Fillable Application to Drill a Bore (Hawkes Bay Regional Council New Zealand)

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Application to Drill a Bore (Hawkes Bay Regional Council New Zealand)

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Country of origin: NEW-ZEALAND
File type: PDF

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Application to Drill a Bore
This application is to drill a bore only, it is not an application to take water, if you plan to take water
for any purpose other than an individuals, domestic and or stock water supply you will need to
apply for a resource consent.
I
MPORTANT: PLEASE READ
1. If you have any questions please contact Council’s Consents Advisor, on 06 833 8090, or
email: ConsentAdvisor@hbrc.govt.nz
2. Your deposit must accompany your application.
3. For payments via online banking, please email the Consent Advisor with the applicant’s
name (from section 1 of this form), postal address and ask for a payment reference,
Account BNZ - 02 0700 030 2819 00
4. Maps, map reference, legal descriptions and existing consent information can be found
using Councils online map portal at hbrc.govt.nz (bottom of home page, consent maps)
5. Post, email or deliver the application and the required deposit to: Consent Advisor, Hawke’s
Bay Regional Council, Private Bag 6006, Napier 4142. 159 Dalton Street, Napier or via
email: ConsentAdvisor@hbrc.govt.nz
6. Ensure you have signed the form and include/arranged for payment of the deposit
before submitting.
Drill up to Two Bores
Deposit of $575.00 for each bore + Actual and Reasonable costs
Drill Three or more Bores
Deposit of $1150.00 + Actual and Reasonable costs
Deposits are Inclusive of GST (GST # 051 227 875)
Council does not invoice for this fee.
Office Use
Bore No. _____________
Charge No. _____________
NAV No. _____________
APP No. _____________
APPLICANT DETAILS
1. Who is this consent to be issued to? - Full legal name of Applicant(s) are required. For
Trusts/Estates/Partnerships, the name of the Trust/Estate/Partnership and full legal names
of all trustees/executors/partners are required.
Private Person(s) Company: Trust: Partnership:
Company Name ______________________________________________________________
Company Number _____________________________________________________________
Trust/Partnership Name ________________________________________________________
The full legal names (first, middle & last names) and contact details for ALL of the Private
Person(s)/Trustee/Partners applying:
Applicant 1 __________________________________________________________________
Postal Address _______________________________________________________________
Cell Phone _____________________________ Home/Work Phone ____________________
Email _______________________________________________________________________
Applicant 2 (if applicable) _______________________________________________________
Postal Address _______________________________________________________________
Cell Phone _____________________________ Home/Work Phone ____________________
Email _______________________________________________________________________
Applicant 3 (if applicable) _______________________________________________________
Postal Address _______________________________________________________________
Cell Phone _____________________________ Home/Work Phone ____________________
Email _______________________________________________________________________
Applicant 4 (if applicable) _______________________________________________________
Postal Address _______________________________________________________________
Cell Phone _____________________________ Home/Work Phone ____________________
Email _______________________________________________________________________
Applicant 5 (if applicable) _______________________________________________________
Postal Address _______________________________________________________________
Cell Phone _____________________________ Home/Work Phone ____________________
Email _______________________________________________________________________
NB* For Trusts & Partnerships, the full legal names and contact details of all trustees/partners are
required above. If more than five persons please attach separately.
Main Contact Person
2. Address for Service
_________________________________________ Business/Home: _______________
_________________________________________ Mobile: ______________________
_________________________________________ E-mail: _______________________
Post Code: _______________________________ ____________________________
If an email address is provided, this will be the default address for service of all processing
documents
Who is the final invoice (bill) to be sent to? The Address for service The Applicant
SITE DETAILS
3. Property Owner’s Name & Address
If same as Applicant (skip to next question)
_________________________________________ Business/Home: _______________
_________________________________________ Mobile: _______________________
_________________________________________ E-mail: _______________________
Post Code: _____________________________ ____________________________
4. Location of Activity (Street Address of property)
________________________________________________________________________
Map Reference (GPS, Easting and Northing of proposed location required in NZTM)
Easting: ______________________________ Northing: _______________________
5. Do you have any existing resource consents on this property? Yes No
If yes, consent/Auth no. ____________________________________________________
