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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.
fins 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 FIRM
leer ,1 e elopme,9 , LLL schen, F6gu-7eerR (n11 p /l y
ADDRESS ("43 G r!Pt,-I/- Ckid ADDRESS C,1 gyyale er/d e ,(art t.ie
(da erlco , /01.0 6070 / la1/-er/ , /ocj& so-o,-.
REPRESENTATIVE TELEPHONE PROJECT OFFICER TELEPI IONE
f laroL/ VOur btu 319-,M-40ai truce P kczctic«
PROJECT IDENTIFICATION
�Ye.er)2e/-74 C:ernre AYeCr"
OWNER AND SYSTEM RECEIVING WASTES
/c2/e r/cam
CERTIFICATE
I am the authorized representative of the owner identified above and state that the proposed sanitary sewerage 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 identified above.
Sl 'N TU TITLE ( y DATE
Mit Vfr
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
sewerage 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 45513, 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.
SIGNATURE TYPED OR PRINTED NAME
TITLE PHONE NUMBER DATE
y o r I a
DNR form 29(Nov 00) 542-3219
Iowa Department of Natural Resources
Wastewater Section
Construction Permit Application
SCHEDULE A,General Information
APPLICANT ENGINEER
0 ER FIRM
eer t'?reek m
,Developr»4, LL_� <Schenk L=r�5ir,eer/i-) Oomy.)0/-)/
ADDRESS (..p4,3 (art .epiy-h (Road ADDRESS 6?/C,0 /3rcx ,&errC/,9-e Dori,
aier7t�, /A 5'70 / Gcla_torlco, MLV -. 5 97e '
REPRESENTATIVE TELEPHONE PROJECT OFFICER TELEPHONE
t/arold Vear ,blue 3IG - (09-4oel 43race I? 2ctelete 3i9- 3a-7ff8o
PROJECT IDENTIFICATION ESTIMATED START DATE * ESTIMATED COMPLETION DATE
(2,reer)bel4 0eifre Area, b-ecemb.r , COlo "97ay a007
PLEASE RESPOND TO ALL QUESTIONS YES NO
I Has an engineering report, facilities plan or other information previously been submitted for this project? ❑ Z
If Yes=> PROTECT 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? [ ❑
For a minor gravity sewer extension within the meaning of 455B.183.3 Code of Iowa and Design
Standard 1 1.1,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'? Z
If Yes=> APPROVED STANDARD SPECIFICATIONS OF DATE APPROVED
(municipality or firm)
( Q eI/e'o
S. 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? ® fE
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? ❑
If Yes=>A construction premit 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? ❑ CS
If No=>A Sewage Treatment Agreement(DNR Form 29)executed by the authority providing treatment must
accompany this application.
8. Is a new or amended operation permit necessary to use the facilities described in this application? L
If Yes=>A new or amended permit to opeft3te 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(s)relative to the proposed construction.
1 U. Will construction inspection be conducted by a licensed engineer employed by the applicant? 2 ❑
If No=> NAME OF ENGINEERING FIRM CONDUCTING INSPECTION
( ./-)enk_ Er7 i7t
, 'eri le p1r)/
CERTIFICATION
APPLICANT ENGINEER
I certify that I am the authorized representative of the owner and I certify that all aspects of design included in this application
state that the project identified above is approved by the owner. 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.
GNA SIGNATURE
Hail
DATE
* Estimated t ion Start Date: Complete applications must be submitted at least 120 days in advance of the date for
starting c n trued n in accordance with Rules 567 IAC 60.4 and 64.2
PLEASE COMPLETE I'HE SCHEDULE CHECKLIST ON THE FOLLOWING PAGE OF 1'HIS FORM
DNR form 28A (Nov 00) 542-3129
Iowa Department of Natural Resources
Wastewater Section
Construction Permit Application
SCHEDULE B, Collection system
D.\TE PREPARED PROJECT IDENTITY DNR USE
//-w39--rl(p PROJECT NO.
DATE REVISED / 1 /)
-ree. li bel-f de fr- it. .., rem PERMIT NO.
