Form Mde/wma-Per018 - Financial Management Plan - Privately Owned Water/sewerage Systems
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209.06
MARYLAND DEPARTMENT OF THE ENVIRONMENT
1800 Washington Boulevard
Baltimore, MD 21230
(410) 537-3000
1-800-633-6101
OFFICE OF BUDGET AND INFRASTRUCTURE FINANCING
Engineering and Capital Projects Program (ECPP)
(410-537-3767)
Financial Management Plan
Privately Owned Water/Sewerage Systems
Article 9-510 of the Annotated Code of Maryland requires that before the issuance of a permit for water and/or sewerage construction,
a Financial Management Plan (FMP) be submitted for review/approval to ensure the future fiscal health of the proposed system.
PART I
A.
Project Name: _____________________________________
County: ___________
Applicant: _____________________
Designated Permit Number: ________________
B.
System Capacity: _______ gallons/day
Total Number of Users:_______________
System Capital Debt: $_________________
Annual Debt Payment: $______________
Source of Revenue for Debt Payment: ______________________________________________
PART II
Has a financial report regarding the proposed system been provided to the Public Service Commission or any other institution?
(Check "yes" or "no")
_____
State the purpose of the financial report (attach a copy), and provide information in "Part III" below that is not included in
(Yes)
the report.
_______________________________________________________________________________________________
_____
Complete information in "PART III" below.
(No)
PART III
A.
Annual Revenue and Operations, Maintenance & Replacement (OM&R) Budget
OM&R Revenue Items
Annual Revenue
•
Water and/or Sewer User Fees
$ ___________________________
•
Other Fees
$ ___________________________
____________________________________________________________________________
Total OM&R Revenue:
$ ___________________________
OM&R Items
Annual Budget for Expense
•
Operations
$ ____________________________
•
Maintenance
$ ____________________________
•
Replacement
$ ____________________________
•
Other
$ ____________________________
________________________________________________________________________
Total OM&R Expense:
$ ____________________________
MDE/WMA-PER018
Page 1 of 2
September 2012
TTY Users 1-800-735-2258
Recycled Paper
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