HomeMy WebLinkAboutIowa Department of Natural Resources-Waste Water Section-4/26/2010Iowa 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
The Fortes Group
FIRM
Ament, Inc
ADDRESS
12207 Illinois Road
Foot Wayne, IN 46814
Or
ADDRESS
3628 University Avenue
Waterloo, Iowa 50701
REPRESENTATIVE
Dirk M. Beck
TELEPHONE
317-413-9104
PROJECT OFFICER
Larry Buchholz
TELEPHONE
319-233-1323
PROJECT IDENTIFICATION
The Preserve at Crossroads
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_
TITTLE
- (-cid%sf %,Cfi•ij
DATE
4i -1-/O
/4-7VP
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 Natural Resources. is agreement shall not be construed in any way to affect any local ordinances, sewer
service agreem t , or fee stems iv ter o be een the parties.
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SICINATU
TYPED OR PRINTED%NAME
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PHONE NUMBER
(1615,2911--/f361
DATE
4/ (20o
Exhibit 8A
Iowa Department of Natural Resources Wastewater Section
Construction Permit Application
SCHEDULE A. General Information
APPLICANT
ENGINEER
OWNER
The Fortes Group
FIRM
Ament, Inc
ADDRESS 12207 Illinois Road
Fort Wayne, IN 46814
ADDRESS 3628 University Avenue
Waterloo, Iowa 50701
REPRESENTATIVE TELEPHONE
Dirk M. Beck 317-413-9104
PROJECT OFFICER TELEPHONE
Larry Buchholz 319-233-1323
f PROJECT IDENTIFICATION
The Preserve at Crossroads
ESTIMATED START DATE *
March 2010
ESTIMATED COMPLETION DATE
December 2010
PLEASE RESPOND TO ALL QUESTIONS YES NO
1. Has an engineering report, facilities plan or other information previously been submitted for this project? ❑ ❑
If Yes=>
PROJECT 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 11.1, 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?
❑ ❑
_
❑ L-]
If Yes=>
APPROVED STANDARD SPECIFICATIONS OF
(municipality or firm)
City of Waterloo
DATE APPROVED
5. 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?
If No=> Processing will be delayed pending receipt of applicable design schedules and certified plans,
specifications or engineering report.
G. 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?
If No=> A Sewage Treatment Agreement (DNR Form 29) executed by the authority providing treatment oust
accompany this application.
8. is a new or amended operation permit necessary to use the facilities described in this application?
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 400 feet of the proposed construction?
If Yes=> Identify and locate the facility(s) relative to the proposed construction.
10. Will construction inspection be conducted by a licensed engineer employed by the applicant?
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a
❑
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❑
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❑
If No=>
NAME OF ENGINEERING FIRM CONDUCTING INSPECTION
11. Will this project utilize CWSRF loan funds? ❑
a
CERTIFICATION
APPLICANT
1 certify that I am the authorized representative of the owner and
state that the project identified above is approved by the owner.
.,-----information r —
c.....----11— 9—/O
ENGINEER
l certify that all aspects of 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. 1 am familiar with the
contained in this application, and to the best of my
knowle e, such information is complete and accurate.
SIGNATURE DATE
SIGN ' DATE
-- \.
r 1 / 1 0
* Estimated Construction Start Date: Complete applications ust be submitted aast 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
DNR form 28A (Apr 04)
Exhibit 8A
Iowa Department of Natural Resources Wastewater Section
Construction Permit Application
SCHEDULE A, General Information
DOCUMENT CHECKLIST
Identify all categories included in this project. Also, identify schedules attached to this application.
INCLUDED IN SUBMITTAL
SCHEDULE TITLE ATTACHED PROJECT DATE
B Collection system
C Lateral Sewer Extension
D Trunk & Interceptor Sewer
E Wastewater Pump Station
F Treatment Project Site Selection
G Treatment Project Design Data
Hl Schematic Flow Diagram
H2 Treatment Process Loading and
Removal Efficiency
113 Mechanical Plant Reliability
T 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
RI 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,
DNR form 28A (Apr 04)
542-3129
Iowa Department of Natural Resources
Wastewater Section
Construction Permit Application
SCHEDULE B, Collection system
DATE PREPARED
3-24-2010
DATE REVISED
PROJECT IDENTITY
The Preserve at Crossroads
DNR USE
PROJECT NO.
