HomeMy WebLinkAbout06 June MSI—75
"" RESERVE CAPACITY CHARG'"
MONTHLY REPORT
Municipality ff•c- % '/<. 'I( /6/./rf Remit to: Metropolitan Sewer Board
Month of ?w .2% /� 7, 3500 Metro Square
Saint Paul,Minnesota 55101
BUILDING SEWER
ITEM TYPE OF UNIT PERMIT CONNECTION UNIT RESERVE CAPACITY
SAC UNITS PERMIT CHARGE CHARGES
aL�4 SAC UNITS
`Poem sT- 44A Single Family House %,
S 1S- si1 Duplexes
`os, Townhouses r-,
406 Total
275.00 x 7.C.-
5-90
~
S.�Q !II!I!II I`I !!!1RI1I
.S-1/ Total 1I001iII0Ii0iiIli0iI110 137.50
B Apartments
Total 1111111111111111111111 220.00
Total 111101110111 r 110.00
C Public Housing
1.Single Family 17. 110111111111111111101111111111 206.25 :>
2.Duplexes C 11111011101101111001206.25 -- _ --
,-"\ 3.Townhouses C 111111111111110111111101206.25
4.Apartments (2 111111111111111 11111111II11 165.00
111111110111 SII 1 Illil
220.00
D Mobile Homes
11111111111111111111 v 110.00
E Commercial&Institutional iIIIIIIIIIIIOIIIOIIHIIIOIIIII 275.00
(Per attached Form MSB—75A) 1111111111111111111
137.50F Industrial 1111111111111111111 275.00
(Per attached Form MSB—75B) IIIIIIIIIIIM ,L,-; 137.50
Total— Reserve Capacity Charges $ _1e ;" S--,
G Demolition Credit(Per attached Form MSB—75C) Subtract $ -
Sub-total $
H Administrative Fee(1% of sub-total) Subtract $ _--'Y. /5
Net Amount Due $ - ' '. >'-'. 2S-
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 ` ;., ; .��ti�y�
e.c. ,- / 7
White copy—Return to M.S.B. .>« o -
Yellow copy—Municipality copy Dote Title :, `=A4
Mse-75A
E. COMMERCIAL & INST, IONAL
Occupant S. A. C. Units c. —
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:
Occupant S. A. C. Units r —
Address
No.of Employees Total Sq.Ft.
Date Permit
Type of Facility: Issued
Basis for determination of SAC Units:
Total S.A.C. Units
Insert Number of Units in Item E Form MSB—75
MSB-73S-1
F. INDUSTRIAL: SEWER CONNECTION APPLICATION
Company name
Location address
Mailing address
Company Representative —
Title `
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
point and describe flowmeter and means of sampling
MSI-75C
G. DEMOLITION CREDIT
TYPE OF UNIT SAC UNIT DEMOLITION
UNITS CREDIT CREDIT
Single Family House
Duplex
Townhouse
Total 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) $
/.*NN � Mse—751.2
13.Discharge quality:
Present Absent Constituent
(Check appropriate box)
�._ Solids
Organics
Acids
Caustics
Temperature(greater than 150'F)
r'f Cadmium
*` Chromium
jam, Copper
1
1/ 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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