HomeMy WebLinkAboutDNR - Sewer Treatment Agmnt - 5/29/2018DSR
Iowa Department of Natural Resources
Wastewater Section
Construction Permit Application
Sewage Treatment Agreement
INSTRUCTIONS
This agreement must be executed for all projects where construction and sewage treatment will be provided by different parties;
i.e., a private subdivision connecting to a municipal system. This agreement must be executed by the parties who are owners at the
time the permit is issued, regardless of whether title to the proposed construction project will be transferred after completion of the
project.
This agreement is not necessary when a contract for sewage treatment already exists; i.e., service contracts between municipa Iities.
However, the Department of Natural Resources must be informed in writing that the contractual agreement does exist.
APPLICANT
ENGINEER
Owner: BCS Properties
Firm: Clapsaddle-Garber Associates
Address: 604 Clay Street Cedar Falls, IA 50613
Address: 16 E. Main St. Marshalltown, IA 50158
Representative: Brent Dahlstrom
Project Officer: Adam C. Daters
Phone Number: 515-867-7000
Phone Number: 641-752-6701
Project Identification: Village West 2nd Addition
Owner and System Receiving Wastes: City of Waterloo - Water Pollution Control Plant
CERTIFICATION
I am the authorized representative of the owner identified above and state that the proposed sanitary sewage facilities shall be
constructed in accordance with the plans and specifications and all wastes contributed by this project shall be discharged to the
treatment system identified above.
Signature Title: Owner Date �[l ✓����
AGREEMENT TO PROVIDE SEWAGE TREATMENT
I am the authorized representative of the owner of the system identified above and state that the connection of the proposed
sanitary sewage facilities identified above is approved by the owner, and that the owner accepts responsibility for providing
adequate treatment of all wastes contributed by this project, in accordance with the provisions of Chapter 455B, Code of Iowa, and
the rules of the Department of Natural Resources. This agreement shall be construed in any way to affect any local ordinances,
sewer service agreements, or fee systems entered into between the parties.
Name: en -A-' rn Title: 0✓
Signature ? mkt C.`F"lam > Date �`�'� �� Phone:
11/2015 cmc DNR Form 542-3219; 29