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Home My WebLink AboutIowa DNR - IUP Application - 5.18.2026Docusign Envelope ID: 4424E839-B3C5-87D6-8168-57EAB6490C3F CLEAN WATER STATE REVOLVING FUND INTENDED USE PLAN (IUP) APPLICATION I n WA. State Revolving Fund The application for inclusion on the Clean Water State Revolving Fund (CWSRF) IUP can be submitted only when the wastewater project is at the right stage of the construction permitting process. This numbered list outlines the requirements of the permitting process that must be met prior to submitting an IUP application. It also identifies the materials and information needed to complete the IUP application. Please follow the preliminary steps and proceeding instructions to make sure your application is complete before submitting it. PRELIMINARY STEPS FOR IUP APPLICATION SUBMISSION Enter the following information here: 1. Applicant Name: City of Waterloo, Iowa 2. DNR Number (e.g. W2025-#### or S2025-####): W2026-0253A 3. DNR Project Manager Name: Nicole Barbee 4. Project Name/Identification: Airline Highway Lift Station, Force Main, and Sanitary Sewer 5. Project Initiation Meeting Held (enter meeting date): 3/23/26 6. Flows and Loads Concurrence by DNR (enter date or N/A): N/A a. If N/A, state reason: Approved flows and loading remain unchanged 7. Wasteload Allocation Completed (enter date or N/A): N/A 8. Antidegradation Alternatives Analysis Approved by DNR (enter date or N/A): N/A 9. Facility Plan Submitted with IUP Application (choose Yes or Previously Submitted): ❑X Yes a. If previously submitted, enter date submitted: b. If previously submitted, enter certification date: ❑ Previously Submitted 10. Iowa Construction Permit Application Schedule A Submitted with IUP Application (enter Yes or No; previously submitted): 11. Iowa Construction Permit Application Schedule F and G submitted with IUP Application (choose Yes, N/A, or Previously Submitted): Ensure that your IUP application includes the following (all boxes must be checked) 12. IUP Application signed 13. Unique Entity ID (UEI) Number included 14. Property Assurance Form signed and dated (Section 6 of the application) 15. Civil Rights Self Certification Form signed and dated (Section 7 of the application) 16. SRF Environmental Review (ER) Checklist and Attachment included with application 17. Socioeconomic Assessment (SA) Worksheet included with application Yes ❑ No ❑ Yes Submission Instructions: n D• o not submit a single file that includes all requested documents. n E• ach requested document must be submitted as an individual, separate document. n E• ach document must be titled using the following naming convention: n Previously Submitted ❑ Previously Submitted N/A Document Name Required Name/Title Structure Example IUP Application ApplicantName_IUPApplication Waterloo_IUPApplication Environmental Review Checklist ApplicantName_ERChecklist Waterloo_ERChecklist 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 4424E839-B3C5-87D6-8168-57EAB6490C3F Document Name Required Name/Title Structure Example Environmental Review Supporting Materials ApplicantName_ERSupplement_No._ *number each additional document sequentially Waterloo_ERSupplement_No.1 Socioeconomic Assessment Worksheet ApplicantName_SAWorksheet — Waterloo SAWorksheet — Facility Plan ApplicantName_FacilityPlan Waterloo_FacilityPlan Iowa Construction Permit Application Schedules A, F and G ApplicantName_ScheduleX Waterloo_ScheduleA Waterloo_ScheduleF Waterloo_ScheduleG *Your application will not be considered complete or acceptable if items 1 through 17 have not been completed and/or included. 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 4424E839-B3C5-87D6-8168-57EAB6490C3F CLEAN WATER STATE REVOLVING FUND In WA INTENDED USE PLAN (IUP) APPLICATION INSTRUCTIONS SC3L kFvcilvir7uiit ITEMS 1-11: Wastewater Construction Permitting The Clean Water SRF Intended Use Plan Application will only be accepted when Items 1 through 11 have been completed through the Wastewater Construction Permitting Process of the DNR Wastewater Engineering Section. Please refer to the Wastewater Permitting Process Manual for detailed information on these steps. 1. Applicant Name: Enter the name of the applicant who is requesting SRF funding. 2. DNR Number (e.g. W2025-#### or S2025-####): All wastewater construction projects are assigned unique numbers for tracking by DNR. A number beginning with W and the fiscal year indicates a Work Record. A number beginning with S and the fiscal year indicates a Project. 