1. Identify proposed construction which is subject to flooding and explain what is proposed to prevent water from entering the
.y.tem. If no portion is subject to flooding, state none.
Segment Flooding Protection
Al le✓a-f� *)px Oct c) �'loc?�' /err)
or /'/Ood-proof /i(-J
•3. Indicate hydraulic capacity of: I) the nearest downstream main or interceptor, 21 the nearest downstream lift station. ane
3) all downstream segments where flow restriction may occur. Indicate the source and accuracy of numerical darn.
Segment Segment Segment
Location it/ T'/4, Se&• A/E4, Se .
to-e8-/3 [n -f3F3-i3
Design capacity,MOD
/3.0 .v-3.O
Peak Hourly Dry weather Flow
MGD(actual) 0•� 0.
Peak Hourly Wet Weather Flow
MOD(actual) 0•G' O. Co
•3. Identify treatment facility,the design loadings and present raw waste loadings. Indicate source and accuracy of numerical data.
aiezter/ Zfer f.- / 60f/1/- C'or2/-re)/ P/c '-
Facility name and number /eecJdL /1/0 . 0 7900/, f-ze /✓k• onek,.. jai S--e)
Facility Loading MGD #BOD5/day
Design .3 ,c' C)
Average Wet Weather(actual) 1�,53 3/,6-00
Peak Hourly Wet Weather(actual) (pn± 4 3,Czl') t
Provide projected design loading increase, which will be added to this facility as a result of this project.
Design Loading Initial Design Year(,70/5- )
Residential service area Acres Acre..
Population Persons Persons
Flow(100 GPCD) GPD GPD
BOD5 (0.17 a!d%cap) q/day o,day
Industrial service area Acres Acres
Rated flow GPD (iP!)
BODS tt/day Et/day
Other Oornrn�re/1/ _ /4o Acres (r¢0 Acres
Rated Flow 70, 0 GPD San,(y7) GPD
BOD5 ii9 elday -514- a!dvy
Total DOD5 //9 e/day .54-4- tt/day
Total Flow '70, CY7) GPD 3 )O, GPD
Peak Hourly Flow /75 00C) GPD e ( ') GPD
• Include a written explanation of items 2 and 3 if the sewer system and/or treatment facility are overloaded.
DNR form 28D (Nov 00) 542.309;
Iowa Department of Natural Resources
Wastewater Section
Construction Permit Application
SCHEDULE C, Lateral Sewer Extension
DATE PREP.\RED PROJECT IDENTITY DNR USE
/I -A9-0 , PROJECT NO.
DATE REVISED /J /
g reel�,t!'el� der Arecz-- PERMIT NU.
1. 1)csiyi basis Initial Design Year(aD/S 1
Residential service area Acres .Acre:
Population Person: PcrsLi
flow(100 GPCD) GPD GPI)
CIODi (0.17 r'd4capr nida.; r,diy
Industrial service area .\eres .-\,.:re
Rated flow CiPI) UPI)
UOD; ??;day L,d;:}
Other Ocinme fcied /4 0 Acres (o4 0 ..\ere
Rated Flow 70, Ord' GPD 3 Q, r` GPI)
BODs /;9 niday 544 r-day
Total BODS //9 1:,'day 544 ;:,day
Total Flow 7Oi 000 GPD .3�I7/r`�.''t') GPD
Peak Hourly Flow /75 OM OPI) t3eV, ') GPn
2. Pipe
Diameter 8 Inch 10 Inch 12 Inch
Material f9-5771 J DAL -O/ '961 Th Dv(v5O-O/ A-Stm ,O.;&",")0/
Joint /.577/7- DD2l5 /)-oi /+,Srm as&' -Q/ t}srm DaroO-O/
Minimum Slope 0,4-0 0/0 0,40 % 0.4-0 %
Maximum Manhole Space .39 s R. 34-O n. 3(03 h
Total Sewer Length / 41,-, ft.. /oao ft. ABf3 ft.
Maximum Cover 6/.0 ft. /o"I,s ft. /4,S" ft.
