HomeMy WebLinkAbout05 May MSB-7S
"'\ RESERVE CAPACITY CHARC" 'N.
MONTHLY REPORT
Municipality ,.A-" r'Iiir,— /7-/ f,IV7--r Remit to: Metropolitan Sewer Board
350 Metro Square
`..-..,,, Month of z-i= / Saint Paul,Minnesota 55101
BUILDING SEWER
ITEM TYPE OF UNIT PERMIT CONNECTION UNIT RESERVE CAPACITY
SAC UNITS PERMIT CHARGE CHARGES
VG
SAC UNITS
AT � G Single Family House
PER C., _.
Duplexes
5-7V ...... .,
57r Townhouses Y _
Total .2_ 111111111101111111101111111275.00 ti-_
Total iIllhIIIJIIIIIII011IIIIllIOl 137.50
B Apartments
Total ;� 111111111111111111111 220.00
Total OhIIIIOH1lIII1IIIIOhIllII 110.00
C Public Housing
1.Single Family IOIII1IIOIIfIIIlIIIIIIIllhhI1HI 206.25
2.Duplexes IJOIllhii111IJOOIllhII1IIIIO11I 206.25
3.Townhouses ; I IIIIII1I<111II118{IIII1I111 206.25
4.Apartments w; IIII1IIIIIIIIIII I1IIIIIIIIII i 165.00
Hilo 1 220.00
D Mobile Homes
IIHIIIIIIIII iIIIIIIIIIOhIIII _. 110.00
---- c --
E Commercial&Institutional C 1110111111111111111111011 275.00
(Per attached Form MSB—75A) 1111111111111111 137.50
F Industrial
1111111111111•111111111 11 275.00
(Per attached Form MSB—75B) 111180111111111111111111137.50
t
c.c.
Total — Reserve Capacity Charges $ 7 C `
G Demolition Credit(Per attached Form MSB—75C) Subtract $
Sub-total $ 5 i
H Administrative Fee(1% of sub-total) Subtract $
',s c'
Net Amount Due $ .. ' c' ---
CERTIFICATION
I certify that the above is true and correct to the best of my knowledge and represents the
i•••., activities for the month indicated above.
-;
Name -7) -� E:, c-` .'
White copy—Return to M.S.B. � � /
Date Title - -`�•.r- -t. <_
Yellow copy—Municipality copy
MSI—73A
E. COMMERCIAL & INSTI..iTIONAL
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:
Occupant S. A. C. Units • y
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
i..\ i0.4\ MSB-738.1
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
.Fv
5.Operating hours per day
6.Operating days per year
f,
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-8b11-8c) gal/year
9.SAC units: Total discharge(8d) _ SAC Units
100,000
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) $
t, r, Ms!—731.2
13.Discharge quality:
...•••••\ Absent Constituent
(Check appropriate box)
Solids
Organics
Acids
Caustics
Temperature(greater than 150'F)
Cadmium
Chromium
Copper
Ai• / 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