3. DNR Project Manager Name: A project manager from the DNR Wastewater Engineering Section is assigned to each project. 4. Project Name/Identification: A brief title/description of the project from Design Schedule A, General Information. The project description must fall under the project scope established at the project initiation meeting. An accurate description is necessary because multiple construction contracts may have the same project numbers. 5. Project Initiation Meeting Held (date): A project initiation meeting must be held with the DNR, Owner, Consulting engineer (licensed professional engineer), and other parties. 6. Flows and Loads Concurrence by DNR (date): If flows and loadings will change due to the project, the DNR Project Manager must concur with the proposed design flows and loadings prior to preparing the Facility Plan. If answer is n/a, state the reason. Example: previously approved flows and loadings remain unchanged. 7. Wasteload Allocation Completed (WLA) (date): If a Wasteload Allocation is required for the project, it must be completed by the DNR and received by the Owner before preparing the Facility Plan. Enter "N/A" if WLA is not required for the project. 8. Antidegradation Alternatives Analysis (AAA) Approved by DNR (date): If an antidegradation alternatives analysis is required for the project, it must be approved by the DNR Project Manager before the Owner prepares the Facility Plan. Enter date of DNR approval of the AAA. If a Facility Plan is submitted prior to DNR approval of Antidegradation Alternatives Analysis, it will not be accepted for review. Enter "N/A' if AAA is not required for the project. 9. Facility Plan Submitted with IUP Application: After completing all applicable planning steps as discussed above, the Facility Plan may be submitted to DNR. Answer "Yes" if a Facility Plan is submitted along with the IUP application: a. If a Facility Plan was previously submitted, enter the date submitted. b. If the Facility Plan was previously submitted, enter the date of certification by a licensed professional engineer. Facility Plan submissions shall follow Chapter 11 of the Iowa Wastewater Facilities Design Standards. All engineering submittals shall follow all applicable law and rule related to submitting engineering documents by licensed professional engineers. Electronic submittals are acceptable as long as they are in compliance with all applicable law, including but not limited to Iowa Code 542E and Iowa Administrative Code 193C. 10. Iowa Construction Permit Application Schedule A: Design Schedule A must be certified by both the Owner and the Consulting Engineer (licensed professional engineer). It is required and must be submitted for all wastewater projects. Schedule A must indicate that Clean Water SRF financing will be requested to be considered as part of this IUP application. 11. Schedules F and G (if needed for the project): Schedule G provides Wastewater Treatment Plant project design information and Schedule F provides site information for treatment process site selection. Enter "N/A" if these schedules are not needed for the project. 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 4424E839-B3C5-87D6-8168-57EAB6490C3F Items 12-17: Additional SRF Requirements for a Complete Application: 12. IUP Application Signed: The IUP application must be signed by the Applicant's authorized representative. Printed or electronic signatures are accepted. 13. Unique Entity ID (UEI) number Included: The U.S. Federal Government has transitioned from using a Dun and Bradstreet Number (DUNS) to using a UEI number. Entity refers to prime contractors, organizations or individuals applying for assistance awards, those receiving loans, sole proprietors, corporations, partnerships, and any Federal Government agencies desiring to do business with the government. You can register your entity to obtain a Unique Entity ID here: https://sam.gov/content/entity-registration 14. Property Assurance Form Signed (Section 6 of this application): This form is required to be signed and dated regardless of whether or not the Applicant currently intends to purchase land using SRF funds. 15. Civil Rights Self Certification Form (Section 7 of this application): This form is required to be signed and dated. 16. SRF Environmental Review (ER) Checklist and attachments completed and submitted: The ER Checklist outlines the information needed to start the SRF ER services. The ER Checklist can be obtained here: https://www.iowasrf.com/environmental-review/. 