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Min Facilities Plan Submittal Checklist nesota Pollution Submissions Required for a Complete Facilities Plan (Minn. R. 7077.0272) Control Agency Water/Wastewater/Financial Assistance/#2.02, May 2003 F11111_1010 x1m, I M V �1'ffi I W1111 cmi MAIN WIN Project Name Proposed Dates for Construction City's Authorized Representative Title Phone Mailing Address Technical Agent or Consulting Engineer Name of Finn/Organization Phone Is the Facilities plan signed by an engineer registered in the State of Minnesota? Yes No Has the municipality in which the facility will be located held at least one public hearing to discuss the proposed project? Yes No Date hearing was held Please see Minn.R. 7077.0272 for more information about the content of facilities plan. ❑ A summary of the public hearing documenting that the following items were discussed: ❑ The various treatment alternatives considered ❑ The location of the project site ❑ The reasons for choosing the selected treatment method ❑ The estimated sewer service charges ❑ A summary of the comments received at the public hearing and the action taken to address those comments ❑ A complete list of addresses used for public notice purposes on a form provided by the MPCA ❑ A copy of the resolution of the municipality's governing body adopting the facilities plan ❑ A list of ordinances or intermunicipal agreements required for the implementation and administration of the project ❑ A signed treatment agreement with each significant industrial user ❑ For surface water dischargers only,a copy of the Preliminary Effluent Limits review letter provided by the MPCA ❑ A completed environmental information sheet(referred to as an EIW)provided by the MPCA ❑ For individual sewage treatment systems that serve more than one structure, an assurance from the municipality stating that all property owners who will be served by the proposed system agree to be part of the system,to participate in the construction project,and to finance future operation,maintenance,and replacement of the system ❑ Copies of all notifications,certifications,and comments received(required to meet the provisions of Minn. Stat. § 116.182) If all of the above items are not included with the facilities plan,the facilities plan is incomplete and may be returned or filed until a complete submittal is received. Facilities plan review will not begin until a complete submittal is received. wq-wwtp#2.02 Minnesota Pollution Control Agency, 520 Lafayette Road North, St. Paul, Minnesota 55155-4194 (651)296-6300,toll-free(800)657-3864,TTY(651)282-5332 or(800)657-3864 This material can be made available in alternative formats for people with disabilities.