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COLORADO DEPARTMENT OF HEALTh" /
WATER POLLUTION CONTROL COMM!_ tON )1-teLett e, .64.Afa„G
4210 East 11 Avenue
Denver, Colorado 80220 Aga
-- APPLICATION FOR APPROVAL OF LOCATION --
• FOR SEWAGE TREATMENT FACILITIES \ 17ra #
Submit In duplicate Complete only Parts A s B See Instructions
l,/
Applicant:
TIMA00 INO•
Address: 1300 &cab w iJa�.�.; Oki.a...1. _
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
„1. S ize and typal of treatment facility: hrtaon efnt_ 11Inalr Assklan Piw
Peet ofthe Es * of the NA. * of Section 10 tvsamMp
2. Location of Facility: 2R Thaw Ad Y of itttiah Prl�pwt mw4disn-
3. Name of watercourse into which effluent is discharged: mu
.4 . . Location of effluent discharge: limpta t P�
a
5. ,, Describe and give distance downstream of water plant raw water intake nearest this
effluent discharge: tones
6. Est.projeet cost: $70s000y0,Est.bid opening date: g��Est.eompl .date: 0/1/1.3
7. Project layout and design criteria: (Attach separate sheets or report showing
entire service area with respect to surrounding areas, habitable buildings, loca-
tion of potable water wells with s mile, effluent discharge point and topography
of area, population to be served.)
8. Additional information may be required, upon request of the District Engineer and
local health department officials. This may Include (a) relationship of this
facility to area-wide plan, (b) flood plain data, (c) provision for maintenance
and operation of the facility including odor control (d) legal status (district,
association, municipality) .
9. Have you contacted local planning and building officials or other county officials
regarding building permits, zoning matters, special use review permits and other
similar matters: Yes No
(Name of those contacted)
10. Consulting Engineer:
Address: 130 Cowl war _ ThweeeA„yk, CO gnp20 Telephone im,4 i7
The undersigned applicant agrees to supply information necessary for Review of Plans and
Specifications and to secure signatures of the appropriate local government officials prior
to submission. (See part 8 on back of this sheet.) �/
7/24/73 ✓ . L�� - dr/—
Data - Signature Signatt 2 ure of Applicant ruiLl
maw, (TYaED NAME 730659
B. SIGNATURE OF LOCAL GO. .ANMENT OFFICIALS: The undersig...d* have reviewed the
proposal for the location, constructton, operation, and point of effluent discharge
of the above-described sewage treatment facility, and RECOMMEND APPROVAL or; D15-
APPROVAL in space provided below:
RECOMMEND RECOMMEND
DATE APPROVAL DISAPPROVAL
Signa re for Lo .i He th Department
P4/7-12 d e-
p a' .. Sig ure for Planning Cormission
gnature for Board o ou y Commissioners
_. Signature for Mayor of City Manager of
,,
Municipality
*Before plans and specifications will be accepted for review, the applicant must show
hereon the action taken on the project by the Local Health Officers, representative
of the Planning Commission, representative of the Board of County Commissioners , and
the Mayor or City Manager of the municipality that might be affected by the discharge
of this waste.
C. THE FOLLOWING FOR STATE HEALTH DEPARTMENT USE:
I , the undersigned District Engineer, have the following comments:
1 . Is this plant located so that It can serve the 'needs of the present and/or
future logical service area?
2. Is the plant located where It Is likely to create nuisance problems for -
existing or now planned development?
3. Has a sufficient amount of suitable land been set aside for expansion?
4. Has the developer or owner of the facility made provision for adequate funding
to buy, maintain, operate, and repair or replace in kind the facility?
5. Are there any community water supply Intakes within 5 miles downstream of the
effluent discharge points?
D. RECOMMENDATIONS:
Date: Signature:
WP-3 (Rev.3-71-20)
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