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In this document, the term scheme has the same meaning as in the Environmental Protection Act 1986, and includes regional and town planning schemes and their amendments. Now also know as local planning schemes under Part 5 of the Planning and Development Act 2005.
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when electronic documentation is not available# additional copies of the scheme documentation for the EPA -ervice (nit to forward to the 2epartment of Environment and +onservation and other agencies for technical advice!
&he EPA -ervice (nit,s Planning and Infrastructure 8ranch can advise on referral requirements and issues of environmental significance! 9iaison with the EPA -ervice (nit may be particularly helpful in the following instances . schemes raising potentially significant environmental issues and whole.of.municipality town planning schemes! &he Planning and Infrastructure 8ranch can be contacted by ringing 6:6$ 6;<< and as)ing for an environmental officer who deals with the region!
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E"#IRO"$E"TA% CHEC&%IST
Title of scheme'1 ===============================================
&his chec)list is intended to assist authorities responsible for schemes to identify potential environmental issues# and to supply the information that the EPA requires to decide whether or not to assess a scheme! Please tic) the appropriate bo/ and supply the information indicated at -ection 2 below to the EPA! 3or clarification of any terms or descriptions used# please refer to EPA 5uidance >o! :: ?Environmental 5uidance for Planning and 2evelopment@ through the EPA website or the Planning and Infrastructure Assessments 8ranch of the EPA -ervice (nit!
A( )io*h!sical factors
1! 2oes the area to which the scheme applies contain or ad6oin any of the followingA a bushland! If yes# identify b a wetland (includes seasonally damp land # watercourse or river . if yes# identify c an estuary or inlet! If yes# identify d coastal area or near.shore marine area! If yes# identify e a public water supply area! If yes# identify f a landform of special interest# for e/ample# )arst# beach ridge plain! If yes# identify *! Is any area to which the scheme applies in a catchment that is of particular environmental concern or interestA
+es
"o Unsure
B B B B B B
B B B B B B
B B B B B B
B B B
If yes# identify the catchment1 9a)e +lifton catchment -wan +oastal Plain catchment of the PeelCDarvey Estuary -wan and +anning "ivers catchment (other than Ellenbroo) catchment Ellenbroo) catchment Ether catchment (please name
B B B B B B
:! Is the land to which the scheme applies the sub6ect of any significant or potentially significant soil or land degradation issues# for e/ample# salinity# waterlogging# erosion# acid sulphate soilA
)( Pollution mana,ement
$! 2oes the scheme allow for a land use that will or could discharge a significant quantity of a potential pollutant to the air# surface water# soil or groundwaterA If yes# please identify the land use0s# and associated pollutants1
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+es "o Unsure ;! 2oes the scheme allow for a land use that could require a buffer over ad6oining landA that is# does it allow for uses that may affect ad6oining land (including land that may be used for future residential use due to gases# noise# vibration# odours# lightA
B B B
If yes# please identify land use0s# and off.site areas that may be affected1 'hat is the distance to the nearest residencesA 6! 'ould the scheme allow a residential area or sensitive land use (e!g! school to be located in an area li)ely to be affected by emissions (e!g! gases# noise# odour from industry# agriculture or infrastructure (e!g! landfill site A
B B
If
yes#
please
identify1
F! 2oes the scheme apply to a site that has been used for a past land use which may have contaminated the soil or groundwater# for e/ample# mar)et garden# industrial use# fillA
B B B B
If
yes#
please
identify1
B B B
B B B
B B B
C( Social surroun-in,s
9! 2oes the scheme raise any issues )nown to be of concern to the publicA If yes# is the concern to the public related to an environmental issueA Please specify the environmental issue(s of concern 1<! Is the scheme li)ely to raise heritage or cultural issues due to impacts on the biophysical environmentA
B B
If
yes#
please
identify
11! 2oes the scheme apply to areas of land where there are e/isting or potential land uses associated with high levels of ris)# for e/ample# a high pressure gas pipe line# heavy industryA
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B B
If yes# please identify1
D( A--itional information
If all answers to the questions above are ?no@# no other environmental information is required to accompany this chec)list! If answers include ?yes@ or ?unsure@# please provide information for those items on1 o the e/isting environment o potential environmental impacts and their magnitude0significance o how the impacts will be managed to ensure a good environmental outcome!
&he EPA will review the chec)list and information submitted and if not sufficient for the EPA to decide whether or not to assess the scheme# the EPA may request additional information! >ame of person completing form1 Position1 +ontact Phone0Email1 2ate1
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