Crane Lake Water & Sanitary District
P.O. Box 306, Crane Lake, Minnesota 55725 | (218) 993-1303 | email@example.com
Application for ISTS Managed System
- 1. Applicant – Owner(s)
1.2. Service Address: _____________________________________________________________________
1.3. Billing Address:______________________________________________________________________
1.4. Telephone Number(s):_________________________________________________________________
(work) (home) (cell)
1.5. Email Address:_______________________________________________________________________
1.6. Legal Description and/or Parcel No. of Property: [Attach real estate tax statement and deed by which Applicant obtained title]
1.7. Survey: [Attach a copy of any survey that Applicant has for the Property.]
1.8. Present Land Use: [Describe the present use of the Property.]___________________________________
1.8.1_______________________________________________________________________________ . Total square foot area of habitable space on the Property:______________________________________
1.8.2. Number of buildings with habitable space:____________________________________________
1.8.3. Total number of bathrooms on the Property:___________________________________________
1.8.4. Total number of bedrooms on the Property:___________________________________________
1.8.5 Total number of persons who will be using the Property at any one time:_____________________
1.8.6 Provide a Well Certificate on the standard Minnesota Well Disclosure Certificate form for each well on the Property.
- 2. Application for ISTS Service
2.1. Applicant does hereby make application for an ISTS Managed System to provide domestic strength wastewater treatment through an Individual Sewage Treatment System (ISTS) on the property and for and limited to the present use of the property as described above.
2.2. A deposit of $350.00 accompanies this Application.
- 3. Conditions
3.1. Applicant (whether one or more) hereby makes application to Crane Lake Water & Sanitary District (“District”) for an ISTS Managed System (“ISTS”). Applicant hereby certifies that the information given on this application is true and correct. Applicant understands that the District will design the ISTS for the Property based on the information contained in this Application and that any changes in the information will require the consent and approval of the District of any such change. Applicant authorizes the District to verify this information and retain the application whether or not it is approved. Applicant further authorizes the District to receive and retain credit information on Applicant’s credit experience with other creditors.
3.2. Applicant hereby agrees to use the ISTS strictly in accordance with the ordinances, rules and regulations of the District, which ordinances, rules and regulations are made part of this application as though printed herein in full. Applicant agrees to pay all valid bills or charges for the ISTS. Applicant further agrees that payment for all amounts related to the ISTS shall be the primary responsibility of the owner of the property served by the ISTS and that any and all unpaid amounts related to the ISTS shall be a lien on the property served by the ISTS and may be certified to the St. Louis County Auditor to be collected in the same manner as other taxes.
3.3. Applicant understands and agrees that if there is more than one Applicant that they are jointly and severally liable for any charges related to the ISTS.
3.4. Applicant hereby agrees that the District has the right to access the ISTS at all reasonable hours for inspection and maintenance of the same or for any other lawful errand.
3.5. Applicant will be obligated to execute and deliver an ISTS Construction and Managed System Agreement (“Managed System Agreement”) prior to obtaining service.
- 4. Representations, Covenants and Agreements of Applicant for Sewer Service
4.1. Applicant do(es) hereby agree(s) as follows:
4.1.1. To indemnify and hold the District harmless from any loss or damage that may be directly or indirectly occasioned by the use of the ISTS.
4.1.2. To comply with the terms and provisions of the Managed System Agreement and the requirements of any applicable ordinances, standards and regulations of the District and other governmental units with respect to the use of the ISTS as they presently exist or are hereinafter adopted or amended.
4.1.3. To pay to the District for the purpose of paying for the construction, reconstruction, repair, enlargement, improvement, maintenance and operation of the ISTS a connection charge as set forth in the Managed System Agreement upon execution of the Managed System Agreement.
4.1.4. To verify the location of any other utilities in the area of any excavation required for the ISTS and to notify the District of such utilities before work is commenced on the ISTS.
4.1.5. All terms used herein shall have the meaning given to them in the Managed System Agreement, unless the context clearly requires otherwise.
|Applicant / Owner
|Co-Applicant / Co-Owner
DATA PRACTICES ADVISORY
Certain information that you are asked to provide in this application is classified by state law as either public, private or confidential. Public data is information that can be given to the public. Private data is information that generally cannot be given to the public, but can be given to the subject of the data. Confidential data is information that generally cannot be given to either the public or the subject of the data.
Our purpose and intended use of this information is to provide ISTS Managed System.
You are not legally required to provide this information.
You may refuse to provide this information.
The known consequences of refusing to supply data is the District may be unable to provide ISTS.
The undersigned has read this advisory and understands it.
Dated this _____ day of ________________, 20__.
Applicant / Owner
Co-Applicant / Co-Owner
Service Approved By: