Discharge Permit To discharge to land andor water from by vqb86251

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									                                                                             Office use only

                                                                             Consent number:_____________________
                                                                             Application number:__________________
                                                                             Date received:________________________
                                                                             Document# __________________________
                                                                             New/Renewal




                        Resource Consent Application
                            (For a consent to discharge contaminants into the environment
                  pursuant to sections 15(1)(a), 15(1)(b) and 88 of the Resource Management Act 1991)



                                         Discharge Permit
              To discharge to land and/or water from a farm dairy

Important: Please Read carefully and complete the form

This form
All applicants need to respond to all of the questions. If a particular section is not applicable to
your application, please say so; do not leave the question blank. Questions may be answered in
attached documentation if it is more convenient or insufficient space is provided on the form. If
that is done, state specifically on the application form where the answer can be found (include
page numbers if referring to a separate report).
If you have any questions relating to completion of this application form, please contact the
Consents Department, Taranaki Regional Council on telephone (06)765-7127 or email
consents@trc.govt.nz.

Cost
     •     The actual and reasonable cost of processing the application is charged to the applicant.
           The minimum charge will be $450 plus GST (per consent application) but in some cases the
           final cost may be higher. The cost primarily depends on the time spent by Council officers
           in processing the application, and will be minimised if the application is complete and
           accurate.
     •     Please do not send any money when making application, an invoice for the cost will be sent
           when the application process has been completed.
     •     If you require your purchase order number to be
           referenced for invoicing, please note it in here.

Ensure you sign the completed form page 6.
Mail or Email the completed form to:
Mail: Taranaki Regional Council, Private Bag 713, Stratford 4352.
      Attention: Consents Administration Officer

Email: consents@trc.govt.nz


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1          Applicant Details

1.1     Applicant’s full name:
        Please provide the name of company, or full name of person(s)to whom consent is to be issued. If a
        Trust, please provide full names of the Trustees.
        Full name: ________________________________________________________________________
         _________________________________________________________________________________
        If Trust/Partnership: Full names of Trustees/Partners: _________________________________________
         _________________________________________________________________________________

1.2     Applicant’s Postal Address                                    Phone Pvt. _________________________
         ___________________________________________                  Bus. _______________________________
         ___________________________________________                  Mob. ______________________________
         ___________________________________________                  Fax. _______________________________
         ___________________________________________                  E-mail _____________________________

1.3     Address for service (if different from above, i.e. consultant, lawyer, or other person handling application)
        Contact Person _____________________________                  Bus. _______________________________
         ___________________________________________                  Mob. ______________________________
         ___________________________________________                  Fax. _______________________________
         ___________________________________________                  E-mail _____________________________



2          Site Details
2.1     Name and address of land owner or occupier at discharge site (if different from 1.1)
        __________________________________________________________________________________
         _________________________________________________________________________________

2.2     Location of activity (Street Address)
         _________________________________________________________________________________
         _________________________________________________________________________________

        NZTM Map Co-ordinates at point of discharge ________________ E                        _______________ N
        Map co-ordinates can be found at http://xplorer.xgl.co.nz/taranaki/region

2.3     Legal description of property at site of activity (refer to land title or rates notice)
         _________________________________________________________________________________
         _________________________________________________________________________________

2.4     What is the name of the river or stream where discharge is entering or if the discharge is to
        land, the closest river or stream to the discharge


2.5     What is your Dairy supply number: __________________



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2.6     Who do you supply milk to:             Fonterra                              Other

        If other, please supply contact details: ________________________________________________
         _________________________________________________________________________________



3          Details of the Activity

3.1     If you have discussed this proposal with a council staff member, please give the person’s name here:
          __________________________________________________________________________

3.2     What is the discharge from:         Cows                  Goats


3.3     Where is the discharge going to: River/Stream/Lake                    Land           Both Land and Water

3.4     What is the method of discharge:           Oxidation ponds to water
                                                   Oxidation pond & spray irrigation to land
                                                   Oxidation pond & honeywagon to land
                                                   Spray irrigation to land
                                                   Holding ponds & spray irrigation to land
                                                   Honeywagon to land
                                                   Holding ponds & honeywagon to land
                                                   Other ________________________________


3.5     What kind of Tertiary Treatment is available:
        None                          Wetland                      Constructed Drain

3.6     What is the maximum number of cows/goats milked: ____________________

3.7     The application must include an aerial photograph or clear map showing the location of:

                  •   Cowshed
                  •   Ponds
                  •   Discharge Point
                  •   Irrigation area
                  •   Local roads
                  •   North point
                  •   Boundaries and other relevant features.