17. Socioeconomic Assessment (SA) Worksheet completed and submitted: The SA Worksheet can be obtained here (use the most current FY worksheet): https://www.iowasrf.com/documents-and-guides/. Complete the requested information in the following sections to the best of your ability. Please print or type the information on the form. If a particular item does not apply to your system, enter "N/A" for "not applicable." Attach supporting documentation as needed. Keep a copy of the completed application for your records and submit the signed form and supporting documents to the following e-mail address: srf-iup@dnr.iowa.gov. 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 4424E839-B3C5-87D6-8168-57EAB6490C3F CLEAN WATER STATE REVOLVING FUND INTENDED USE PLAN (IUP) APPLICATION FORM This form may be used to apply for inclusion on the project priority list (PPL) of the Clean Water SRF IUP after or concurrent to submitting the Facility Plan to DNR for approval. IUPs are developed on an annual basis with quarterly updates as needed. This form is not an application for a loan. SRF loan application materials may be obtained at https://opportunityiowa.gov/community/water-quality/srf-programs/drinking-water-loan-program. The loan application should not be completed until after bids are received. Applicants will be required to comply with all applicable State and Federal requirements in order to be eligible to receive SRF funding. A list of these requirements can be found at: https://opportunityiowa.gov/community/water-quality/srf- resources/documents-and-guides. Section 1: Applicant and Other Project Contacts Applicant Name: City of Waterloo, Iowa Applicant Address: 715 Mulberry Street City: Waterloo State: Iowa Authorized Representative: David Boesen Zip: 50702 Telephone Number: 319-291-4301 E-mail: mayor@waterloo-ia.org (—Signed by: Signature: Paw4 f761-Sun, `442EA7459855493... UEI Number: QFUUVJ8QTDN3 Title: Mayor NPDES Number: 0790001 Population Served by System: 68,000 Population Served by Project: 2,000 Consulting Engineer Firm: AECOM Contact Person: Nicholas Schrock, P.E. Telephone Number: 319-874-6581 E-mail: nick.schrock@aecom.com Was a qualifications -based procurement process used to select this engineer firm? ❑ Yes // No Do you anticipate using the Construction Manager at Risk (CMaR) construction delivery model for this project? ❑ Yes // No Bond Counsel Firm: Ahlers Cooney Contact Person: Kristin Billingsley Cooper Telephone Number: 515-246-0330 E-mail: kcooper@ahlerslaw.com Municipal Advisor Firm: Speer Financial, Inc. Contact Person: Maggie J. Burger Telephone Number: 319-291-2077 E-mail: mburger@speerfinancial.com (Municipal Advisor Information is required at time of application) 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 4424E839-B3C5-87D6-8168-57EAB6490C3F Section 2: Project Schedule Anticipated final plans and specifications submittal date: Anticipated construction start date: Spring 2027 January 29, 2027 Section 3: Brief Project Summary and Environmental Outcomes (Attach additional pages if necessary.) Describe the reasons for the proposed project: (i.e. specific water quality problem or system improvement) The northwest portion of the City of Waterloo, Iowa sanitary sewer collection and pumping system has been identified as one of the areas that requires attention due to high wet weather flow rates and the condition of the sanitary sewer system infrastructure in the area. The following are the primary objectives of the Airline Highway Lift Station, Force Main, and Sanitary Sewer Project: 1) To replace the aging lift station, force main, and downstream gravity sewer due to current conditions and upgrade this infrastructure for future conditions. 2) To install an on -site emergency generator and necessary components. 3) To line the upstream gravity sewer with Cast -In -Place Pipe lining to mitigate inflow and infiltration. Describe the proposed project: (i.e., specific solution to the water quality problem, or proposed system improvement) The new lift station will be constructed at the location of an existing lift station (Airline Highway Lift Station). The Lift Station currently pumps wastewater to a 12-inch gravity line at approximately Airline Highway and Diagonal Street. The new lift station will reuse the existing lift station wet well, sized at 8-foot diameter and approximately 32 feet deep. A new operator building will house instrumentation and controls and a valve and meter room. A new 10-inch force main will replace the existing 600 foot long, 8-inch force