Sanitary Sewer Extension Application Form

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					           Sanitary Sewer Extension Application Form

                 Western Lake Superior Sanitary District

WLSSD Review Process:
       Upon receipt of application, District staff reviews submitted
information for completeness. After review by District staff the
application is either sent back to applicant requesting more information
or forwarded with staff report to the District Planning Committee for
review prior to the District Board review. The District Board convenes
on the third Monday of the month at 5:00 p.m. in the Administrative
Building located at 2626 Courtland Street. The Board meeting schedule
can be found at the WLSSD web site listed below. Should the District
Board approve the extension request, the application is then forwarded
to the Minnesota Pollution Control Agency for their review. Should the
District Board deny the application; the application will be returned to
applicant stating reasons for denial.

Instructions: Applications must be submitted no later than 14 days prior
to scheduled Board meeting. Please answer each question by providing
as much information as possible. Attach any maps, photos or other
material that will be helpful during the review process. Extra sheets
may be attached if necessary to accommodate text and/or data. Your
application will be returned if all of the required information is not
MPCA Web site:

WLSSD Web site:
Project Name: ____________________________Date: _________

Applicant:        ___________________________________________

Owner:            ___________________________________________

Sanitary Sewer Extension Application Form

1. Please describe the proposed project, including its location, existing and future area(s) to be
   served, streets and water resources. Specifically include a copy of the following:

    A.      Attach a piping system map showing the location of the proposed sewer
            modification/extension and all identified existing and former downstream bypass and
            SSO locations;
    B.      Attach a site map with pipe sizes, diameters, compositions and lengths of each.

2. Provide the average wet weather flow associated with the proposed sewer modification or
   extension at startup and at its known ultimate flow. Identify in the estimates of average wet
   weather flow Average Wet Weather Flow for any phased-in connections, which would add to
   the proposed sewer extension flow rates at known ultimate development. The District has
   adopted the following minimum standards for determining residential wastewater flows.
   Please use these minimum standards. For instances where these minimum standards do not
   apply, additional guidance can be found in “Design Flow and Loading Determination
   Guidelines for Wastewater Treatment Plants” located on the following web site: Information must include
   estimates of both initial and ultimate flows once the service area is completely developed.

            Population density per residential unit = 2.6 persons per unit
            Average flow = 100 gallons per person per day

3. Provide an estimate of how the new sewage flow associated with the proposed sewer
   modification or extension will impact existing and former downstream bypass and SSO
   locations in terms of volume and frequency.
4. Provide an assessment of whether the proposed sewer modification or extension will prevent
   or delay compliance with the provisions of the District/City of Duluth Consent Decree
   beyond the applicable work completion notification deadlines set forth in Section V of said
   Consent Decree (Discussion with WLSSD will be required to answer this question).

5. Has the City or Township submitted their I & I Reduction Plan and Progress Report (Annual
   Report) to the District? Has the immediate area (basin) experienced problems with basement
   flooding, surcharging, or exceedances of Level of Service violation(s) in the last 3 years due
   to limited capacity in the local sewer system or excessive infiltration and inflow of clear
   water? If so, please describe the most recent steps being taken by the City of Township to
   correct this situation.

6. How does this project relate to future plans for sewer extensions in the immediate area? Are
   further sewer extensions planned or anticipated? Include a description of the existing land
   uses, zoning maps/classifications and the approximate area, in acres, to be served.

7. Is provision of public sewer and development as proposed consistent with the local
   Comprehensive Land Use Plan? If so, please explain and indicate when plan was last

8. Describe inspection and testing procedures that will be taken during construction of the
    proposed sewer to insure that clear water from sump pumps, footing drains and roof drains
    are not introduced or connected to the sewer system.
9. In regards to new developments (large and small), has consideration been given to minimizing
     the potential for surface drainage to enter the sanitary system? Does footing and roof
     drainage have a place to go? Please explain.

10. Who will be responsible for future operation and maintenance of the proposed sewer utility?

11. On October 6, 2003, the District established minimum standards for Design, Construction,
    and Inspection of District sewer system assets and connected municipal sewer lines (see
    attached resolution 03-21). Please complete Design and Construction Standards checklist and
    submit with this application.


            Signature:________________________          Reg. No._____________

            Printed:   ________________________



            Printed:    _______________________
This Application form and accompanying attachments can be found at the following web site:

The Minnesota Pollution Control Agency Sewer Extension information and forms can be found at
the following web site:

Answers to question #6 on the MPCA Sanitary Sewer Extension Permit Application

   6) Specification of current WWTF (Wastewater Treatment Facility) where flow will be

           1)      Where will the wastewater be treated? WLSSD
           2)      Design Average Wet Weather flow (AWW) 48.4 MGD
           3)      Actual current annual average daily flow received in the past 12 months) 38
           4)      Actual current annual average daily CBOD5 loading in the past 12 months)
                   128 mg/L
           5)      Estimate the total number of new connections anticipated, including other
                   projects, in the next 12 months. City or Township provides
           6)      Do the downstream collection facilities and WWTF have sufficient capacity
                   to treat current flow and the flow from this and other approved connections
                   not yet constructed? City or Township provides

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