Minimum Cover t¢,5- II. 9,0 It. /a,S ft
3. Construction specifications(indicate.ASTM No, or other standard included in the specifications). .A brief description is required
in each part.
A. Bedding class ,' 7Y ("/a$ 1/, W,3 /-OS e ieeof as /y)(r/iYed t77 19-S7rM D6,80-0/
B. Pipe1aYin$ 6-ST/Y? (itisSS II D2_321•D5- eireJf as c1//?'ty f t"//2I darnft`D/
C. Compaction Q % ICI dard f'rerrior Dens?-1y
D. Manhole ,q-Srm C 73, 48".Dva--
E. Specified maximum Infiltrationiexfiltration rate Q/) ) CPDPMP(
•
F. Infiltratiunicxliltratiun test procedures V_A/Q/-Ch a)g,r/ Te/rlii SIi-CJ� Dr fir Test
(..i Alignment & grade test procedures ill
(I) During construction: Stake& batter board X Laser )4'
f 2) Alter construction: Lumping X Other TPv/e ,c i j7_ '
H. Donuctiun test procedures 1j4
4. Are detailed manhole drawings included: Yes ❑ No Q
t Typical frame and cover assembly Neenah , 4-3
.-Ve manhole covers nomented: Yes 2 No Oil
Manhole diameter 4-8 in.
Manhole opening diameter �4- in. Material ON-7(1re7/-
111ntmtun sewer x water main separation: Horizontal /D It. \'croeal /8 Are specifications specifications included'' A/D
6 Stream.road. or railroad crossing protection /6, '� x i¢ / �S/ee_/ COGS/l-7
.\re specifications included?
DNK form 28C'(Nov 00) c42.3oy(,
t
STATE OF IOWA
DEPARTMENT OF NATURAL RESOURCES
HENRY A.WALLACE BUILDING
DES MOINES,IOWA 50319
CONSTRUCTION PERMIT
Deer Creek Development,LLC PERMIT NO.: 2007-0368-S
Attn: Mr.Harold Youngblut FILE: Waterloo -Sewage
643 Griffith Road RE: Greenbelt Center Area
Waterloo,IA 50701 PROJECT NO: S2007-0354
In accordance with the provisions of Section 455B.173.3 and 455B.174.4, Code of Iowa, and Rule
567--64.2(455B) or Rule 567--65.6(455B), or Rule 567--43.3(455B) of the Iowa Administrative Code, the
Director of the Department of Natural Resources does hereby issue a permit for the construction of:
1646 linear feet of 8-inch, 1020 linear feet of 10-inch,and 288 linear feet of 12-inch
sanitary sewer,manholes,and all related appurtenances necessary to complete the project
in accordance with the approved plans and specifications.
The construction of the project shall be initiated within one year of issuance of this permit or this permit is
no longer valid. Within thirty days after completion of construction, the permit holder shall submit a
certification by a licensed professional engineer that the project was completed in accordance with the
approved project documents.
No construction activities shall be initiated unless an Iowa NPDES General Permit No. 2 for "Storm
water associated with construction activities" is obtained from the department if the site disturbance and
preparation equals to or exceeds one (1) acre."
The issuance of this permit in no way relieves the permittee of the responsibility for complying with any
other local, state,and federal laws, ordinances, regulations or other requirements applicable to this facility.
Pursuant to Section 455B.174.4, Code of Iowa, you have the right to appeal any condition of this permit by
filing with the Director of the Department of Natural Resources a notice of appeal and request for
administrative hearing within thirty days of receipt of this permit.
Contact Satya Chennupati,P.E. at 515-281-8995 with any questions or comments.
FOR THE DEPARTMENT OF NATURAL RESOURCES
RICHARD A. LEOPOLD,DIRECTOR
n
>'
By
2 /
ENV ONMENTAL SERVI ES DIVISION
Date: May 9,2007
cc: IDNR Field Office#1
IDNR Sewage File 6-07-90-0-01
Schenk Engineering Company
City of Waterloo,City Clerk
Plan Distribution
[1] Applicant; [1] Engineer; [] City of ; [] DNR File; [] Field Office
Koffi Gangba
C`C)
4.f)i
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