.6 The position of all new boundaries: The areas of all new allotments, unless the subdivision involves a cross lease, company lease, or unit plan: The locations and areas of new reserves to be created, including any esplanade reserves and esplanade strips: The locations and areas of any part of the bed of a river or lake to be vested in a territorial authority under section 237A: The locations and areas of any land within the coastal marine area (which is to become part of the common marine and coastal area under section 237A): The locations and areas of land to be set aside as new roads. Page 8 09/17
B4: Plans Checklist Applicant B4.1 Current copy of Certificate(s) of Title (less than 2 months old) including diagram page, copies of any encumbrances, easements etc, and copies of all legal instruments (e.g. consent notices and covenants) affecting the subdivision and any revocations or cancellations required. Council Check B4.2 B4.3 A Locality Plan showing the location of the site in the context of the surrounding area. A Scheme Plan (to a scale of either 1:100 or1:200 for sites larger than 1500m 2 ) showing: (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r) (s) A north arrow and the scale. All proposed and existing easements (including private). Any amalgamations. The location of existing and proposed site boundaries. Stages (if applicable). Location of fence positions relative to boundaries. Existing and proposed dimensions and sizes of lots. Legal and physical roads, accessways, and rights of way including grades All existing buildings and structures, their distance to existing and proposed boundaries (measured from the building footing), and the position of any eaves in relation to rights of way/accessways Site coverage calculations. Existing and proposed access points (entrances) and sight distances. Building platforms for all allotments including shape factors. On-site manoeuvring, and existing and proposed vehicle parking spaces (where required). Significant trees, bush stands, protected trees (including the extent of their drip line), covenanted areas, or other features Archaeological and/or cultural heritage sites. Water bodies. Existing high voltage electricity lines and gas lines. Areas of likely or confirmed contamination. Areas subject to land hazards e.g. unstable slopes, areas of flooding, peat soils, fill. Page 9 09/17
B4.3 (t) Location of any proposed reserves and their appropriate classification i.e. local purpose reserve. This requires evidence of consultation with the appropriate Council Property or Assets team. A Services and Engineering Plan showing: (a) (b) (c) (d) (e) (f) (g) (h) Location of existing and proposed service connections (including connections to reticulated services) and/or systems i.e. water, wastewater, stormwater and any easements. On-site effluent treatment and disposal areas and fields. Details of proposed stormwater management appropriate to the scale and nature of the subdivision, e.g.: Pipework and on-site stormwater systems. Open drains (including ownership). Effect of subdivision and end use on existing overland flow paths. Contours showing existing and finished ground level (levels to Moturiki) at 0.5m intervals within the subdivision, and at 2m intervals on adjoining properties (to enable effects on those properties to be assessed). A separate plan may be needed to show these details. Areas of proposed or existing fill or excavation. (i) (j) (k) Any proposed retaining walls or embankments (note if retaining wall over 1m is proposed, a typical cross section is required. In urban areas, details of the percentage of proposed and existing impermeable and permeable areas. Natural hazards e.g. unstable slopes, areas of flooding, ponding, peat soils. B4.4 Elevations (to scale) of buildings which are affected by the location of new boundaries (e.g. where height in relation to boundary rules apply) Page 10 09/17
B5. Reports/Technical Information Checklist Applicant The following reports may need to be provided: B5.1 Site History Checklist for Contaminated Land Council Check B5.2 Where it has been identified that a HAIL activity is being undertaken, has been undertaken or is more likely than not to have been undertaken on the land, the following reports may also be required: (i) Preliminary Site Investigation Report (PSI) (ii) Detailed Site Investigation Report (SIR) (iii) Site Remediation Action Plan (RAP) (iv) Site Validation Report (SVR) (v) Ongoing Monitoring and Management Plan (MMP) All reports must be prepared in accordance with the current edition of the Ministry for the Environments Contaminated Land Management Guidelines No. 1. Reporting on Contaminated sites in New Zealand. B5.3 Geotechnical report from a suitably qualified and experienced geo professional identifying any requirements for site specific foundation design, wastewater, storm water disposal, cleanfill and/or earthworks. Including a risk assessment to address section 106 of the RMA. B5.4 A land use capability assessment (soil report) for all Transfer Lot subdivisions (covering both donor and receiver properties) and all subdivision where rule 25.5 (d) or (e) of the Waikato District Plan (Waikato Section) may apply. B5.5 A traffic impact assessment (TIA), if the subdivision may result in significant changes to traffic movements on nearby roads. B5.6 A landscape assessment report from a suitably qualified person to show how visual effects of the proposed activity can be mitigated. B5.7 A report from a suitably qualified person if