Application for
Trade Waste Discharge Consent
(Wastewater Authority)
Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
Trade Name
or; Owner
of premises
(if different)
Phone
Mobile
Fax
Address
1. Applicant Details
This Application Relates to: (please tick appropriate box)
Proposed new trade waste discharge
Renewal of a consent
Location of point or place of discharge:
An existing discharge for which no consent exists:
Location of point or place of discharge:
Variation to an existing consent
Consent Number:
Consent Number:
Nature of variation:
Term of Consent Sought:
1 year 2 years 5 years Other (specify)
From (Date):
Ofce Use Only:
Trade Waste Number:
Application Received
and checked by:
Permitted Controlled
Conditional
Property Valuation No:
Building Consent No:
Trade Waste Consent:
Received:
Checked:
Approved:
Number:
Application Fee:
Receipt Number:
713 08 270 Benneydale
714 08 270 Piopio
711 08 270 Te Kuiti
Exempt
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233927 : 003/004 : TWD
Application for
Trade Waste Discharge
(Wastewater Authority)
Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
Attach additional sheets if required.
Is the premises already connected to the public sewer?
2. Declaration
Description of main Trade Activity:
Declaration:
1. I am duly authorised to make this application.
2. I believe that all the information contained in this application is true and correct.
Signature:
Full Name:
Position:
Date:
Yes No
Size : (note minimum size is 100mm)
Size:
No:
No:
Diagram for Connection Location: (Use separate sheet if required)
Show distances from boundaries, kerbs and buildings.
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click to sign
signature
click to edit
Application for
Trade Waste Discharge
(Wastewater Authority)
Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
3. Description of Trade Waste and Premises
General Premises (please print clearly)
Trade Name and Street Address:
Phone: Fax:
Name and Address of Owner/Occupier:
Total Volume of Waste:
Average daily volume:
m
3
Maximum volume in any 8 hour period: m
3
Maximum daily volume: m
3
Maximum ow: Litres p/second
Seasonal uctuation (range): m
3
Source of water used on premises is:
(a) from
Council,
m
3
/ working day
(b) from other sources (state source)
,
m
3
/ working day
The waste do / do not (delete as applicable) contain condensing water or stormwater and the lay-
out of drains on the premises is / is not (delete as applicable) such as to reasonably exclude the
possibility of such becoming mixed with trade wastes.
It is / is not (delete as applicable) proposed that domestic wastewater and trade waste should be
discharged at the same point of discharge.
The proposed method for ow measurement is:
A permanent installation of suitable ow measuring equipment
Based on water usage as measured by meter
Other (please specify)
List any substances contained in Schedule 1A or 1B of the Trade Waste Bylaw which are
stored, used or generated on the premises:
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233927 : 003/004 : TWD
Application for
Trade Waste Discharge
(Wastewater Authority)
Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
3. Description of Trade Waste and Premises continued
Describe mitigation measures employed to prevent accidental spillage of these substances from
entering the public sewer or stormwater system:
Please attach site plans of the premises which clearly show the location of the following:
Process areas Flow measuring devices Trade waste drains
Domestic waste Emergency spill devices Open areas draining to water
drains
Stormwater drains emergency
spill containment
Other (specify)
Main Trade Waste Pre-treatment Systems
Screens pH control Flow balance
Chemical treatment Biological treatment
Please attach detailed drawings and descriptions for the following (as appropriate):
Pre-treatment systems Flow measuring devices Emergency spill containment
Sampling points Method of ow meter
calibration
Open areas draining to water
drains.
An independent waste audit of the premises has / has not (delete as applicable) been carried out
by:
A Discharge Management Plan is / is not (delete as applicable) attached.
Please specify the premises health and safety requirements and security arrangements
for Wastewater Authority Staff entering the premises:
Process
(please use a separate sheet for each process and attached copies of typical analyses for wastewa-
ter from each separate process).
Process name and description:
Type of product processed:
Volume of Wastewater:
Average daily volume: m
3
Maximum daily volume: m
3
Maximum ow: Litres p/second
If batch discharges:
Quantity: m
3
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233927 : 003/004 : TWD
Application for
Trade Waste Discharge
(Wastewater Authority)
Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
3. Description of Trade Waste and Premises continued
Frequency:
m
3
Rate of discharge: Litres p/second
The wastewater contains the following characteristics which when mixed with other
wastewaters and discharged from the premises, are near or in excess of the limits
stipulated in Schedule 1B of the Trade Waste Bylaw:
(Note: the characteristics in Table 1A.2
and Table 1A.3 have a limit of zero
unless approval for that particular
characteristic is applied for).
Value or Concentration
Form Process At Point of Discharge
Typical Maximum Typical Maximum
The following steps have been/ will be (delete as applicable) taken to improve the trade
process as part of a strategy of cleaner production:
Date of Improvements:
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