Q-2, r. 21 - Regulation respecting waterworks and sewer services

Schedule Disposition versions

2012-09-01

FORM 7

(s. 49)

GOUVERNEMENT DU QUÉBEC

MINISTÈRE DU DÉVELOPPEMENT DURABLE, DE L’ENVIRONNEMENT ET DES PARCS

APPLICATION FOR A SEWER SYSTEM OPERATING PERMIT

In accordance with section 32.1 of the Environment Quality Act (chapter Q-2), the undersigned applicant hereby applies for a sewer system operating permit.

For such purpose, the applicant gives the following information:

1. Name and address of individual, partnership, association, legal person or company applying for the permit:

Name ______________________________________________________________________

Address _____________________________________________________________________

2. Nature of applicant: individual, partnership, association, legal person or company (strike off inapplicable designations).

3. Date and place of registration or constitution (in the case of a partnership, association or legal person):

____________________________________________________________________________

4. Person responsible for administration:

Name _______________________________________________________________________

Address _____________________________________________________________________

Telephone number ____________________________________________________________

(area code)

5. Person responsible for operation:

Name _______________________________________________________________________

Address _____________________________________________________________________

Telephone number ____________________________________________________________

(area code)

6. Give the following information on the table hereunder:

(a) name of the municipality or municipalities where the service is provided and their designation as city, town, village, parish, township, etc.;

(b) number of subscribers in each municipality where the service is provided; in the case of a system operated by a municipality, give the total number on the entire system and, separately, the number of subscribers outside the municipal territory;

(c) the detailed tariffs in force in each municipality where the service is provided; in the case of a system operated by a municipality, give the detailed rates in force outside the municipal territory. Indicate in the “Tariff” column of the table hereunder whether it is an annual, semi-annual, quarterly or monthly tariff.

 ____________________________________________________________________
|                   |                  |               |             |
|    Municipality   |    Designation   | Subscribers   |   Tariff    |
|___________________|__________________|_______________|_____________|
|___________________|__________________|_______________|_____________|
|                   |                  |               |             |
|___________________|__________________|_______________|_____________|
|                   |                  |               |       |     |
|                   |                  |               | Item  |  $  |
|___________________|__________________|_______________|_______|_____|
|___________________|__________________|_______________|_______|_____|
|                   |                  |               |       |     |
|___________________|__________________|_______________|_______|_____|
|                   |                  |               |       |     |
|___________________|__________________|_______________|_______|_____|
|                   |                  |               |       |     |
|___________________|__________________|_______________|_______|_____|
|                   |                  |               |       |     |
|___________________|__________________|_______________|_______|_____| 
                

7. Total length of main and secondary conduits, with the exception of service pipes:

____________________________________________________________________________

8. Total length of conduits, their diameter, nature and year of installation; in the case of a system operated by a municipality, indicate which conduits are installed within and which conduits are installed outside the municipal territory:

 ________________________________________________________________________________
|                     |                    |                  |                  |
|       Length        |      Diameter      |      Nature      |      Year        |      
|_____________________|____________________|__________________|__________________|
|_____________________|____________________|__________________|__________________|
|                     |                    |                  |                  |
|_____________________|____________________|__________________|__________________|
|                     |                    |                  |                  |
|_____________________|____________________|__________________|__________________|
|                     |                    |                  |                  |
|_____________________|____________________|__________________|__________________|
|                     |                    |                  |                  |
|_____________________|____________________|__________________|__________________|
|                     |                    |                  |                  |
|_____________________|____________________|__________________|__________________|
|                     |                    |                  |                  |
|_____________________|____________________|__________________|__________________|
                    

9. Average depth of conduits in the ground: ______________________________________________

10. Nature of soil: __________________________________________________________________

11. The sewer will operate:

by gravity _____________________________________________________________________

or by pumping _________________________________________________________________

12. The flow of each pump in litres per minute or per hour and the power of the motor driving it:

 
 ________________________________________________________________________________  
|                                       |                                        |
|              Flow of pump             |             Power of motor             | 
|_______________________________________|________________________________________|
|_______________________________________|________________________________________|
|                                       |                                        |
|_______________________________________|________________________________________|
|                                       |                                        |
|_______________________________________|________________________________________|
|                                       |                                        |
|_______________________________________|________________________________________|
|                                       |                                        |
|_______________________________________|________________________________________|
|                                       |                                        |
|_______________________________________|________________________________________|
                    

13. Will the waste water be treated: _____________________________________________________

_______________________________________________________________________________

14. Description and dimension of the waste water treatment device, where applicable: (septic tank, absorption field, stabilization pond, or other)

_______________________________________________________________________________

_______________________________________________________________________________

15. Date of collection of subscriptions: __________________________________________________

Will the subscription be payable in advance: ___________________________________________

16. Cost of sewer system with its accessories: ____________________________________________

17. If the waste water is discharged into another existing sewer system, indicate the name and address of the owner of that system and give the price and terms and conditions agreed upon for the evacuation or treatment of waste water:

Name:_________________________________________________________________________

Address: ______________________________________________________________________

Price: ________________________________________________________________________

18. Annex the following documents:

(a) a plan or sketch of the sewer system; in the case of a system operated by a municipality, clearly indicate which conduits are outside the municipal territory;

(b) a copy of the contract forms used for the various services;

(c) a copy of the by-laws (where applicable);

(d) a copy of the financial report covering the last year of operations. In the absence of such report, it will be necessary to submit a detailed statement of the assets and liabilities together with the receipts and expenditures for the past year.

19. Give all additional information on the sheet attached hereto.

_______________________________________

Applicant

Date: this ______________________ 20_____

ADDITIONAL INFORMATION TO BE PROVIDED WHERE NECESSARY

R.R.Q., 1981, c. Q-2, r. 7, Form 7.