HomeMy WebLinkAboutDNR Form 29 - Cedar Valley Crossing - 10/22/2018 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 municipalities.
However,the Department of Natural Resources must be informed in writing that the contractual agreement does exist.
APPLICANT ENGINEER
Owner: Fusion Investments, LLC. Firm: Clapsaddle-Garber Associates,Inc.
Address: 13557 Sharwood Court,Dyersville,IA 52040 Address: 5106 Nordic Dr,Cedar Falls,IA 50613
Representative: Nick Koelker Project Officer: Daryl D.Albertson,P.E.
Phone Number: 563-542-7707 Phone Number: 319-266-0258
Project Identification: Cedar Valley Crossing
Owner and System Receiving Wastes: City of Waterloo Waste Water Management
CERTIFICATION
I am the authorized re resentative of the owner identified above and state that the proposed sanitary sewage facilities shall be
constructed in accorda e with the plans and specifications and all wastes contributed by this project shall be discharged to the
treatment system' ent i a�-�-
Signature Title: (p��S1d&A , Date
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 4558,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 parities.
Name: Vel F trt +ill t Title: NA(x-, o t<.
Signature Date Phone:
11/2015 cmc DNR Form 542-3219;29