Daytime phone: Mobile:

Transcription

1 Application No: Application for Services Consent Water, Sewer, Stormwater, Channel Crossing, Vehicle Access, Occupation of Road Reserve (including all private underground and/or aboveground services within Road Reserve) SECTION 1 CONTACT DETAILS Applicant Details Name: Company: Postal Address: Application does not constitute Approval (only required if different from Applicant) Landowner / Purchaser / Client Details Name: Company: Postal Address: Daytime phone: Mobile: Daytime phone: Mobile: SECTION 2 DETAILS OF PROPERTY REQUIRING SERVICES Street Address: Town: Valuation No.: Legal Description: (Proposed Lot ) Does this application occur because of a: Building Consent? If yes, advise Building Consent No. Subdivision / Land Use Consent? If yes, advise Resource Consent No. If Consent is intended, but not yet lodged, please state Consent No. as Pending and include detailed plan of proposal (including intended property boundaries / land area). Activity on site Residential (Domestic Use only) Residential (Home Business) Specify Type: Commercial Specify Type: Industrial Specify Type: Farming Activities Specify Type: SECTION 3 DEMOLITION REQUIRING EITHER TEMPORARY OR PERMANENT DISCONNECTIONS Temporary Disconnections are permitted when the lateral is to be re-used within 24 months. Water Temporary Disconnection (to be capped inside boundary) Effective from Permanent Disconnection (to be capped at main) Effective from Sewer Temporary Disconnection (to be capped inside boundary) Effective from Permanent Disconnection (to be capped at main) Effective from Stormwater Temporary Disconnection (to be capped inside boundary) Effective from Permanent Disconnection (to be capped at main) Effective from Vehicle Access Removal of Redundant Vehicle Access Effective from Application fees are not required if application is solely for disconnections.

2 SECTION 4 URBAN WATER SUPPLY Timaru / Temuka / Geraldine / Pleasant Point / Peel Forest / Winchester Connect to existing Lateral Existing Pipe Size: mm Upgrade / Relocate existing Connection Proposed Pipe Size: mm New Connection to existing Public Water Main Proposed Pipe Size: mm Is this a dedicated Fire Sprinkler Connection? Dispensation from Storage (Pleasant Point Water Supply only) Application fees are not required if application is solely for Storage Dispensation. SECTION 5 RURAL WATER SUPPLY Downlands (incl. Pareora & St Andrews) / Te Moana / Seadown / Orari / Beautiful Valley / Rangitata-Orari New Connection: Redistribution of current units Additional allocation of units Temporary Increase: Starting: / / Finishing / / Relocation of Tank to different position Replacement of Tank in same position Application fees are not required if application is solely Replacement of a Tank in the same position. Relocation of Rangitata-Orari Water Race SECTION 6 SEWER Connect to existing Sewer Lateral Existing Pipe Size: mm If Required: Provide Proof of Easement with the application Upgrade / Relocate existing Connection Proposed Pipe Size: mm New Connection to existing Public Sewer Main Proposed Pipe Size: mm New Connection to existing Public Sewer Manhole Proposed Pipe Size: mm Installation of new Public Sewer Manhole Connection to Arowhenua Sewer Network (pressurized network) SECTION 7 STORMWATER Discharge rates must not exceed pre-development levels. Any excess stormwater must be attenuated on site prior to discharge. Connections to sumps are not permitted. Connect to existing Stormwater Lateral Existing Pipe Size: mm If Required: Provide Proof of Easement with the application Upgrade / Relocate existing Connection Proposed Pipe Size: mm New Connection to existing Public Stormwater Main Proposed Pipe Size: mm New Connection to existing Public Stormwater Manhole Proposed Pipe Size: mm Installation of new Public Stormwater Manhole Existing No. of Units: Additional Units required: Total No. of Units: Domestic Allocation: No. of Pans No. of Urinals New Connection to Kerb and Channel Proposed Pipe Size: mm Application fees are not required if application is solely for relocation of existing stormwater outlet or sump due to installation of a channel crossing. Does the activity on the site appear on the Canterbury Land and Water Regional Plan s Schedule 3 Hazardous Industries and Activities List? (refer to for details) If YES: Provide details of stormwater treatment / attenuation with application Does the site involve the use, storage or disposal of hazardous substances as defined in the Canterbury Land and Water Regional Plan s Schedule 4 Hazardous Substances? (refer to for details) If YES: Provide details of stormwater treatment / attenuation with application Refer to attached Information Sheet and/or for further information.