main to handle the higher flowrate. A new, 3,600 foot long 24-inch gravity sanitary sewer will replace the existing 12-inch gravity sewer to No Name Creek. The upstream 12-inch gravity sewer (approximately 1,400 foot long) will be lined with Cast -In -Place Pipe to mitigate inflow and infiltration during wet weather events. Primary Impacted Waterbody: Cedar River Designated Surface Water Uses (e.g. Al, BWW): Al, BWW1, HH Project Will Contribute to Water Quality... (check one) n Improvement Q Maintenance ❑ Not Applicable Project Will Allow the System to... (check one) ❑ Achieve Compliance n Maintain Compliance n Not Applicable Project Will Allow the System to Address... (check all that apply) ❑ Existing TMDL ❑ Projected TMDL ❑ Watershed Management Plan Q Not Applicable Does your project involve a consolidation of two or more wastewater systems? (check one) ❑ Yes /1 No If yes, list systems and populations served: 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 4424E839-B3C5-87D6-8168-57EAB6490C3F Section 4: Connection & User Revenue Information (most recent fiscal year) Number of Connections Percent of System Usage Annual Revenue Residential Commercial Industrial Other Unmetered Total Number of Connections: Total Revenue: Section 5: Project Cost Cost Category Estimated Total Cost in $ Legal Expenses 10,000 Land and Easements +20,000 Engineering Planning Fees + Engineering Design Fees +484,800 Engineering Construction Fees +592,400 Construction +4,487,500 Equipment + Other: + Other: + PROJECT SUBTOTAL = 5,594,700 Contingencies +897,600 Planning and design loan proceeds, if rolling into construction loan + Less Any Funds Requested from Other Sources - LOAN SUBTOTAL =6,492,300 Loan Initiation Fee (Loan Subtotal x .005) +32,462 TOTAL IUP REQUEST (Round to the nearest $1,000) = 6,525,000 Which other funding programs are you considering to assist in completion of this project? (Check all that apply) Funding Program Yes No Amount (If Known) Community Development Block Grant (CDBG) ❑ X USDA — Rural Development Grant and/or Loan ❑ X Reserve Funds ❑ X Other —Specify: ❑ X 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 56E65D98-AA59-84BA-83F6-E11 B52534128 Section 7: Civil Rights Self Certification Iowa State Revolving Fund (SRF) Borrower Civil Rights Self -Certification Form As a recipient of financial assistance through the Iowa State Revolving Fund (SRF) program, the undersigned hereby acknowledges and certifies that the Borrower shall comply with all applicable federal civil rights laws and regulations. These requirements apply to the entire operations of the assistance recipient, not just the project or activity receiving SRF funds. In accordance with federal law and U.S. Environmental Protection Agency (EPA) regulations at 40 CFR Part 7, the Borrower agrees to adhere to the following nondiscrimination statutes: Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq.) No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. Section 13 of the Federal Water Pollution Control Act Amendments of 1972 (Pub. L. 92-500; see 33 U.S.C. § 1251, note) No person in the United States shall, on the ground of sex, be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program or activity receiving federal assistance under the Clean Water Act. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794) No otherwise qualified individual with a disability in the United States shall, solely by reason of their disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. The Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.) No person in the United States shall, on the basis of age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving financial assistance. Additional Requirements for Borrowers whose projects are selected as federal "equivalency" projects: Borrowers who are selected to received SRF funds "equivalent to" a federal grant aware are considered "equivalency" projects and are subject to the civil rights requirements in 40 CFR Part 7. The Borrower agrees to: • Be subject to the prohibition against intimidation and retaliation. • Maintain records demonstrating compliance with these civil rights laws, including: o A list of any civil rights complaints received. o Reports from any external civil rights compliance reviews. o Descriptions of any pending discrimination lawsuits. o Demographic data regarding populations served (e.g., race, ethnicity, national origin, sex, disability status, and age). • Provide access to documentation and cooperate with any compliance reviews or investigations