HomeMy WebLinkAboutDNR - Sanitary Sewer 4803 Sergeant Rd - 3.17.2025Iowa 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.
Owner:
APPLICANT
DGOGWaterlooia02142024, LLC
Address: 1906 E Battlefield Rd, Springfield MO 65804
Representative: Jacob Stauffer
Phone Number: 417-256-4790
Firm:
ENGINEER
Overland Engineering, LLC
Address: 1598 Imperial Center, Suite 2009, West Plains, MO
Project Officer: Russell Doss
Phone Number: 417-256-8150
Project Identification: Waterloo Dollar General #30840 - Sanitary Sewer Extension
Owner and System Receiving Wastes: City of Waterloo STP
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 identified above.
Signature
Title: Engineer Date 02/11/2025
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 Hart
Signature 62%cer %rc 9-tar
[10 'ALLY
SIGNS
Title: Mayor
Date 3/17/2025 Phone: 319-291-4301
9/2018 cmc DNR Form 542-3219; 29