HomeMy WebLinkAbout03 March MSB-75
"1 RESERVE CAPACITY CHARG°"
MONTHLY REPORT
Municipality (":7),-/k.- t"r7k'K /4,7,4:,917j Remit to: Metropolitan Sewer Board
350 Metro Square
'....,,, Month of /1,/////e/it /? 7') 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
W 4 caw. Sc 6 Duplexes
W 4664 S3 7 Townhouses
u- O
Total : 111111111111101111111101111275.00 '" :5-.-
Total
Total IIOhIIIIIIOHIIl!IIIHOIIII, 137.50
B Apartments
Total 1>IIII{IIIUIIIIIIIIIIIIIIIIIIII 220.00
Total OIIIIIIOIIIlIIIIIIIIIIIIIOhII 110.00
C Public Housing
1.Single Family11111111111111111101111111111 206.25
2. Duplexes 111111111111011110111111101206.25
3.Townhouses r {ILII{l�h1111{{1111IIlIIllIOhIt 206.25
4.Apartments llhlIIIlIIIllll1111111111111111111
165.00
D
Mobile Homes
1Il1IIIIII111I il 111Ff!1 I22000
11111111111111111110.00
E Commercial&Institutional 11111111111110111111111111111110 275.00
(Per attached Form MSB—75A) 111111I1I111111 " 137.50
F Industrial , 111111R1111N111111111{Il1 1 275.00
(Per attached Form MSB—75B) {{II{IIIIIIIIIIIIII1111118.I �; 137.50
Total — Reserve Capacity Charges $________,3 -`r
G Demolition Credit(Per attached Form MSB—75C) Subtract $
Sub-total $ t ``
H Administrative Fee(1% of sub-total) Subtract $ ..--'
Net Amount Due $ ,j76 . 7-s~
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 -` `'--c-
'
¢
r _ (--`2-'�-r'Z
/
White copy—Return to M.S.B. /_
Date Title -''-'i.1,-:- ' v
Yellow copy—Municipality copy
E. COMMERCIAL & INSIJTIONAL ''1 ase-75A
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 v —
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:
Total S.A.C. Units __
Insert Number of Units in Item E Form MSB-75
r, MSB-736.1
F. INDUSTRIAL: SEWER c.ONNECTION 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)
= 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
MS!-73C
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) $ ._
. .riw
..••••••,, MSB-751.2
13. Discharge quality:
Present Absent Constituent
(Check appropriate box)
Solids
Organics
Acids
Caustics
rte, Temperature(greater than 150°F)
A Cadmium
Chromium
,.•
Copper
. Cyanide
•
Iron
Lead
fr 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