conducted by the Iowa DNR or EPA. Borrower Name: City of Waterloo Project Name: Airline Highway Lift Station, Force Main, and Sanitary Sewer 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 56E65D98-AA59-84BA-83F6-E11 B52534128 Certification By signing below, I affirm that I am authorized to sign on behalf of the Borrower named above and that the Borrower will comply with all applicable federal civil rights laws and regulations as a condition of receiving SRF assistance. "—Signed by: Signature: Pot, t5Ot-SU , Name (Printed):39350Pcni&esen Title: Mayor Date: 5/4/2026 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 56E65D98-AA59-84BA-83F6-E11 B52534128 Section 6: Acquisition of Property by SRF Applicants US ENVIRONMENTAL PROTECTION AGENCY ASSURANCE WITH RESPECT TO REAL PROPERTY ACQUISITION OF TITLE III OF THE UNIFORM RELOCATION ASSISTANCE AND REAL PROPERTY ACQUISITION POLICIES ACT OF 1970 AS AMENDED The City of Waterloo (Applicant) hereby assures that it has authority under applicable State and local law to comply with Section 213 of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, Public Law 91-646, 84 Stat. 1894 (42 U.S.C. 4601) as amended by the Surface Transportation and Uniform Relocation Assistance Act of 1987, Title IV of Public Law 100-17, 101 Stat. 246-256 (42 U.S.C. 4601 note) and 49 CFR 1.48(cc); and certifies, assures and agrees that, notwithstanding any other provision set forth in the application. 1. For projects resulting in the displacement of any person: a. It will adequately inform the public of the relocation payments and services which will be available as set forth in Subparts A, C, D and E of 49 CFR 24. b. It will provide fair and reasonable relocation payments to displaced persons as required by Subparts D and E of 49 CFR 24. c. It will provide a relocation assistance program for displaced persons offering services described in Subpart C of 49 CFR 24. d. Comparable replacement dwellings will be available pursuant to Subpart F of 49 CFR 24, or provided if necessary, a reasonable period in advance of the time any person is displaced. e. In acquiring real property, it will provide at least 90 days written notice to each lawful occupant of real property acquired, stating the date such occupant is required to move from a dwelling or to move his business or farm operation. 2. For projects resulting in the acquisition of real property: a. It will fully comply with the requirements of Subpart B of 49 CFR 24. b. It will adequately inform the public of the acquisition policies, requirements and payments which apply to the project. c. It will make every effort to acquire real property expeditiously through negotiation. d. Before the initiation of negotiations, it will have the real property appraised and give the owner or his representative an opportunity to accompany the appraiser during inspection of the property, except as provided in 49 CFR 24.102(c)(2). e. Before the initiation of negotiations, it will establish an amount which it believes to be just compensation for the real property, and make a prompt offer to acquire the property for that amount; and at the same time, it will provide the owner a written statement of the basis for such amount in accordance with 49 CFR 24.102. f. Before requiring any owner to surrender possession of real property it will pay the agreed purchase price; or deposit with the court, for the benefit of the owner, an amount not less than the approved appraisal of the fair market value of the property; or pay the amount of the award of compensation in a condemnation proceeding for the property. g. If interest in real property is to be acquired by exercise of the power of eminent domain, it will institute formal condemnation proceedings and not intentionally make it necessary for an owner to institute legal proceedings to prove the fact of the taking of this real property; and h. It will offer to acquire the entire property, if acquisition of only part of a property would leave its owner with an uneconomic remnant. References to 49 CFR are citations to Title 49, Code of Federal Regulations, Part 24, published in the Federal Register Vol. 54, No. 40, March 2, 1989. This document is hereby made part of and incorporated in any contract or agreement, or any supplements and amendments thereto, relating to the above -identified application and shall be deemed to supersede any provision therein to the extent that such provisions conflict with the assurances or agreements provided therein. Legal Name of Applicant: City of