HomeMy WebLinkAboutDNR_-_Sewage_Treatment_Agmnt_-_6.2.2025 Docusign Envelope ID:01103EED-CIAO-4BA5-BO38-OC40EB96CC3F
Iowa Department of Natural Resources
D 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: Panther Builders Firm: McClure Engineering Company
Address: 616 Clay St. Cedar Falls, IA 50613 Address: 2229 E. Grantview Lane, Suite 2 Coralville, IA 52
Representative: Kevin Fittro Project Officer: Bryce Achen
Phone Number: 319-493-0919 Phone Number: 319-626-9090
Project Identification. Baltimore Fields 2nd Addition
Owner and System Receiving Wastes. WATERLOO CITY OF STP- 790001
CERTIFICATION
I am the authorized representative of the owner identified above and state that the proposed sanitary sewage facilities shall be
constructed in accorda ce with the plans and specifications and all wastes contributed by this project shall be discharged to the
treatment system ide tiff d above.
Signature Title: Manager Date 5/6/25
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 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.
Quentin Hart Mayor
Name: Docusignedby: Title:
Signatur a(AlLfi , A� Date 6/2/2025 phone:
9/2018 cmc DNR Form 542-3219;29