HomeMy WebLinkAbout04 April ........NMSB—7s
RESERVE CAPACITY CHARGP'1
MONTHLY REPORT
Municipality 1C 1".--/k K / 'I 1 &A/7! Remit to: Metropolitan Sewer Board
Month of , ;f 1G .' i'•` 350 Metro Square
Saint Paul,Minnesota 55101
BUILDING SEWER
ITEM TYPE OF UNIT PERMIT CONNECTION UNIT RESERVE CAPACITY
SAC UNITS PERMIT CHARGE CHARGES
SAC UNITS
R-12 A4 rr AA Single Family House
f a
.s-4 3 SSL Duplexes
s-L51 gsS x ,-.;
_ Townhouses
SSS 6-42 ,.. IIIIIIIIOhIlolJJIJItOJJJJOIIJlTotal 275.00
S Total iiiiiiiiiiiiiiii!iiiiiJiiiiiii i 137.50
B Apartments
Total I I1IIIIIIIIIIIIIIIIIIIIIIlIIllhII 220.00
Total OIOIIIOOIII1lIIlI011I 110.00
C Public Housing
1.Single Family IOhIIIIOIIOIIIIOIIJIIII!JIIIIII 206.25
2.Duplexes ', _ II!!IlIIINIIIlIIIIlI1!lIIIlNIIII 206.25
--..,, 3.Townhouses111111 I1111111111206.25
; ,._ ,_, ___
4.Apartments miimmiplit 165.00
IIIIIIIIII1I_ 110.00
Iii. 220.00
D Mobile Homes
IIIIIIlIlII1III(NIIlIIIIBIII � - _ --
t
E Commercial&Institutional :' JII1OOIOII 275.00
(Per attached Form MSB—75A) 11111111111111 11 ti 137.50
F Industrial 011111111i01111111110 I 275.00
(Per attached Form MSB—75B)
11101111111111111 - —
137.50
Total — Reserve Capacity Charges 1,_______ 76,
G Demolition Credit(Per attached Form MSB—75C) Subtract $
Sub-total $ --2 (:„ • .C7-
H Administrative Fee(1% of sub-total) Subtract $ - .-- --
Net Amount Due $ C Kai. ;:r—.
,
CERTIFICATION
I certify that the above is true and correct to the best of my knowledge and represents the
...--1, activities for the month indicated above.
Name (c r: {---r .;r{`
Whit.copy—Return to M.S.B. f � - --_•
Yelbw Date Title - J`r
copy—Municipality copy
MS$—75A
E. COMMERCIAL & INS1 TIONAL
Occupant S. A. C. Units L
Address
No.of Employees Total Sq.Ft.
Date Permit
Type of Facility: Issued
Basis for determination of SAC Units:
Occupant S. A. C. Units " O ""
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:
Occupant S. A. C. Units " 0
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-75B-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
MSS-SSC
G. DEMOLITION CREDIT
TYPE OF UNIT SAC UNIT DEMOLITION
UNITS CREDIT CREDIT
Single Family House
Duplex
Townhouse
Total 275.00
Apartments
Total ti� �' 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) $
imo\ � Ms6—751.4
13.Discharge quality:
Present Absent Constituent
(Check appropriate box)
Solids
Organics
Acids
Caustics
Temperature(greater than 150°F)
Cadmium
Chromium
Copper
t €" 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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