3 SECTION 8 VEHICLE CROSSING Kerb & Channel (Urban) Application fees are not required if application is solely for installation of a channel crossing. New Crossing Total Length metres Extension to existing crossing Total length (including extension) metres The existing crossing is to be removed Length metres The existing crossing is to be kept? Type of Crossing Required Residential Asphaltic Concrete / Concrete Commercial Asphaltic Concrete / Concrete Industrial Concrete / Concrete (Heavy Duty) SECTION 9 VEHICLE ACCESS Non Kerb & Channel (Rural) Application fees are not required if application is solely for installation of a vehicle access. A new vehicle access is to be installed Driveway width metres The existing vehicle access is to be upgraded Driveway width metres Proposed drainage pipe details (if required): Pipe Type (eg upvc, mpvc, steel, concrete, etc) Pipe Length (across Driveway) metres Pipe Diameter: mm Any required drainage pipe should extend a minimum of 1.0 m either side of the access formation. Does the vehicle access cross a Council water race Does the vehicle access cross a privately owned irrigation race If Yes: Provide proof of approval from the relevant Irrigation Race Owner that crossing of the irrigation race is permitted with the application. SECTION 10 OCCUPATION OF ROAD RESERVE (All private services) All applications to install private services within the road reserve must supply written authority from existing road users with their application. Provide letters of approval from the following organisations regarding this proposal with your application: Environment Canterbury (Required when proposal involves a natural waterway) Private Irrigation Co (Required when proposal involves crossing a privately owned Irrigation Scheme i.e. Kakahu, Levels Plain Irrigation, Opuha Water Ltd, Rangitata Water Irrigation) Producer Statement (Required when proposal involves installation of Culvert/Structure greater than 1.0m in height) In addition statements from other relevant existing road users may also be required other than those listed above. Refer to attached Information Sheet and/or for further information. Road frontage: Underground: (to be laid at a minimum depth of 900mm) Pipe Type Pipe Size Construction Method eg upvc, mpvc, e.g. thrust boring, steel, concrete, trenching, mole plough Stock Underpass Specific Design details to be provided Access / Entranceway culverts greater than 1.0m mm Pipeline (to carry ) mm Effluent pipe mm Private electrical cables mm Private telecommunication cables mm Other: All road crossings shall be trenchless installation unless specific written dispensation is granted.

4 Above Ground Structure Material / Type e.g. Post and wire, netting, Construction Method Box Culvert, Occupation of unformed road Road Encroachment Fence Stock Crossing Fences / Gates Structure on Road Reserve: Other: Council may permit the planting of trees and shrubs on roadsides where such planting will enhance the environment for the General public. Shelter belt planting is not permitted on the road reserve. Planting of Trees and Shrubs on Road Reserve Detailed diagram showing proposed planting layout, site orientation and relative positions of relevant services and features, including list detailing plant names, estimated height at maturity and proposed distances from both road boundary and edge of carriageway to be provided with application SECTION 11 SUMMARY Have you selected all services required? The Services Consent will be issued to your mailing address with Conditions of Approval. Incomplete applications will be returned for completion and re-submission. Attachments Required (if applicable) Plan Attached Application Fee Payable Sections 1 and 2 have been fully completed N/A Section 3 Demolitions / Disconnections CCTV Footage if temporary N/A disconnections Section 4 Urban Water Proof of Easement (if required) Section 5 Rural Water Proof of Easement (if required) Section 6 Sewer Copy of Tradewaste Consent (if required) Section 7 Stormwater Proof of Easement (if required) Details of stormwater treatment / attenuation Stormwater Device Information Form (if required) Section 8 Channel Crossing N/A Section 9 Vehicle Access N/A Section 10 Occupation of Road Reserve Written Approval from: Environment Canterbury (if required) Attach Plan of Proposal showing: Private Irrigation Company (if required) Property boundaries, roads, buildings, etc Proposed location of water, sewer and stormwater Producer Statement (if required) connections to Council infrastructure Proposed position of channel crossing / vehicle access. Include distances and dimensions to boundaries. In rural areas, please give approximate distance to nearest intersection. I / We hereby agree to pay the Timaru District Council all fees and charges as are from time to time requested; and I / We will abide by all the bylaws and regulations which affect the service applied for. Signed: Date: FOR OFFICE USE ONLY R # W/O # Application Fee $ Services within Sections 4, 5, 6, 7 or a mix 12 W Date Received Services solely within Sections 8, 9 and W Receipt No.

5 PLAN OF PROPOSAL