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13. Location of boundary of 100-year flood. <br />14. Tvpe of individual sewage disposal system proposed. <br />15. Proposed design of the individual sewage disposal system, including any <br />restriction on the use of adjoining property which may result from the <br />minimum separation requirements set forth in Table of Minimum Horizontal <br />Distances. (See Section 4.02). <br />16. Signature of owner or authorized agent. <br />17. Agreement to execute a Declaration of Covenants regarding subsequent <br />connection to sewage treatment works when available. <br />18. Such additional infomration as may be required by the heahh officer or his/her <br />designated representative. When evidence is present of surface or subsurface <br />conditions which may cause difficulties in sewage treatment or pollution of <br />State waters, the health officer or his/her designated representative may <br />require the applicant to provide additional hydrological, geological or <br />engineering data prepazed by an Registered Professional Engineer or <br />Professional Geologist. <br />19. When the proposed site is two (2) acres or less, an alternative wastewater <br />system is required. When the proposed site is more than one two (2) acres <br />and the 200 foot separation between the proposed absorption field and all <br />surrounding wells can not be met, an alternative wastewater system is <br />required. Refer to Section VI of these regulations. <br />All new well installations shall maintain a 200' separation from any existing <br />absorption fields that do not include pre-treatment. From systems that <br />include pre-treatment, 100' is required. The requved separation may be <br />achieved by deep grouting. In such cases, sepazation would be measured <br />from the nearest point of the absorption field to the deepest point sealed by <br />grout. All deep grouting must be done by pressure injection. <br />20. Information on low flow plumbing fixtures, if applicable. <br />B. A permit fee shall be paid to the local health department at the time of application <br />according to the current fee schedule as established by resolution of the local board <br />of health. Such fee shall be based on the average cost for processing said applications <br />in Gilpin County during the preceding calendaz year. <br />C. Tn the event the local heahh department receives written notice from the applicant that <br />an application is to be withdrawn prior to final inspection of the system, the local <br />12 <br />