Rural Development Authority Questionnaire for Decentralized Sewer Systems

1

Name of Development

 *

Name of Development

2

Location

 *

Location

3

Developer information

Developer information

Name

Street Address

City, State, ZIP

Phoneext.

Faxext.

4

Engineer information

Engineer information

Name

Street Address

City, State, ZIP

Phoneext.

Faxext.

5

Type of system (described in detail)

Type of system (described in detail)

6

Owner of system once completed and operational

Owner of system once completed and operational

7

Proposed licensed waste water operator

Proposed licensed waste water operator

8

Proposed method of billing, collection, and procedures for failure to pay

Proposed method of billing, collection, and procedures for failure to pay

Name of person or entity responsible

Description of proposed method

9

Proposed schedule of maintenance and testing

Proposed schedule of maintenance and testing

10

Population of development

Population of development

Number of living units anticipated

Total anticipated population once development is completed

11

Estimated date that system will be operational

Estimated date that system will be operational

12

Estimated date that all proposed homes/living units will be built, occupied, and system fully operational

Estimated date that all proposed homes/living units will be built, occupied, and system fully operational

13

Proposed rate per household

Proposed rate per household

14

Breakdown of rate

	Rate
Ongoing maintenance and operation	Breakdown of rate
Rural Development Authority Fee	Breakdown of rate
Long term capital reserves	Breakdown of rate

15

Attach proposed contracts with waste water operator person or entity responsible for billing and collection.

Note: If you have multiple files or your file is too large, please contact the Washington County Public Utility Department at (479) 444-1896 .

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