HomeMy WebLinkAbout07 July MSB-73
' RESERVE CAPACITY CHARG(
MONTHLY REPORT
Municipality ,•'i<,' • ;L/ ', 7,-, Remit to: Metropolitan Sewer Board
350 Metro Square
Month of . - - Saint Paul,Minnesota 55101
BUILDING SEWER
ITEM TYPE OF UNIT PERMIT CONNECTION UNIT RESERVE CAPACITY
SAC UNITS PERMIT CHARGE CHARGES
SAC UNITS
A Single Family House
Duplexes
Townhouses - ___
Total - c - 1IIIII1OIOOI1JIOIOOhJIII1OI 275.00
Total IIIIIIIIIOIOHIOIIOIIIIIII 137.50
B Apartments _
Total _ . I IIIIIIIIIIIIIIIIIIIIIII 220.00
Total ooiiiooiiiiiooiii000 --- 110.00
C Public Housing
1.Single Family !OIOOIOIllOIIIJIIIII011IOhII 206.25
- .
2. Duplexes 11111JI11IIIIIII1111I11IOII0 206.25
3.Townhouses 111111111100114000014
206.25
4.Apartments 1IIIIIIIIIIII IIIIII 165.00
1111111111. I ILLII 220.00
Mobile Homes 111111111111111
110.00
il6,9 E Commercial&Institutional 11111111111101111111101275'00 ,_t-
(Per attached Form MSB—75A)
1111111111111 ' '' - 137.50
F Industrial - 4001141101100011100100111 275.00
(Per attached Form MSB—75B) 111111111{1101110111 11
137.50
Total— Reserve Capacity Charges $
G Demolition Credit(Per attached Form MSB—75C) Subtract $
Sub-total $ ' "- - -.
H Administrative Fee(1% of sub-total) Subtract $
Net Amount Due $ ,y ` ,
CERTIFICATION
I certify that the above is true and correct to the best of my knowledge and represents the
"'\ activities for the month indicated above.
Name , _ - ,:,...i,-. .,f e
White copy—Return to M.S.B.
Data Title -
Yellow copy—Municipality copy
75A
E. COMMERCIAL & INST�TIONAL Mse—
Occupant a/vx-"/tii_-.64� ( ( 1Zc- eowsr- ) S. A. C. Units
Address
No.of Employees / Total Sq.Ft. / y^2 0
Date Permit
Type of Facility: `')t Tr-3 i L . >, c 5 Issued
Basis for determination of SAC Units: C Ci�� r ")%. E _ 7/5 /7 3
/ - L< /4>Fi fro - 5 c u i ca i3o.igv /1.--7.,44/(Jr>L
Occupant S. A. C. Units
Address
No.of Employees Total Sq.Ft.
Date Permit
Type of Facility: Issued
Basis for determination of SAC Units:
Occupant S. A. C. Units
Address
No.of Employees Total Sq.Ft.
Date Permit
Type of Facility: Issued
Basis for determination of SAC Units:
Occupant S. A. C. Units
Address
No.of Employees Total Sq.Ft.
Date Permit
Type of Facility: Issued
Basis for determination of SAC Units:
--ice .-.
Total S.A.C. Units
Insert Number of Units in Item E Form MSB-75
-7SB-1
F. INDUSTRIAL: SEWER CONNECTION APPLICATION
Company name -
Location address ---
Mailing address
Company Representative
t'`
Title
1
Phone number
1.Nature of business
2.Projected date for facility start up
3.Total facility area sq.ft.
4. No.of employees
5.Operating hours per day
6.Operating days per year
7.Water supply:
a. Municipal water supply gal/year
b.Well water supply gal/year
c.Other (specify) gal/year
d.Total water supply gal/year
8.Waste discharge:
a.Sanitary waste discharge gal/year
b. Uncontaminated cooling water discharge gal/year
1.) . .. .to sanitary sewer gal/year
2.) . . . .to storm sewer gal/year
c. Industrial waste discharge gal/year
d.Total discharge to sanitary sewer(8a+8b1+8c) gal/year
9.SAC units: Total discharge(8d)
100,000 = SAC Units
10.SAC Charge:
SAC Units (9) X Unit Charge = SAC Charge
11. Pretreatment: [Refer to Sections 5-5 and 5-6 of the Waste Control Rules and Regulations.] Does the Company plan any in-plant
treatment of wastes? If yes, describe
12.Sampling & Flow Measuring: [Refer to Section 5-9 of the Waste Control Rules and Regulations.] Indicate location of sewer access
-0.••\ point and describe flowmeter and means of sampling
MSS-75C
G. DEMOLITION CREDIT
TYPE OF UNIT SAC UNIT DEMOLITION
UNITS CREDIT CREDIT
Single Family House
Duplex
Townhouse �l
Total `, `f 275.00
Apartments
Total 220.00
Mobile Home Park 220.00
Commercial, Institutional and Industrial
Address Type of Facility
Total 275.00
Total Demolition Credit (Enter Amount in Item G Form MSB—75) $
MSB--75B-2
13. Discharge quality:
Present Absent Constituent
(Check appropriate box)
Solids
Organics
Acids
Caustics
Temperature(greater than 150'F)
Cadmium
i r Chromium
Copper
Cyanide
Iron
Lead
Mercury
Nickel
Zinc
Phenols
Grease and'or oil
Solvents
Radioactive wastes
14.Additional information, sketches or descriptions may be attached for the purpose of adequately describing the waste discharge.
�� CERTIFICATION
This is to certify that agrees to comply with the rules
and regulations governing connection to and use of the Metropolitan Disposal System.
Company(Signature of official)
Date Title
Transmitted by Community
Signature
Title
Date
Approved by Metropolitan Sewer Board
Signature
Title
Date
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