ࡱ> {}z @ ^bjbjFF /f,,6?FFFF8J4E&F!(!!!,-Tk-,6=8=8=8=7o=AD$FRI(D2/E,@,2/2/DFF!!K TE5552/ F8!!6=52/6=55::,~z;!: 0R1; <<jE0E(;R:J:2:Jz;FFFF:Jz;-L-65.,E.---DD. 5. DOWNSTREAM FACILITIES CAPACITY REQUEST Date:  FORMTEXT       3 Name of Development:  FORMTEXT       3 Address/Tax Block/Lot of Development:  FORMTEXT       3  FORMCHECKBOX  Jefferson County  FORMCHECKBOX  Oldham County Sanitation District  FORMCHECKBOX  Other  FORMTEXT       3 Owner/Developer: Contact Name:  FORMTEXT       3 Company Name:  FORMTEXT       3 Address/City/State/Zip:  FORMTEXT       3 Tel. No.:  FORMTEXT       3 FAX No.  FORMTEXT       E-Mail:  FORMTEXT       Design Firm/Contact: Contact Name:  FORMTEXT       3 Company Name:  FORMTEXT       3 Address/City/State/Zip:  FORMTEXT       3 Tel. No.:  FORMTEXT       3 FAX No.  FORMTEXT       E-Mail:  FORMTEXT       Closest Sewer Connection: Record Number:  FORMTEXT       3 Manhole Number:  FORMTEXT       3 Attach Map with Site Labels & Manhole (SUBMITTALS WITHOUT A MAP WILL BE REJECTED) Wastewater Treatment Plant Service Area:  FORMTEXT       3 Amount of Flow (Based on MSD Standards):  FORMTEXT       GPD 3 Show Calculation: 3 Number of: Homes:  FORMTEXT       Apts.: One BDR:  FORMTEXT       Two BDR:  FORMTEXT       Three BDR:  FORMTEXT       Condos: One BDR:  FORMTEXT       Two BDR:  FORMTEXT       Three BDR:  FORMTEXT       Commercial (Describe):  FORMTEXT       Industrial (Describe):  FORMTEXT       Pump Station Needed: Yes  FORMCHECKBOX  No  FORMCHECKBOX  3 Recapture Area: Yes  FORMCHECKBOX  No  FORMCHECKBOX  3 ADDITIONAL COMMENTS:  FORMTEXT        LE/Application #: ___________ Capacity Determination: Approved  FORMCHECKBOX  Not Approved  FORMCHECKBOX  Flow____________ Until __________________ (If you wish to reserve capacity beyond the 90 reservation period, please call Development Team Manager) MSD _______________________________________________________________Date _______________ Please retain this form to submit with Application for Approval of Sanitary Sewer Projects Downstream Facilities Capacity Request Submittal Assistance Document The Downstream Facilities Capacity Request (DFCR) is submitted for the purpose of determining if capacity exists for your Lateral Extension Project. Included with the submittal of the DFCR must be a Site Location Map with the parcel(s) to be served noted. MSD seeks to provide a prompt definitive determination of capacity on your project. Diligent submittal of information on the DFCR and Site Location Map documents is essential. Submittals that include omissions and/or erroneous information can lead to delayed determination of capacity on your project. Anywhere there is information requested on the DFCR form, and that information does not apply to your project, at a minimum insert NA. A short explanation of why information is not included on the DFCR maybe helpful in making a prompt capacity determination on your project. Below is information that will help you provide the essential information needed to determine capacity for your project. Date - is the date that the form is completed for submittal to MSD. (MSD will stamp the document with the received date upon reception of the submittal at MSD). Name of Development - if the development does not currently have a name, or will not be named, reference the development by street name accompanied with the word which best describes the development type. For instance, East Broadway Commercial Development, Grandview Apartments, Bardstown Road Condos, etc. Address/Tax Block/ Lot of Development please provide both the property address, and Tax Block / Lot number. If a valid address does not exist, tax block and lot will suffice. If the project will exist on more than one address, please provide those addresses also. Owner/Developers Name include an owner or developer contact name. Inclusion of the Owner/Developer name will assist MSD in communications that may eliminate delays. Owner/Developers Address address where Owner/Developer contact name will receive mail. Owner/Developers Tel. 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Inclusion of more than one telephone number is welcomed. Closest Sewer Connection: Record Number Manhole Number MSD Atlas Page Wastewater Treatment Plant Service Area This information is readily attainable in the MSD Sewer Atlas. For information on how to attain a MSD Sewer Atlas, call MSD Customer Relations at 587-0603. The Closest Sewer Connection information is also attainable by calling MSD Customer Relations at 587-0603 and speaking to a Customer Relations agent. Amount of Flow the MSD Design Manual, pages 8-18 through 8-20, include the information needed to calculate the amount of flow from the development to the MSD system. The Design Manual Information can be retrieved from MSDs website at http://www.msdlouky.org/insidemsd/pdfs/designmanual02/Chapt08-2000.pdf. Pump Station needed the designation of whether a pump station is needed is required to assess if your project can be developed. Recapture Area if you do not know whether your project resides in a recapture area, you may call MSD Customer Relations at 587-0603 to get the answer. Downstream Facilities Capacity Request Site Location Map The Site Location Map (SLM) is used to determine the general location of the project for which sanitary sewer capacity is sought. The SLM maybe a copy of a USGS map, Sewer Atlas map, Topographical map, MapsCo map, or any similar map which can easily depict the location of your project in MSDs service area. The SLM must include a North arrow designation and drawn boundaries of the development site.  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