Regulation 22 – Domestic Wastewater
Step 2: Application Form
Section 22.5: Increasing / Decreasing the Design
Capacity of an Existing Wastewater Treatment Facility
Colorado Department of Public Health and Environment
Water Quality Control Division
4300 Cherry Creek Drive South, B2
Denver, Colorado 80246-1530
3/22/2016
303-692-3500
DRAFT
Regulation 22 Application Form
Regulation 22 - Site Location and Design Approval Regulations for Domestic Wastewater Treatment Works
A. Project and System Information
System Name
Project Title
County
Date Fee Paid or payment
attached
Invoice Number and Check
Number
Design Company Name
Design Engineer
CO License Number
Address
Email
Phone
Fax
Applicant / Entity
Representative Name/Title
Address
Email
Phone
Fax
B. Type of Site Application
Treatment Facility
New Domestic Wastewater Treatment Works (Section 22.4 of
Regulation 22)
Existing Domestic Wastewater Treatment Works – Increasing or
Decreasing Capacity (Section 22.5 of Regulation 22)
For existing domestic wastewater treatment
No
Yes
works, does the project include a new outfall?
Amendment to Existing Site Location Approval
Amendment of an Existing Site Location Approval – Disinfection
Changes Only (Section 22.8(2)(b)(ii) of Regulation 22)
Amendment of an Existing Site Location Approval – All other
Amendment Requests (Section 22.8 Regulation 22)
C. Project Information
Location (existing or proposed site)
Brief location description
Legal Description
(e.g., Township, Range)
County
Latitude
Longitude
Will a State or Federal grant or loan be sought to
Funding
finance any portion of the project (e.g., State
Process
Revolving Fund)?
Lift Station
New Lift Station (Section 22.7 of Regulation 22)
Expansion of Existing Lift Station (Section 22.7
of Regulation 22)
Interceptors
Interceptor Sewers Not Eligible for Certification
(Section 22.7 of Regulation 22)
Certification for Eligible Interceptors (Section
22.6 of Regulation 22)
Proposed Project Capacity
Maximum Month Average
Hydraulic Capacity in million
MGD
gallons per day (MGD)
Peak Hour Hydraulic Capacity in
million gallons per day (MGD)
MGD
Organic Capacity (lbs. BOD5/day) –
Treatment Facility Only
lbs. BOD5/day
No
Yes
If yes, please list
project number
Project Schedule and Cost Estimate
Estimated Bid Opening Date
Estimated Completion Date
Estimated Project Cost
Revised March 2010
Page 1 of 8
Colorado Department of Public Health and Environment
Water Quality Control Division
4300 Cherry Creek Drive South, B2
Denver, Colorado 80246-1530
3/22/2016
303-692-3500
DRAFT
Regulation 22 – Domestic Wastewater
Step 2: Application Form
Section 22.5: Increasing / Decreasing the Design
Capacity of an Existing Wastewater Treatment Facility
Regulation 22 Application Form
Section 22.5 of Regulation 22: Increasing or Decreasing the Design Capacity
of an Existing Wastewater Treatment Facility
Project and System Information
Project Title
System Name
County
CDPS Permit No.
CDPS Permit
Expiration Date
Original site location
approval number and
date
Treatment Facility Information
1.
Existing Facility Process Overview
a) Please describe the existing wastewater treatment facility process(es)
b) Existing Facility Approved Capacities
Existing Hydraulic Capacity:
Maximum Month Average:
million gallons per day (MGD)
Peak Hour:
million gallons per day (MGD)
Existing Organic Capacity: Maximum Month Average
lbs of BOD5/day
c) Existing Facility – Current Flow and Loading
2.
Current Flows:
Maximum Month Average:
million gallons per day (MGD)
Percent of Existing Capacity:
Peak Hour:
million gallons per day (MGD)
Percent of Existing Capacity:
Current Organic Load: Maximum Month Average:
lbs of BOD5/day
Percent of Existing Capacity:
Proposed Facility Process Overview
a) Please describe the proposed wastewater treatment facility process(es) and any existing treatment process(es) or
equipment being retained.
Site Information
3.
Vicinity maps of facility location which includes the following:
a) 5 mile radius map: all wastewater treatment facilities, lift stations and domestic water supply intakes
b) 1 mile radius map: habitable buildings, location of public and private potable water wells, an approximate indication of the
topography, and neighboring land uses
Revised March 2010
Page 2 of 8
4.
Site Location Zoning
a) Present zoning of the site location?
b) Zoning within a one (1) mile radius of the site?
5.
Floodplain or Natural Hazard Area
a) Is the facility located in a 100-year floodplain or other natural hazard area? If so, what precautions are being taken?
b) Has the floodplain been designated by the Colorado Water Conservation Board, Department of Natural Resources or
other agency? If so, please list agency name and the designation.
6.
Land Ownership
a) Who owns the land upon which the facility will be constructed? Please attach copies of the document(s) creating authority
for the applicant to construct the proposed facility at this site.
7.
Nearby Facilities
a) Please list all municipalities and water and/or sanitation districts within 5-miles downstream of the proposed wastewater
treatment facility site.
Treatment Facility Effluent Information
8.
Effluent disposal method (please check all that apply)
Surface Discharge to watercourse (enter watercourse name below)
Groundwater Discharge
Land application
Treated Effluent Reuse (Regulation 84)
Evaporation
Other (describe below)
9.
