HomeMy WebLinkAboutIowa DNR - Sewage Agreement - Audubon Heights 7th Addition 9.28.2020Iowa 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; Le., service contracts between municipalities.
However, the Department of Natural Resources must be Informed in writing that the contractual agreement does axicr
APPLICANT
ENGINEER
Owner: Midwest Development Co.
Firm: Wayne Ciaassen Engineering and Surveying, Inc/
Address: 4111st Avenue SE, Cedar Rapids, IA 52401
Address: 2705 University Ave. Waterloo, IA 50701-0898
Representative: e J , r, -+} ,-,
Project Officer: William J. Claassen, P.E.
Phone Number: `t 4 3 04 t 9
Phone Number: 319-235-6294
Project Identification: Audubon heights 7th Addition, 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 id tified above.
Signature Title: Date - r
AGREEMENTTO 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 a[] 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 not be construed in any way to affect any local ordinances,
sewer service agreements, or fee systems entered into between the parties.
Name: Quentin Hart Title: Mayor
Signature Q"t(A Dart ° Date September 28, 2020 Phone; 319-291-4301
912018 cmc ONR Form 542-3219; 29