6. Legal Description of Property (Lot and DP number from rates notice, or valuation notice)
______________________________________________________________________
7. Legal Description of Property water is to be used on (if different from above)
______________________________________________________________________
8. Are you the owner of the property? Yes No
If no, have you discussed the application with the property owner(s)? Yes No
Have the owner(s) given their approval for the application? Yes No
9. Well Driller:
Baylis Bros Limited: Honnor Drilling Limited:
Other: _______________________________________ Business/Home: _______________
_______________________________________ Mobile: _______________________
_______________________________________ E-mail: _______________________
Post Code: ___________________________________ ____________________________
BORE DETAILS
10. Is this application to alter an existing bore:
No: (move to next question)
Yes:
a) What is the well number of the existing bore?
b) What is the diameter ? mm
c) What alterations are proposed?
11. The bore will be constructed to ensure that it does not allow access to more than
one aquifer? Yes No
12. The bore will be constructed to ensure that it does not allow leakage from the
ground surface into ground water? Yes No
13. Bore details
a) Proposed bore diameter: _____________mm
b) Proposed depth: ____________________m
14. Primary Land Use: (e.g. dairying, cropping, pastoral farming, orchard, lifestyle, vineyard)
______________________________________________________________________
15. Proposed use of bore:
Stock water: Ground water monitoring:
Domestic: Number of properties bore will service: ________
Irrigation: Proposed area of irrigation: _________________hectares
Other use: Specify: ________________________________
16. There are no bores within 500 metres of the proposed bore: Yes No
17. List the three bores, closer than 500metres that are not on your property, nearest to
the proposed bore, and mark them on the site plan for attachment.
Council well information can be found at hbrc.govt.nz – Online Maps.
Bore No: Diameter: Unused: Irrigation: Domestic: Stock:
________ _____mm
________ _____mm
________ _____mm
18. Give the name of the nearest surface water body (river, stream, lake, etc)
And approximate distance (m) from the bore.
__________________________________________________________________
19. If known, will the bore be fitted with a surface or submersible
pump.________________
20. For multiple Wells please attach a clear site plan, showing the proposed location of
each bore, attach extra information detailing GPS coordinates, depth and diameter per
bore.
Please provide a site map showing:
The location of the property showing road names
The position of any existing bores on the property
The proposed bore site clearly marked
Any waterways within 500m that normally flow during summer
A Google map of the property showing street names is acceptable
Costs of Debt Recovery and Information
It is agreed by the consent holder that it is a term of the granting of this resource consent that all costs incurred
by the Council for, and incidental to, the collection of any debt relating to this resource consent, whether as an
individual or as a member of a group, and charged under s36 of the Resource Management Act, shall be borne
by the consent holder as a debt due to the Council, and for that purpose the Council reserves the right to produce
this document in support of any claim for recovery.
Please note that all information collected and held by the Hawke’s Bay Regional Council is public information
under section 2 of the Local Government Official Information and Meetings Act 1987 (LGOIMA), as such any
and all information may be requested by a third party. Access to information held by Council is administered in
accordance with LOGIMA and the Privacy Act 1993. If you have any concerns over the disclosure of any aspect
of your consent or personal/property details, either in person or electronically, you must raise your concern in
writing to The Council and detail what “good reason” you believe there is for withholding information pursuant to
section 7 of LGOIMA. Council will assess your request and advise you of any decision made. Please note that
no person has the right of veto over any information held by Council. Council intends for all information it holds,
submitted without a request for non disclosure (as above), to be public, and accessible to any persons who
requests it pursuant to LGOIMA. If you require more
SIGNATURES:
To be completed by the property owner – Only if different from applicant:
An application to undertake an activity on your property is being made. Please confirm your
approval for the activity to occur on your property by signing below.
Signature of Property owner or authorised agent: ____________________________
Name: ___________________________________________ Date: _____________
Please print full name of person who signed above.
Should you have any questions with regards to the giving of approval for this application and the legal
implications, please contact the Council’s Consents Advisor on 06 833 8090.
To be completed by the Applicant:
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.
A deposit must accompany the application. The application will not be processed until the deposit is received.
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Application to Drill a Bore (Hawkes Bay Regional Council New Zealand)

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Completed 26 November 2020

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