HomeMy WebLinkAbout4.0 BOCC CertificationColorado Department
of Public Health
and Environment
Water Quality Control Division
Engineering Section
4300 Cherry Creek Drive South, B2
Denver, Colorado 80246-1530
CDPHEINCIEnpReviewastate.co.us
303-692-6298
Applicant Certification and Review Agencies Recommendation
Section 22.7 of Regulation 22: Interceptor Sewers Not Eligible for Certification and Lift Stations
A. Project and System Information
System Name
Sunlight View Wastewater Treatment Facility
Project Title
Sunlight View Lift Station
County
Garfield
1. Applicant Certification
I certify that I am familiar with the
Wastewater Treatment Works,
by the regulations, has been prepared
requirement of Regulation 22 - Site Location and Design Approval Regulations for Domestic
and have posted the site in accordance with the Regulations. An engineering report, as described
and is enclosed.
Applicant Legal
Date
Typed Name / Agency
Sign ture
Representative (e.g. Public
7/6/15
John Martin, Garfield County
Board of County Commissioners
Works Dlrectorf
Date
Typed Name
Signature
President
31.4.4,zDennis
21 200
Levin
----"'"",� s
"`
The system legal representative is the legally responsible agent and decision-making authority (e.gmayor, president of a board, public works
director, owner) The Consulting Engineer is not the legal representative and cannot sign this form.
2. Recommendation of Review Agencies
As required in Section 22.7(2 and 3), the application and the engineering report must be submitted to alt appropriate local govemments,
208 planning agencies and State agencies for review and comment prior to submittal to the Division. By signing below, the entity or
agency: 1) acknowledges receipt of the proposed site location application, 2) has reviewed the proposed site location application and
may elect to provide comments, and 3) has provided a recommendation to the Division. The recommendation should be based on the
consistency of the proposed site location application with the local comprehensive plan(s) as they relate to water quality and any
adopted water quality management plans(s). Please note: If a govemmental authority does not racomr nd approval then the authority
must attached a letter describing the reason for their decision or comment on the next page.
Signature of County, if proposed
facility is located in unincorporated areas of a county
Role
Date
Typed Name / Agency
Sign ture
Chairman
7/6/15
John Martin, Garfield County
Board of County Commissioners
41=w�'
Recomm d Approval? 11 1'f 1 No 1 0
Signature of City or Town, if site is located within three miles of the City/Town bound Ty `o
Role
Date
Typed Name / Agenc
c,,,
tu
S n re
6/17/2013
Jeff Hecksel, City Managerf
City of Glenwood Springs
�
"
eRe4:,)_:7-,-7
,nd
A Koval?
es-jT❑ 1 No 1 0
Signature of Local Health Authority
Role
Date
Typed Name 1 Agency
\
igna
Chairman
7/6/15
John Martin, Garfield County
Board of Health
' i ,
Rec . end Approval?,'l Yes 1 MN, 1 No 1 0
Signature of 208 Planning Agency
/ \
Role
Date
Typed Name 1 Agency,
Sidnaturu 1
/ ,
Recommend Approxipl?
Yes
-'❑
No
0
Revised October 2012
Section 22.7: Application Form
Page 4 of 6
Signature of Other State or Federal Agencies, if facility is located on or adjacent to a site that is owned or managed by a
federal or state agency.
Role
Date
Typed Name / Agency
Signature
Recommend Approval? Yes 1 0 No
❑
Review Agency Comments:
Revised October 2012 Section 22.7: Application Form Page 5 or 6