HomeMy WebLinkAboutIowa Department of Natural Resources - Sewage Treatment Agreement - 4/6/2020Iowa 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 writine that the contractual aereement does exist.
APPLICANT
ENGINEER
Owner: Midwest Development Company
Firm: Clapsaddle-Garber Associates, Inc.
Address: 417 1st Ave, SE, Cedar Rapids, IA 52401
Address: 5106 Nordic Dr, Cedar Falls, IA 50613
Representative: Kevin Fittro
Project Officer: Daryl D. Albertson, P.E.
Phone Number: 319-493-0919
Phone Number: 319-266-0258
Project Identification: Lincolnshire Addition
Owner and System Receiving Wastes: City of Waterloo Waste Water Management
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 id en Tied above.
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Signature woet Title: V p 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 not be construed in any way to affect any local ordinances,
sewer service agreements, or fee systems entered into between the parties.
Name: U%koi� j/� QVr Title: �nj%,Jj"
Signature �L /y1Sti W ( - Date U aVaO Phone: 31 q ���^�3a3
9/2018 cmc DNR Form 542-3219; 29