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MN SHOVEL READY CERTIFIED DEVELOPMENT SITE APPLICATION <br /> Municipal Sanitary Sewer Provider and Service Description Page 4 of 4 <br /> Contact Name Sewer line in place near/at site? Yes or No <br /> Municipality Diameter of line at site inches <br /> Address Size of sewer main in public inches <br /> right-of-way? <br /> City/State/Zip Depth of sewer in public feet <br /> right-of-way? <br /> Phone Any special pretreatment Yes or No <br /> E-Mail Any incremental treatment capacity <br /> planned? If yes, note additional Yes or No <br /> capacity GPD <br /> Municipal Storm Sewer Service Description/Requirements Based on City Engineer input: <br /> Contact Name Capacity of sewer during 5- CFS <br /> year storm event <br /> Municipality Capacity of sewer during 10- CFS <br /> year storm event <br /> Address Capacity of sewer during 20- CFS <br /> year storm event <br /> Cit /State/Zip <br /> Phone <br /> E-Mail <br /> Any additional storm water treatment or rate of discharge control required for this site? Yes or No <br /> If yes, describe treatment/control required: <br /> MPCA MS4 (Small Municipal Separate Storm Sewer Systems) program compliance: <br /> Are you required to obtain permit coverage for storm water discharges? If yes, attach copy of MPCA letter on <br /> permit application. Yes or No <br /> Have you satisfied the MS4 permit conditions to develop/implement storm mgmt. program and report on <br /> status/effectiveness? Yes or No <br /> Are you required to obtain a NPDES (Nat'l Pollutant Discharge Elimination System) permit for storm water <br /> during construction? Yes or No <br /> If yes, have you prepared a Storm Water Pollution Prevention Plan (SWPPP)for erosion prevention/sediment <br /> control? (Attach copy of plan) Yes or No <br /> Telecommunications Providers and Service Description <br /> Contact Name <br /> Company <br /> Address <br /> Cit /State/Zip <br /> Phone <br /> E-Mail <br /> Is there telecommunications service currently available at the site? Yes or No <br /> Does the site have broadband service? Yes or No <br /> If there is broadband service, what is the upstream band width? Mbps <br /> What is the downstream band width? Mbps <br /> What is the type of delivery medium (copper, fiber optics, etc.) <br /> If service not available, how soon could it be installed? Weeks <br /> Vlll. VERIFICATION AND ASSURANCE <br /> I agree that the information is valid and accurate on a best effort basis, that the site can be listed on the MNPRO web site, and <br /> that the site information and community profile will be updated every 120 days. Signature: <br /> Name: Title: Organization: Date: <br />