HomeMy WebLinkAbout3.0 CDPHE Site Approval - Garfield County - SIGNED• Colorado Department
of Publ ic Hea lth
and Environment
Water Quality Control Division
Engineering Section
4300 Cherry Creek Drive South, 82
Denver, Colorado 80246-1530
CDPHE. WQEngReview@state.co.us
303-692-6298
Applicant Certification and Review Agencies Recommendation
Section 22.4 of Regulation 22: New Domestic Wastewater Treatment Facility
A. Project and System lnfonnation
System Name High Mesa RV Park Wastewater Treatment Plant
Project Title Hiq h Mesa RV Park Wastewater Treatment Plant
Countv Garfield
1 A r t C rtlfl •DD 1can e 1cat1on
I certify that I am famil iar with the requirement of Regulation 22 -Site Location and Design Approval Regulations for Domestic
Wastewater Treatment Works , and have posted the site in accordance with the Regulations . An engineering report, as described
by the regulations , has been prepared and is enclosed .
Applicant Legal
Representative (e.g., Public
Works Director) Date TvDed Name Signature
Robert Graham
The system legal representative is the legally responsible agent and decision-making authority (e .g. mayor, president of a board, public works
director , owner). The Consulting Engineer is not the legal representat ive and cannot sign this form .
2. Recommendation of Review Agencies
As required in Section 22.4(2), the application and the engineering report must be submitted to all appropriate local governments, 208
planning agencies and State ag enci es for revie w a nd comment prior to submittal to the Divis ion . By sign in g bel ow , the entity or agency:
1) acknowledges receipt of the proposed site location application, 2) has reviewed the proposed s ite loca tion appl ic ation and may elect
to provide comments, and 3) has provided a recommendation conce rning the application to the Division . The recom men dation should
be based on the factors outlined in Section 22.4(2); for example, on the consistency of the proposed site location application with t he
local compre hensive plan(s) as they relate to water quality and any adopted water quality ma nagement plans(s). Please note: Re view
agencies are encouraged to provide project comments; however, if a review agency do es not recommend appro val then the agen cy
"!ust attached a letter describing the reason for their decision or com ment on the next p age .
Si nature of Mana enc , If differ en t from other enti tles list ed be l ow
Role Date
Si nat ure of Coun
Role
S ignatu re of City or Town, If s ite is located within three mlle
sheets as nee d ed
Role Date
SI
Role
Board of County
Commisioners of Garfield
Count
Revised December 2013
/{-/,
Section 22.4: Application Form
Si nature
No 0
0
S lanature of 208 Pla nn lna Age n cy
Role Date Tvned Name I Agency Signature
Recommend Aooroval? I Yes I I I I No I I I
Signature of Other State or Federal Agenc ies, if facility Is located on or adjacent to a site that Is owned or managed by a
federal or state aaency.
Role Date Typed Name I Agency Signature
Recommend Approval? I Yes I 0 I No I 0
Si gnatu re of Other Basin Water Quallty Au th ority, Watershed Association, Watershed Authority, etc., If facility Is located in
a Water Quality Control Commission Watershed Protection Control Area.
Role Date Typed Name I Agency Signature
Recommend Aooroval? I Yes I 0 I No I 0
Review Aaency Comments:
Revised December 2013 Section 22.4: Application Form Page 5 of 5