PERMIT NO.
1. Identify proposed construction which is subject to flooding and explain what is proposed to prevent water from entering the
system. If no portion is subject to flooding, state none.
Segment
none
Flooding Protection
*2. Indicate hydraulic capacity of: I) the nearest downstream main or interceptor, 2) the nearest downstream lift station, and
3) all downstream segments where flow restriction may occur. Indicate the source and accuracy of numerical data.
Location
Design capacity, MGD
Peak Hourly Dry weather Flow
MGD (actual)
Peak Hourly Wet Weather Flow
MGD (actual)
Segment
Segment
Segment
RIVE
0.7(3
0,430
*3. Identify treatment facility, the design loadings and present raw waste loadings. Indicate source and accuracy of numerical data.
Facility name and number Waterloo Wastewater
Treatment facility
#0790001
Facility Loading
Design
Average Wet Weather (actual)
Peak Hourly Wet Weather (actual)
MGD
#BODS/day
39.2(
2g.a0
24. 53
31,roo
G0_*
17, 000
±
Provide projected design loading increase, which will be added to this facility as a result of this project.
Design Loading
Initial
Design Year (2010 )
Residential service area G. yz Acres 64 V2 Acres
Population 0 Persons 144 Persons
Flow (100 GPCD) 0 GPD 14400 GPD
BOD5 (0.17 #/d/cap) 0 #/day 24.48 4/day
Industrial service area 0 Acres 0 Acres
Rated flow 0 GPD 0 GPD
BOD5 0 #/day 0 #/day
Other 0 Acres 0 Acres
Rated Flow 0 GPD 0 GPD
BOD5 0 #/day 0 #/day
Total BOD5 0 4/day 24.48 #/day
Total Flow 0 GPD 14400 GPD
Peak Hourly Flow 0 GPD 36000 GPD
Include a written explanation of items 2 and 3 if the sewer system and/or treatment facility are overloaded.
Iowa Department of Natural Resources
Wastewater Section
Construction Permit Application
SCHEDULE C, Lateral Sewer Extension
DATE PREPARED
4-15-2010
DATE REVISED
PROJECT IDENTITY
The Preserve at Crossroads
DNR USE
PROJECT NO.
PERMIT NO.
I. Design Basis
Residential service area
Population 0
Flow (100 GPCD) 0
Initial
6.42
Design Year (
Acres 6.42
Persons 144
GPD 14400
BOD5 (0.17 #/d/cap) 0 #/day 24.48
Industrial service area NA Acres NA
Rated Flow GPD
BOD5 #/day
Other NA Acres NA
Rated Flow GPD
BOD5 #/day
Total BOD5 0 #/day 24.48
Total Flow 0 GPD 14400
Peak Hourly Flow 0 GPD 36000
2. Pipe
Diameter
Material
Joint
Minimum Slope
Maximum Manhole Space
Total Sewer Length
Maximum Cover
Minimum Cover
8 Inch
ASTM D 2680
ASTM D-3212
1.4
300
722
12
10
ft.
ft..
ft.
ft.
10 Inch
ft.
ft.
ft.
ft.
12 Inch
Acres
Persons
GPD
#/day
Acres
GPD
#/day
Acres
GPD
#/day
#/day
GPD
GPD
%
ft.
ft.
ft.
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 Class B
B. Pipe laying ASTM -D2321-00
C. Compaction ASTM -D2321-00
D. Manhole ASTM C-478
E. Specified maximum Infiltration/exfiltration rate 200 GPDPMPI
F. Infiltration/exfiltration test procedures City of Waterloo
G. Alignment & grade test procedures
(1) During construction: Stake & batter board Laser X
(2) After construction: Lamping X Other
H. Deflection test procedures City of Waterloo
4. Are detailed manhole drawings included: Yes Si No ❑
Typical flame and cover assembly Neenah R-1643
Are manhole covers nonvented: Yes ® No
Manhole diameter 48
Manhole opening diameter 24 in.
5. Minimum sewer & water main separation: Horizontal
Are specifications included? No
in.
Material Concrete/Precast
10
ft. Vertical l8
m.