Preliminary Effluent Limits (please attach a copy in Engineering Report)
a) Preliminary Effluent Limits date:
b) Preliminary Effluent Limits expiration date:
10.
Downstream Distances
a) Downstream distance from the discharge point to the nearest domestic water supply intake? Name of supply? Address of
supply?
Distance:
Name of Supply:
Address of Supply:
Revised March 2010
Page 3 of 8
10.
cont
b) Downstream Distance from the discharge point to the nearest other point of diversion? Name of user? Address of user?
Distance:
Name of User:
Address of User:
Project Information
11.
a) What entity is financially responsible for the construction of the facility?
12.
a) What entity has the financially responsibility for owning and long term operating expense of the proposed facility?
13.
a) What entity has the responsibility for managing and operating the proposed facility after construction?
Additional Factors
14.
Please identify any additional factors that might help the Water Quality Control Division make an informed decision on your
site location application.
Revised March 2010
Page 4 of 8
Regulation 22 – Domestic Wastewater
Step 2: Application Form
Section 22.5: Applicant Certification and
Review Agencies Recommendation
Colorado Department of Public Health and Environment
Water Quality Control Division
4300 Cherry Creek Drive South, B2
Denver, Colorado 80246-1530
303-692-3500
3/22/2016
DRAFT
Applicant Certification and Review Agencies Recommendation
Section 22.5 of Regulation 22: Increasing or Decreasing the Design Capacity
of an Existing Wastewater Treatment Facility
A. Project and System Information
System Name
Project Title
County
1. Applicant Certification
I certify that I am familiar 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
Typed Name
Signature
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 representative and cannot sign this form.
2. Recommendation of Review Agencies
As required in Section 22.5(4) and referencing the procedure in Section 22.4(2), the application and the engineering report must be
submitted to all appropriate local governments, 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 concerning the
application to the Division. The recommendation should be based on the factors outlined in Section 22.4(2); for example, 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: Review agencies are encouraged to provide project comments; however, if
a review agency does not recommend approval then the agency must attached a letter describing the reason for their decision or
comment on the next page.
Signature of Management Agency, if different from other entities listed below
Role
Date
Typed Name / Agency
Signature
Recommend Approval? Yes
Signature of County, if proposed facility is located in unincorporated areas of a county
Role
Date
Typed Name / Agency
Signature
No
Recommend Approval? Yes
No
Signature of City or Town, if site is located within three miles of the City/Town boundary (if multiple, attach additional
sheets as needed)
Role
Date
Typed Name / Agency
Signature
Recommend Approval?
Signature of Local Health Authority
Role
Date
Typed Name / Agency
No
Signature
Recommend Approval?
Revised March 2010
Yes
Yes
No
Page 5 of 8
Signature of 208 Planning Agency
Role
Date
Typed Name / Agency
Signature
Recommend Approval? Yes
No
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
No
Review Agency Comments:
Revised March 2010
Page 6 of 8
Colorado Department of Public Health and Environment
Water Quality Control Division
4300 Cherry Creek Drive South, B2
Denver, Colorado 80246-1530
3/22/2016
303-692-3500
DRAFT
Regulation 22 – Domestic Wastewater
Step 2: Completeness Checklist
Section 22.5: Increasing / Decreasing the Design
Capacity of an Existing Wastewater Treatment Facility
Regulation 22 Application Completeness Checklist
Section 22.5 of Regulation 22: Increasing or Decreasing the Design Capacity
of an Existing Wastewater Treatment Facility
Project and System Information
Project Title
System Name
County
Regulation
22 Citation
22.5(1)
Submittal Requirements
Site Application Forms including:
- Signature of local authorities and 208 planning agency (see 22.5(4))
- Signature of responsible party of the proposed facility
Engineering Report including
Service Area Definition
Applicant to fill out
Included/Addressed
Location
in Site Location
in
Submittal?
Submittal
Yes/No/NA
(page)
Service Area Changes including:
- Changes to existing service area
22.5 (2)(a)
-
Population changes
Staging or phasing
-
Flow and loading projections
Preliminary Effluent Limitations
22.5 (2)(b)
Preliminary Effluent Limits:
- Summary of PELs including issuance and expiration date
-
Pretreatment program or enforceable mechanism
description, if applicable
Existing Treatment Works
22.5 (2)(c)
22.5 (2)
Analysis of the existing treatment works, including:
- Loading
-
Capacities
Performance
Alternatives Analysis (including Consolidation)
22.5 (2)(d)
Analysis of Alternatives Means to Treat, including:
- Consolidation Analysis
Selected Alternative
Recommended
Selected Alternative Description, including:
- Treatment system description
-
Design capacities
Operational staffing needs
Financial information
Financial system changes which will result from the proposed
increase or decrease in design capacity, including
22.5 (2)(e)
- Rate structure changes
Implementation plan and schedule
Implementation plan and schedule, including:
22.5 (2)(f)
Revised March 2010
-
Estimated construction time
Estimated date upon which the modified plant will be in
operation
Page 7 of 8
22.5 (3)
22.5 (4)
Geotechnical site conditions evaluation material
Soils Report in design phase which states the selected site will support the
proposed facility
Site Application Review and Comments from:
(a) Management Agency
(b) County
(c)
City or Town
(d) Local Health
(e) 208 Planning Agency
(f) Other state or federal agencies
Revised March 2010
Page 8 of 8