                  An aerial photograph of the site can be obtained free of charge from Taranaki Regional Explorer;
                  http://xplorer.xgl.co.nz/taranaki/region/. Alternatively, contact the Consents Department
                  at the Council and request an aerial photograph to be provided.

            Aerial photograph (or map) included

            Or map drawn on page 7


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4           Assessment of Environmental Effects
        In accordance with the Resource Management Act 1991, all applications for discharge of
        contaminants into the environment must provide the environmental information requested
        below, to enable the application to be processed.

        Please complete the section applicable to you [4.1 or 4.2 or both]. This information is required
        to determine under which rule of the Council’s Regional Fresh Water Plan your activity can
        be considered. A Council officer will undertake an assessment of these aspects when the
        application in processed.

 4.1 Discharge to water - To the best of your knowledge will the following conditions be complied with?

        A dilution rate of 1:100 will be achieved at all times at the point of discharge         yes   no        unsure


        At all times you will adopt the best practicable option to prevent                       yes   no        unsure
        or minimise adverse effects of discharge on any waterbody


 4.2 Discharge to land - To the best of your knowledge will the following conditions be complied with?

        The discharge will not cause any contaminant to enter surface water                      yes   no            unsure


        The discharge will not occur within 150 metres of any dwelling                           yes   no            unsure


        The discharge will not occur within 50 metres of any water supply                        yes   no            unsure
        bore, well or spring

        The discharge will not occur within 25 metres of any surface water body                  yes   no            unsure


        At all times you will adopt the best practicable option to prevent or                    yes   no            unsure
        minimise adverse effects of discharge on environment

        The nitrogen application rate will not exceed 200 kg /ha/year                            yes   no            unsure
        [see note – Cow numbers/Area required table below]


      In order to achieve 200 kg N/ha/year, the following guidelines are provided for farm dairy
      discharges to land:

                  Cow numbers milked                             Irrigation area required [hectares]
                       100                                                3.0
                       150                                                4.5
                          200                                            6.0
                          250                                            7.5
                          300                                            9.0
                          350                                           10.5
                          400                                           12.0
                          450                                           13.5
                          500                                           15.0

        If you answered no or unsure to any of the previous questions please answer 4.3, otherwise
        please go to section 5



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                                                            5




4.3     What, if any, actual or potential effects will this activity have on the environment?

                  There will be a significant odour generated                     No    Sometimes             Yes

                  There will be a significant effect on soil and/or               No    Sometimes             Yes
                  groundwater quality

                  There will be a significant decrease in surface water quality   No    Sometimes             Yes

                  Other [specify] ______________________                          No    Sometimes             Yes

        If Yes, there are likely to be effects, please describe further below
         _________________________________________________________________________________
         _________________________________________________________________________________
         _________________________________________________________________________________
         _________________________________________________________________________________


5          Consultation / Affected Parties

5.1     Please list the persons that are likely to be directly affected by the discharge [usually your
        downstream neighbours for discharge to a water body and neighbours who are close to the discharge
        area for a discharge to land].
        Name                             Address                                       Phone
         _________________________________________________________________________________
         _________________________________________________________________________________
         _________________________________________________________________________________

           OR

          Nobody affected

5.2     Detail the consultation undertaken with people listed in 5.1 above and their views. Attach
        correspondence if appropriate. The consultation undertaken and the information provided is
        to aid the Council in determining who may be adversely affected by the proposal.
         _________________________________________________________________________________
         _________________________________________________________________________________
         _________________________________________________________________________________
         _________________________________________________________________________________
         _________________________________________________________________________________

           OR

          No consultation undertaken

5.3     To your knowledge, is this activity likely to impact on Maori spiritual or cultural values?

                  Yes             No




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        If YES please describe below
         _________________________________________________________________________________
         _________________________________________________________________________________




6          Renewal applications

        Please complete this section only if your application is to renew an existing consent

6.1     I agree to the Taranaki Regional Council taking more than 20 working days to complete
        processing this application, provided processing is completed before my existing consent
        expires?

                  Yes                  No


6.2     My existing consent for this activity is to be surrendered when this application is granted?
        [If it has not expired]

                  Yes                  No




                        Application is hereby made for the consent(s) detailed in this form

        Signature of applicant or authorised agent: ___________________________

        Name: ___________________________________                          Date:_____________
        Please print full name of person who signed above.




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Map showing the location of cowshed, ponds, discharge point, irrigation area, local roads, north
point, boundaries and other relevant features.




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