6. Stream, road, or railroad crossing protection City of Waterloo
Are specifications included? No
DNR form 28C (Nov 00)
542-3096
IOWA DEPARTMENT OF NATURAL RESOURCES
Wastewater Disposal System Construction Permit
Application Fee Form
OWNER: _The Fortus Group
ADDRESS: 12207 Illinois Road
Fort Wayne, IN 46814
PROJECT IDENTIFICATION: _The Preserve at Crossroads
$100 Fee enclosed
32-3202
IDNR Cashier's Use Only
0945-542-NPDE-0570
Please sign and return this form with a check or money order payable to "Iowa
Department of Natural Resources". Place it and the check or money order on top of
other Construction Permit Application documents.
Effective beginning July 1, 2006, Applications for Construction Permits for wastewater disposal systems
required by Iowa Code 455B.173 and rules in Iowa Administrative Code 567 IAC 64, must be
accompanied by the fee required by Iowa statute (HF2540).
The fee is $100 for each application, regardless of project size and project type including sanitary sewers,
pump stations, treatment units or a combination thereof. The fee shall be submitted with the certified
engineering documents necessary to apply for a construction permit (plans, specifications and related
application schedules A, F, and G as well as the appropriate schedules identified on page 2 of Schedule A).
The construction permitting process is initiated as planning for construction begins. Planning coordination
and submittal of preliminary engineering reports or facility plans precedes submittal of technical documents
necessary to constitute a construction permit application. The application fee is not necessary when
submitting a planning document but must accompany construction permit application documents. A fee
should accompany each permit application received on or after July 1, 2006.
Failure to submit a fee with the application may delay the processing of a construction permit. If you have
any questions regarding the application fee, please contact Wayne Farrand at 515/281-8877 or
wayne.farrand rnidnr.state.ia.us
Signature of owner or representative
Telephone or email contact 3/7 Li/ 3 — T/c76(
Send with application to:
Iowa Department of Natural Resources. WasteiN ater Construction Section
Wallace State Office Building
502 East 9th Street
Des Moines, IA 50319
CITY OF WATERLOO, IOWA
CHANGE or EXTRA WORK ORDER NO. 1
PROJECT: F.Y. 2010 ASPHALT OVERLAY PROGRAM CONTRACT NO. 771
Date Prepared:
April 14, 2010 AMOUNT: $98,584.83 INCREASE
TO: Aspro, Inc. , Contractor
You are hereby ordered to make the following changes from the plans and specifications or perform
the following extra work on your contract dated March 1, 2010.
A. Description of change to be made or extra work to be done:
Add work in Black Hawk County on Balsam Street and Juniper Drive.
B. Reason for ordering change or extra work:
The City is overlaying Balsam Street within the city limits. The County wants to overlay
the rest of Balsam Street and Juniper Drive outside of the city limits. The County will
reimburse the City for the cost of construction.
C. Settlement for cost of work to be made as follows:
Compensation to be as shown on the attached sheet.
NET INCREASE $98,584.83
CITY OF ERLOO
BY: / (�
ayor
(d ASPRO, INC.
Date CONTRACTOR
BY: / n
(7 Date
�rn��(v PRINTED NAME: M7/Li ,7/q/rOK/ 4' //
b.0 Our
Date
TITLE: /64ri ,41 4 /)J
APPROVED:
2-0/
City Engineer Date
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TOTAL ESTIMATE
TRAFFIC CONTROL
UNIVERSAL MH ADJ. RING OR EQUAL
HMA (1,000,000 ESAL) BASE/INTERMEDIATE, 3/4" MIX
HMA (1,000,000 ESAL) SURFACE, 1/2" MIX , NO FRICTION REQD.
CRACK AND SEAT
MILL WEDGE
(USE EXISTING CASTING)
REMOVE AND REPLACE E -1-C
DESCRIPTION
CONTRACT #771
CHANGE ORDER #1 (COUNTY WORK -BALSAM ST. AND JUNIPER Dit)
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424.50
376.00
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QUANTITY
TOTAL
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$ 540.00
$ 97.40
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$ 2,700.00
UNIT PRICE
ASPRO
$ 98,584.83
$ 750.00
$ 3,780.00
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$ 6,177.33
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TOTAL EST.
ASPRO