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Home My WebLink AboutJDE Engineering, PLC.-11/9/2015Exhibit 11A Iowa Department of Natural Resources Wastewater Engineering Section Construction Permit Application orm ep 542-3129 APPLICANT ENGINEER OWNER E-MAIL ADDRESS CITY OF WATERRLOO eric.thorson@waterloo-ia.org FIRM E-MAIL ADDRESS JDE ENGINEERING, PLC jdeeng(ulpctel.net ADDRESS 715 Mulberry Street, Waterloo, IA 50703 ADDRESS 3731Pheasant Lane, Suite #201, Waterloo, IA 50701 REPRESENTATIVE TELEPHONE Eric Thorson 319-291-4312 PROJECT OFFICER TELEPHONE Jim D. Ellis, PE 319-464-7913 PROJECT IDENTIFICATION N. E. Industrial Park San. Sewer & Water Main Ext. ESTIMATED START DATE * 12/01/2015 ESTIMATED COMPLETION DATE 07/01/2016 1. Has an engineering If Yes=> 2. Does the Loadings, facilities If No=> 3. Are there For Standard three 4. Are approved If Yes=> 5. Does each "professional If No=> Processing specifications 6. Is this a If Yes=> A Water 7. Is the applicant If No=> A accompany 8. Is a new If Yes=> A 9. Is any waterline within 400 If Yes=> Identify 10. Will construction If No=> 11. Will this project construction plan? Provide three a minor sets joint construction Sewage or new PLEASE RESPOND TO ALL QUESTIONS YES NO report, facilities plan or other information previously been submitted for this project? ❑ X PROJECT IDENTITY DATE SUBMITTED and construction permit application, as submitted, follow the recommendations, design schedule, permit limits, and conclusions of the approved engineering report or the design basis and technical information justifying all changes. complete sets of plans and specifications accompanying this application? gravity sewer extension within the meaning of 455B.183.3 Code of Iowa and Design 11.1, two complete sets will be adequate for expeditious approval. For more complex projects, of plans and specifications may be requested. standard specifications a part of this application? X ❑ X ❑ X ❑ X ❑ X ❑ X ❑ ❑ X ❑ X ❑ X ❑ X APPROVED STANDARD SPECIFICATIONS OF (municipality or firm) SUDAS Standards DATE APPROVED 10/18/2011 set of plans and specifications or engineering report accompanying this application contain a engineering seal" executed in conformance with 542B.16, Code of Iowa? will be delayed pending receipt of applicable design schedules and certified plans, or engineering report. wastewater and water supply project? permit application for the water supply project should be submitted separately to the Supply Section. A water supply permit fee may be required. to provide treatment of effluent resulting from this construction? Treatment Agreement (DNR Form 29) executed by the authority providing treatment must this application. amended operation permit necessary to use the facilities described in this application? or amended permit to operate may be requested prior to the receipt of a construction permit. located within 10 feet; or any private or public well, lake, or public recreation area located feet of the proposed construction? and locate the facility(s) relative to the proposed construction. inspection be conducted by a licensed engineer employed by the applicant? NAME OF ENGINEERING FIRM CONDUCTING INSPECTION JDE Engineering, PLC project utilize CWSRF loan funds? CERTIFICATION APPLICANT I certify that I am the authorized representative of the owner and state that the project identified above is approved by the owner. ' ENGINEER I certify that all aspects of design included in this application conform to applicable standards contained in Chapter 567 IAC 64, or that an explanation and justification for any proposed variations from such standards is attached. I am familiar with the information contained in this application, and to the best of my knowledge, such information is complete and accurate. - / iNA / / DA 0` R f (� /. - / I SIGN r DATE �. ii/51l * . ' imated Con 'ructio " tart Date: Complete applications must be submitted at Least 120 days in advance of the date for starting construction in accordance with Rules 567 IAC 60.4 and 64.2 PLEASE COMPLETE THE SCHEDULE CHECKLIST ON THE FOLLOWING PAGE OF THIS FORM orm ep 542-3129 IOWA DEPARTMENT OF NATURAL RESOURCES Wastewater Disposal System Construction Permit Application Fee Form CASHIER'S USE ONLY 0945-542-N P DE -CP -0570 32-3202 Owner Owner Name: City of Waterloo Address: 715 Mulberry Street City, State, Zip: Waterloo, IA 50703 Project Identification: N E Industrial Site Sanitary Sewer and Water Main Extension $100 Fee enclosed Please sign and return this form with a check or money order payable to "Iowa Department of Natural Resources". Place it and the check or money order on top of other Construction Permit Application documents. Effective beginning July 1, 2006, Applications for Construction Permits for wastewater disposal systems required by Iowa Code 455B.173 and rules in Iowa Administrative Code 567 IAC 64, must be accompanied by the fee required by Iowa Code 455B.197 and Iowa Administrative Code 567 IAC 64.16(3)"c". The fee is $100 for each application, regardless of project size and project type including sanitary sewers, pump stations, treatment units or a combination thereof. The fee shall be submitted with the certified engineering documents necessary to apply for a construction permit (plans, specifications and related application schedules A, F, and G as well as the appropriate schedules indentified on page 2 of Schedule A). The construction permitting process is initiated as planning for construction begins. Planning coordination and submittal of preliminary engineering reports or facility plans precedes submittal of technical documents necessary to constitute a construction permit application. The application fee is not necessary when submitting a planning document but must accompany construction permit application documents. A fee should accompany each permit application received on or after July 1, 2006. Failure to submit a fee with the application may delay the processing of a construction permit. If you have any questions regarding the application fee, please contact Donna Gomm at 515-281-8502 or Donna.Gomm@dnr.iowa.gov Signature of Owner or Representative: Printed Name: Ernes-- Q. Telephone or email contact: Mail to: Iowa Department of Natural Resources Wastewater Engineering Section 502 East 9th Street Des Moines, IA 50319-0034 06/2011 cmz DNR Form 542-1245