Sanitary Sewer Extension Application Form

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Western Lake Superior Sanitary District
Sanitary Sewer Extension Application
Instructions:
Please answer each question completely, providing as much information as possible and
submit to WLSSD Planning Department located at 2626 Courtland Street, Duluth, MN
55806. 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 provided.
A completed Minnesota Pollution Control Agency (MPCA) Sanitary Sewer Extension Permit
Application must be submitted to WLSSD along with the WLSSD application and required
documents. More information and the MPCA application may be found at:
http://www.pca.state.mn.us/water/permits/index.html#sanitarysewer.
Applications must be submitted no later than 10 days prior to a scheduled WLSSD
Planning Committee meeting for consideration (please call for scheduled dates 218-7223336).
Review Process:
 Upon receipt of the completed application, WLSSD staff will review the submitted
information for completeness.
 After review by District staff, the application is either sent back to applicant
requesting more information or presented by WLSSD staff to the WLSSD Board
Planning Committee for review prior to a review by the full WLSSD Board of
Directors.
o For Committee review, applications must be submitted no later than 10
days prior to a scheduled committee meeting. Applications received fewer
than ten (10) days prior to a scheduled Planning Committee meeting will
be reviewed at a subsequent meeting. Please contact WLSSD Planning
Department for upcoming committee meeting date(s).
o Planning Committee meetings are scheduled as needed, typically
monthly.
o The WLSSD Board convenes on the third or fourth Mondays of the
month at 5:00 p.m. in the WLSSD Administrative Building located at
2626 Courtland Street. The Board meeting schedule can be found at the
WLSSD web site at www.wlssd.com.
 Should the District Board approve the extension request, the application is then
forwarded, by WLSSD, 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.
Western Lake Superior Sanitary District
Sanitary Sewer Extension Application
Project Name: ____________________________
Applicant:
___________________________________________
Owner:
___________________________________________
Date: _________
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:


Attach a site map of the entire project area including: location of existing and proposed sewer,
property lines, roads, buildings, and other significant physical features;
Attach a piping system map (plan and profile) with pipe sizes, diameters, compositions and lengths
of each.
2. Provide a copy of the completed MPCA’s “Sanitary Sewer Extension Permit Application”.
3. Who will be responsible for future operation and maintenance of the proposed sewer utility?
4. On October 6, 2003, WLSSD 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.
If located within the City of Duluth, does the design meet all the requirements of the City of Duluth
Master Specification?
PROJECT ENGINEER
Signature:________________________
Printed name:
Reg. No._____________
________________________
CITY OR TOWNSHIP REPRESENTATIVE
Signature:_________________________
Printed name:
Title________________
_______________________
This Application form and accompanying attachments can be found on WLSSD’s website at:
http://www.wlssd.com
The Minnesota Pollution Control Agency Sewer Extension information and forms can be found at the
following web site:
http://www.pca.state.mn.us/water/permits/index.html#sanitarysewer.
Answers to question #6 on the MPCA Sanitary Sewer Extension Permit Application
6) Specification of current WWTF (Wastewater Treatment Facility) where flow will be
treated.
a)
b)
c)
d)
e)
Where will the wastewater be treated? WLSSD
Design Average Wet Weather flow (AWW) 48.4 MGD
Actual current annual average daily flow received in the past 12 months) 38.1 MGD
Actual current annual average daily CBOD5 loading in the past 12 months) 191 mg/L
Estimate the total number of new connections anticipated, including other projects, in the
next 12 months. (your municipality provides this information)
f) 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?
(Your municipality provides this information in consultation with WLSSD)
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