HomeMy WebLinkAboutIowa Department of Natural Resources-Sewage Treatment Agreement-12.21.2009 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 Natural Resources must be informed in writing that the contractual agreement does exist.
APPLICANT ENGINEER
OWNER FIRM
Hope M.Anderson VJ Engineering
ADDRESS ADDRESS
PO Box 777,Waterloo,IA 50704 1501 Technology Parkway, Suite 100,Cedar Falls,IA 50613
REPRESENTATIVE TELEPHONE PROJECT OFFICER TELEPHONE
Hope M.Anderson 319-234-1715 Bruce P.Radue,P.E. 319-266-5829
PROJECT IDENTIFICATION
Anderson Building,et al
OWNER AND SYSTEM RECEIVING WASTES
City of Waterloo
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.
SIGNATURE TITLE DATE
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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 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.
SIGNATURE TYPED OR PRINTED NAME
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TITLE PHONE NUMBER DATE
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DNR form 29(No 0) 542-3219
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