HomeMy WebLinkAboutDNR Form 29 - Lost Worlds Theme Park - 8/12/2019Iowa 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
Owner: Lost Island Real Estate, LC
ENGINEER
Firm: Wayne Claassen Engineering and Surveying
Address: 2225 E. Shaulis Rd., Waterloo, IA 50701
Address: 2705 University Ave. Waterloo, IA 50701-0898
Representative: Eric Bertch
Project Officer: William J. Claassen
Phone Number: 319-290-7588
Phone Number: 319-235-6294
Project Identification: Lost Worlds Theme Park, Waterloo, Iowa
Owner and System Receiving Wastes: CITY OF WATERLOO, IOWA
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 identifie bo e.,
Signature - ,,)/...23 /—'^*- Title: Eric Bertch, Registered AgentDate • 7 ��
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 not be construed in any way to affect any local ordinances,
sewer service agreements, or fee systems entered into between the parties.
Name: Quentin M. Hart Title: Mayor
Signature _.k, t_i2,yl51 / Date / (2 / i 164k Phone: 319-291-4301
9/2018 cmc
DNR Form 542-3219; 29