Waterloo Signed by: Signature of Authorized Representative: Pm- 6ot-sun, "-393E8397B3D3421... Date: 5/4/2026 08/2025 cmc INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-1320 Docusign Envelope ID: 56E65D98-AA59-84BA-83F6-E11 B52534128 Exhibit 11A Iowa Department of Natural Resources Wastewater Section Construction Permit Application SCHEDULE A, Construction Permit Application APPLICANT ENGINEER Owner: City of Waterloo, Iowa Firm: AECOM Address: 625 Glenwood Street Representative: Randy Bennett Address: 501 Sycamore Street, Waterloo, Iowa 50703 Project Officer: Nick Schrock, P.E. Phone Number: 319-291-4445 ext. 3656 Phone Number: 319-874-6581 Email: randy.bennett@waterloo-ia.org Email: nick.schrock@aecom.com Project Identification: Airline Highway Lift Station, Force Main, and Sanitary Sewer Estimated Start Date*: Spring 2027 Estimated Completion Date: Spring 2028 PLEASE RESPOND TO ALL QUESTIONS 1. Has an engineering report, facilities plan or other information previously been submitted for this project? If Yes: Project Identity: Waterloo - Master Plan Date Submitted: December, 2017 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. To Be Submitted after Design 3. Is there an electronic set of plans and specifications accompanying this application? Completion Attachment size is limited to 25MB. Please use zip files or other options to submit attachments greater than 25MB. 4. Are approved standard specifications a part of this application? If Yes: Approved Standard Specifications of (municipality or firm): 2026 SUDAS Date Approved: 12/16/2025 5. Does each set of plans and specifications or engineering report accompanying this application contain a 0 ❑ "professional engineering seal" executed in conformance with 542B.16, Code of Iowa? 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? ❑ 0 If Yes: A construction permit 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? ❑X ❑ If No: A Sewage Treatment Agreement executed by the authority providing treatment must accompany this form. 8. Is a new or amended operation permit necessary to use the facilities described in this application? ❑ 0 If Yes: A new or amended permit to operate 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 0 ❑ 400 feet of the proposed construction? Expected Water Main Crossing If Yes: Identify and locate the facility(ies) relative to the proposed construction. 10. Will construction inspection be conducted by a licensed engineer employed by the applicant? 0 ❑ If No: Name of Engineering Firm Conducting Inspection: AECOM 11. Will this project utilize CWSRF loan funds? 0 ❑ CERTIFICATION APPLICANT I certify that I am the authorized representative of the owner and state that the project identified above is approved by the owner. a —Signed by: Signature VeaM., Date 5/4/2026 "-393E8397B3D3421... ENGINEER I certify that all aspects of the design included in this application 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. Signature %'� Date 05/06/26 *Estimated Construction Start Date: Complete applications must be submitted at least 120 days in advance of the date for starting construction in accordance with Rules 567 IAC 60.4 and 64.2 Please complete the Schedule Checklist on the following page of this form. 09/2024 cmc DNR Form 542-3129; 28A Docusign Envelope ID: 56E65D98-AA59-84BA-83F6-E11 B52534128 DOCUMENT CHECKLIST Identify all categories included in this project. Also, identify schedules attached to this application. Schedule Title Attached Included in Project Submittal Date B Collection System ❑ 0 C Lateral Sewer Extension ❑ ❑ D Trunk & Interceptor Sewer ❑ 0 E Wastewater Pump Station ❑ 0 F Treatment Project Site Selection ❑ ❑ G Treatment Project Design Data ❑ ❑ H1 Schematic Flow Diagram ❑ ❑ H2 Treatment Process Loading and Removal Efficiency ❑ ❑ H3 Mechanical Plant Reliability ❑ ❑ I Screening, Grit Removal and Flow Measurement ❑ ❑ J Septic Tank System ❑ ❑ K1 Controlled Discharge Pond ❑ ❑ K2 Aerated Pond ❑ ❑ K3 Anaerobic Lagoon ❑ ❑ L Setting Tanks ❑ ❑ M Fixed Film Reactor -Stationary Media ❑ ❑ N Rotating Biological Contactor ❑ ❑ O Aeration Tanks or Basins ❑ ❑ P Gas Chlorination ❑ ❑ Q Sludge Digestion and Holding ❑ ❑ R1 Sludge Dewatering and Disposal ❑ ❑ R2 (A&B) Low Rate Land Application of Sludge ❑ ❑ R3 Land Application of Sewage Sludge (To be developed) ❑ ❑ S Land Application of Wastewater (To be developed) ❑ ❑ Sewage Treatment Agreement ❑ ❑ Identify any categories included in this project which are not provided in the above list of schedules. 09/2024 cmc DNR Form 542-3129; 28A