the proposal affects a tree, cultural or historical heritage protected under the relevant District Plan. B5.8 An ecological report from a suitably qualified person if the subdivision includes areas of native bush or wetland that may be adversely affected by the subdivisions. Such a report will be required if the subdivision includes conservation lots. B5.9 An archaeology assessment from a suitably qualified archaeologist if there are any known or suspected archaeological sites that may be adversely affected by the proposed subdivision. B5.10 An Urban Design assessment from a suitably qualified urban designer. B5.11 Comments (and, where appropriate, design) regarding proposed servicing. B5.12 On-site water supply proposals (including location of tanks and bores). B5.13 Building platforms for all allotments including shape factor. B5.14 A report from a suitably qualified person if the application requires site specific design for building works, wastewater, stormwater disposal, or earthworks. B5.15 Minimum floor levels (if area is known to flood or pond regularly). Page 11 09/17
B6: Consultation Checklist B6.1 You may wish to provide the following to help avoid potential delays. Evidence of consultation from these agencies in the following situations: (a) New Zealand Transport Agency, if the subdivision gains access from or otherwise affects, a State Highway. (b) Transpower New Zealand, if the subdivision contains high voltage lines (110kV or greater). Applicant Council Check (c) Waikato Regional Council (WRC), if regional resource consents are required, the subdivision is located within a WRC drainage district, or there is a potential effect on WRC drains or other assets. (d) Heritage NZ, if the subdivision contains a registered historic site. (e) The Department of Conservation, if the subdivision contains or may contain, an area or item of interest to that department. (f) (g) The relevant Council, if the subdivision adjoins another Council boundary, or otherwise affects another Council s area. Kiwi Rail (NZ Rail) if the land is adjacent to or requires access over Kiwi Rail s railway line. (h) Power and telecommunication companies regarding the feasibility of providing these services to the proposed lots. B6.2 (i) The gas companies if a gas pipeline traverses the property. Evidence of consultation with local Iwi/Hapu groups, and Waikato - Tainui will be required if the application may affect the Waikato River catchment or other matters identified in an Environmental Management Plan that has been served on Council. Page 12 09/17
Appendix A: An Assessment of the Actual or Potential Environmental Effects Guide only The effects listed below is not an exhaustive list and is only intended as a guide to provide a starting point for providing an assessment of the actual or potential effect on the environment of the activity. Effects on the character/amenity values of the area - How will the character/amenity values of the area be maintained as result of the proposal? Or - How will the proposal change the character/amenity values of the area? How will these effects be mitigated? Visual amenity effects - Is any existing fencing and/or vegetation proposed to be removed as result of the proposal? - Is there any fencing and/or landscaping proposed to mitigate any visual amenity effects? Streetscape effects - How will the development appear when viewed from the road? - Is the proposal consistent with the appearance of other development/building in the area when viewed from the road? - What (if any) measures are proposed to mitigate streetscape effects? Building effects - Will the proposal result in any dominance effects? - Will the proposal result in any shading effects? - Will the proposal result in any sunlight effects? - Will the proposal result in any privacy effects? - What (if any) measures are proposed to mitigate building effects? Traffic effects - What effect will the proposal have on the roading network? - What is the anticipated number of vehicle movements as result of activity? - Is proposal utilising an existing access or proposing new access? - Is their sufficient parking/loading/manoeuvring on site? - What (if any) measures are proposed to mitigate traffic effects? Noise effects - Duration and types of construction noise - Anticipated noise effects as result of proposal being established - What (if any) measures are proposed to mitigate noise effects? Dust effects - What (if any) measures are proposed to avoid, remedy and mitigate dust effects? Odour effects - What (if any) measures are proposed to avoid, remedy and mitigate odour effects? Page 13 08/16
Earthwork effects - Duration of activity - Hours of operation (e.g. Monday to Friday between 7.30am and 5pm) - What erosion and sediment controls are going to be installed on site - Location of any cut material being taken off site - Number of traffic movements associated with earthworks including machinery, staff vehicles and transportation of material off site. - Timeframes for revegetation of site post earthworks Servicing effects - How is stormwater proposed to be managed? - How is wastewater proposed to be managed? - Details of proposed water supply - Is the proposal utilising existing power & telephone connections? To find an example of an Assessment of Environmental Effects (AEE), please refer to Appendix 2 of Ministry for the Environment s A Guide to Preparing a Basic Assessment of Environmental Effects at https://www.mfe.govt.nz/sites/default/files/media/rma/aee-guide-aug06.pdf Page 14 08/16