mvlwb municipa… · 2016-05-19 · may 19, 2016 mackenzie valley land and water board gwich’in...

MVLWB Municipal Water Licence Questionnaire Application

May 19, 2016 Mackenzie Valley Land and Water BoardGwich’in Land and Water BoardSahtu Land and Water BoardWek’èezhìi Land and Water Board

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Municipal Water Licence Questionnaire Application

Applicant Information

Community Name:

Community Status: (City, Village, Town, Hamlet, Settlement Corporation)

Contact Person:

Contact Phone Number:

Contact Email:

Fax Number:

Postal Address:

Community Population (Refer to: http://www.statsnwt.ca/population/community-projections/)

Year Population (Use Projections from www.statsnwt.ca)

Current Year:

Year +1:

Year +2:

Year +3:

Year +4:

Year +5:

Health Concerns

Please indicate if there have been any health concerns with the operation or maintenance of any

facilities.

Facility Concerns

Water Treatment Plant

Water Storage Facility (Reservoir)

Wastewater Treatment System (Lagoon)

Solid Waste Facility (Landfill)

http://www.statsnwt.ca/population/community-projections/

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Environmental Concerns

Please indicate if there have been any environmental concerns with the operation or maintenance of

any facilities.

Facility Concerns


Water Storage Facility (Reservoir)



Facility Condition

Please indicate the general condition of the existing facilities.

Facility Condition (Satisfactory/Unsatisfactory)

If unsatisfactory, please explain


Water Storage Facility



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Upgrades

Please indicate if any changes or upgrades to the existing facilities are planned. If yes, please describe

changes and attach a copy of the plan, if available.

Facility Planned Upgrade Reason for Upgrade Date of Planned Upgrade





Abandoned and Restored Facilities

Abandoned Facilities Location(s) Abandoned? (Y/N) Restored? (Y/N)





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Studies

Please list and attach any relevant reports and studies related to regional or local water quality, water

use, water storage, water treatment, wastewater treatment and solid waste management in the

community

Study Name Year Information Covered Please attach or provide hyperlink here

Operation and Maintenance Plan Templates for Municipal Water Licences

The Mackenzie Valley Land and Water Board

www.mvlwb.comBox 2130

7th Floor - 4922 48th StreetYellowknife, NT X1A 2P6

Phone: (867) 669-0506Fax: (867) 873-6610

Municipal QuestionnaireNew Municipal WL Questionnaire Application Document Final May 19 2016

Community Name: Community Status City Village Town Hamlet Settlement Corporation: Contact Person: Contact Phone Number: Contact Email: Fax Number: Postal Address: YearCurrent Year: Population Use Projections from wwwstatsnwtcaCurrent Year: YearYear 1: Population Use Projections from wwwstatsnwtcaYear 1: YearYear 2: Population Use Projections from wwwstatsnwtcaYear 2: YearYear 3: Population Use Projections from wwwstatsnwtcaYear 3: YearYear 4: Population Use Projections from wwwstatsnwtcaYear 4: YearYear 5: Population Use Projections from wwwstatsnwtcaYear 5: ConcernsWater Treatment Plant: ConcernsWater Storage Facility Reservoir: ConcernsWastewater Treatment System Lagoon: ConcernsSolid Waste Facility Landfill: ConcernsWater Treatment Plant_2: ConcernsWater Storage Facility Reservoir_2: ConcernsWastewater Treatment System Lagoon_2: ConcernsSolid Waste Facility Landfill_2: Condition SatisfactoryUnsatisfactoryWater Treatment Plant: If unsatisfactory please explainWater Treatment Plant: Condition SatisfactoryUnsatisfactoryWater Storage Facility: If unsatisfactory please explainWater Storage Facility: Condition SatisfactoryUnsatisfactoryWastewater Treatment System Lagoon: If unsatisfactory please explainWastewater Treatment System Lagoon: Condition SatisfactoryUnsatisfactorySolid Waste Facility Landfill: If unsatisfactory please explainSolid Waste Facility Landfill: Planned UpgradeWater Treatment Plant: Reason for UpgradeWater Treatment Plant: Date of Planned UpgradeWater Treatment Plant: Planned UpgradeWater Storage Facility: Reason for UpgradeWater Storage Facility: Date of Planned UpgradeWater Storage Facility: Planned UpgradeWastewater Treatment System Lagoon: Reason for UpgradeWastewater Treatment System Lagoon: Date of Planned UpgradeWastewater Treatment System Lagoon: Planned UpgradeSolid Waste Facility Landfill: Reason for UpgradeSolid Waste Facility Landfill: Date of Planned UpgradeSolid Waste Facility Landfill: LocationsWater Treatment Plant: Abandoned YNWater Treatment Plant: Restored YNWater Treatment Plant: LocationsWater Storage Facility: Abandoned YNWater Storage Facility: Restored YNWater Storage Facility: LocationsWastewater Treatment System Lagoon: Abandoned YNWastewater Treatment System Lagoon: Restored YNWastewater Treatment System Lagoon: LocationsSolid Waste Facility Landfill: Abandoned YNSolid Waste Facility Landfill: Restored YNSolid Waste Facility Landfill: Study NameRow1: YearRow1: Information CoveredRow1: Please attach or provide hyperlink hereRow1: Study NameRow2: YearRow2: Information CoveredRow2: Please attach or provide hyperlink hereRow2: Study NameRow3: YearRow3: Information CoveredRow3: Please attach or provide hyperlink hereRow3:

mvlwb municipa… · 2016-05-19 · may 19, 2016 mackenzie valley land and water board gwich’in...

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