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Home My WebLink AboutDNR - Sewage Treatment Agreement - 4/22/10IOWA 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: Magnolia Development, LLC Address: 1732 Pinehurst Ln City, State, Zip: Waterloo, IA 50701 Project Identification: Magnolia Hills $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 4556.197 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 515-725-8427 or Donna.GommPdnr.iowa.gov Signature of Owner or Representative: Printed Name: r-\-\ Y\ Telephone or email contact: Mail to: Iowa Department of Natural Resources Wastewater Engineering Section 502 East 9th Street Des Moines, IA 50319-0034 11/2014 cmc DNR Form 542-1245 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 Nat uralResources must be informed in wr't'mth t Lt i ng a e contractual agreement does exist. APPLICANT Owner: Magnolia Development, LLC ENGINEER Firm: Clapsaddle-Garber Associates, Inc. 1732 Pinehurst Ln, Waterloo, IA 50701Phillip Address: Shirk Address: 5106 Nordic Dr, Cedar Falls, IA 50613 Representative: Phillip Shirk Project Officer: Daryl D. Albertson, P.E. Phone Number: 319-239-4446 Phone Number: 319-266-0258 Project Identification: Magnolia Hills Owner and System Receiving Wastes: City of Waterloo Waste Water Management CERTIFICATION I am the authorized representative of the owner identified above and constructed in accordance with the plans and specifications and all treatment system identified above. Signature Title: state that the proposed sanitary sewage facilities shall be wastes contributed by this project shall be discharged to the 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 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: 0 \s eAr\-\-'\ y --\c_{ t _. Title: 1,k_Ct.i. c I," �-- Signature ; i :, - ,'_f ^ Date 0-- � I Phone: 11/2015 cmc DNR Form 542 3219; 29 Exhibit 11A Iowa Department of Natural Resources Wastewater Section Construction Permit Application SCHEDULE A, Construction Permit Application APPLICANT Owner: Magnolia Development, LLC Address: 1732 Pinehurst Ln, Waterloo, IA 50701 Representative: Phillip Shirk Phone Number: 319-239-4446 Email: phillip@amywienands.com ENGINEER Firm: Clapsaddle-Garber Associates, Inc. Address: 5106 Nordic Drive, Cedar Falls, IA 50613 Project Officer: Daryl D. Albertson, P.E. Phone Number: 319-266-0258 Email: dalbertson@cgaconsultants.com Project Identification: Magnolia Hills, Waterloo, IA 50701 November Estimated Start Date*: April 2019 Estimated Completion Date: 2019 PLEASE RESPOND TO ALL QUESTIONS 1. Has an engineering report, facilities plan or other information previously been submitted for this project? If Yes: Project Identity: Date Submitted: 2. Does the project and construction permit application, as submitted, follow the recommendations, design loadings, construction schedule, permit limits, and conclusions of the approved engineering report or facilities plan? If No: Provide the design basis and technical information justifying all changes. 3. Are there three complete sets of plans and specifications accompanying this application? Yes No CI ® ❑ ® ❑ For a minor gravity sewer extension within the meaning of 455B.183.3 Code of Iowa and Design Standard 11.1, two complete sets will be adequate for expeditious approval. For more complex projects, three sets of plans and specifications may be requested. 4. Are approved standard specifications a part of this application? If Yes: Approved Standard Specifications of Iowa SUDAS and City of Waterloo (municipality or firm): Standard Specifications Date Approved: 5. Does each set of plans and specifications or engineering report accompanying this application contain a "professional engineering seal" executed in conformance with 542B,16, Code of Iowa? If No: Processing will be delayed pending receipt of applicable design schedules and certified plans, specifications or engineering report. 6. Is this a joint wastewater and water supply project? 111 ® ❑ If Yes: A construction permit application for the water supply project should be submitted separately to the Water Supply Section. A Water Supply permit fee may be required. 7. Is the applicant to provide treatment of effluent resulting from this construction? If No: A Sewage Treatment Agreement executed by the authority providing treatment must accompany this form. 8. Is a new or amended operation permit necessary to use the facilities described in this application? If Yes: A new or amended permit to operate may be requested prior to the receipt of a construction permit. 9. Is any waterline located within 10 feet; or any private or public well, lake, or public recreation area located within 400 feet of the proposed construction? If Yes: Identify and locate the facility(ies) relative to the proposed construction. 10. Will construction inspection be conducted by a licensed engineer employed by the applicant? ® ❑ ® n If No: Name of Engineering Firm Conducting Inspection: 11. Will this 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. Signature *Estimated �f ! Date _'.- I `k Signature Date Construction Start 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 ENGINEER I certify that all aspects of the 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. 04/2016 cmc DNR Form 542-3129; 28A Item Coversheet Page 1 of 1 CITY OF WATERLOO Council Communication Resolution approving Construction Plans for Paving, Sanitary Sewer, and Storm Sewer serving Magnolia Hills, as submitted by Clapsaddle-Garber Associates, Inc., of Cedar Falls, Iowa, and Sewage Treatment Agreement DNR Form 29 (Nov 00) with the Department of Natural Resources and the final acceptance of construction plans subject to the review and acceptance by the DNR; and authorize Mayor to execute said agreement. City Council Meeting: 4/22/2019 Prepared: 4/17/2019 REVIEWERS: Department Reviewer Action Date Engineering Knutson,.lar Rejected 4/17/2019 - 10:05 AM SUBJECT: Submitted by: Summary Statement: Resolution approving Construction Plans for Paving, Sanitary Sewer, and Storm Sewer serving Magnolia Hills, as submitted by Clapsaddle-Garber Associates, Inc., of Cedar Falls, Iowa, and Sewage Treatment Agreement DNR Form 29 (Nov 00) with the Department of Natural Resources and the final acceptance of construction plans subject to the review and acceptance by the DNR; and authorize Mayor to execute said agreement. Submitted By: Dennis Gentz, PE, Assistant City Engineer These construction plans have been reviewed by the Engineering Department. They appear to meet current design standards and specifications, therefore they are recommended for approval by the City Council. https://waterloo.novusagenda.com/AgendaWeb/CoverSheet.aspx?ItemID=14385 4/17/2019