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Home My WebLink AboutOWTS Design SpecsI29 CAINS LANE CRReor\¡oRLE, CO 41623 970.3O9.5259 CARLA.oSTBERG@GMAI L.coM -(.it,:¡,.t r( : (:( >¡;sI I r.'¡¡l\(* August 6,2022 Project No. C173'1 Curt Hanson Cmhanson.T4@qmail.com Subsurface lnvestigation and Onsite Wastewater Treatment System Design 3-Bedroom Residence 416 Mineota Drive Garfield County, Colorado Curt, CBO lnc. performed a subsurface investigation and completed an onsite wastewater treatment system (OWTS) design forthe subject residence. The 15.807-acre property is located outside of Silt, in an area where OWTSs are necessary. Legal Description: Section: 15 Township: 6 Range: 92 Subdivision: MINEOTA RIDGE ESTATES 2ND Lot: 03 15.808 ACRES Parcel lD: 2179-152-02-002 SITE CONDITIONS A 3-bedroom, single-family residence presently exists on the property and is served by an existing OWTS. The existing OWTS consists of a 1000-gallon, two-compartment Copeland Concrete septic tank followed by two trenches, each with 16 'Standard' lnfiltrator@ chambers for a total of 32 chambers and 600 square feet of infiltrative area. Gafüeld County lndividual Sewage Disposal System Permit 2349 documents this system. The permit received finalapprovalfrom Garfield County on May 30, 1995. The existing soil treatment area (STA) is experiencing slow draining conditions and there is a desire to replace it. The residence is served by a community water system. The water line runs up the existing driveway. We have approximated this location on the site plan, as described by you. The water line will not come within 25-feet of any existing or proposed OWTS component. The proposed soil treatment area (STA) location has an approximate five percent slope to the northwest. The area is vegetated with native grasses. There should be no traffic or staging of material over the future STA site to avoid compaction of soils prior to construction of the STA. Page 2 SUBSURFACE The subsurface was investigated on June 8,2022 by digging two soil profile test pit excavations (Test Pits) A visual and tactile soil analysis was completed by Carla Ostberg at the time of excavation.l The materials encountered in Test Pit #1 consisted of medium brown sandy clay loam with moderate structure grade to 1.O-feet, underlain by medium brown sandy clay loam with weak structure grade to a maximum depth explored of 7.O-feet. No bedrock or groundwater was encountered. The materials encountered in Test Pit#2 consisted of medium brown sandy clay loam with moderate structure grade to 2.O-feet, underlain by medium brown sandy clay loam with weak structure grade to a maximum depth explored of 6.O{eet. No bedrock or groundwaterwas encountered. A sample of the soils was taken from Test Pit #1 at 3-feet below grade. Soil structure grade was weak. The soil formed a ball and a ribbon 1 to 2-inches in length before breaking. Soil structure shape was blocky and consistence was firm. Soil texture was gritty. STA sizing is based on Soil Type 34, Sandy Clay Loam with weak structure grade. A long term acceptance rate (LTAR) of 0.3 gallons per square foot will be used to design the OWTS. Test Pit #1 Sidewall i weak structure grade ' Carla Ostberg holds a Certificate of Attendance and Examination from the CPOW Visual and Tactile Evaluation of Soils Training. i:a:-, Page 3 Sieved sample Ribbon between 1 and 2-inches before breaking Test Pit #2lBackfill Sidewall / Test Pil#2 DESIGN SPECIFICATIONS The existing sewer line from the house to the septic tank will remain in use. We recommend using a camera to explore the sewer line to assure it is in good condition. The existing septic tank will remain in use. A 4-inch diameter, full size Orenco@ Biotube Effluent filter must be installed on the outlet side of the septic tank. Risers must be added to the manhole lids to bring access to grade. *o*h: View of existing septic tank lids looking toward residence Page 4 Outlet side of septic tank / add effluent filter / View of septic tank looking toward STA (add risers to manhole lids) Desiqn Calculations: Average Design Flow = 75 GPD x 2 people/bedroom x 3 Bedrooms = 450 GPD LTAR = 0.3 GPD/SF 450 GPD / 0.3 GPD/SF x 1.0 (gravity trenches) x 0.7 (chambers) = 1050 SF The OWTS design is based on 3-bedrooms. An average daily wastewater flow of 450 GPD will be used. Forthe purposes of this OWTS design, Benchmark Elevation has been established as 100'as the sewer line existing the existing septic tank. CBO lnc. should be notified of any discrepancies or problems with grade elevations of proposed components during installation of the OWTS. *Elevations are based upon standard OWTS installation practices. Component elevations may change during installation due to site conditions. Minimum grade refers to piping between components. A new 4-inch SDR-35 sewer line must be installed from the existing septic tank to a new distribution box. A Bullrv Run Valve may be installed on the existing sewer line to the existing SI4 as an option to utilize the existing STA in the future. Effluent will gravity flow to a distribution box, and then to four gravelless chamber trenches. The distribution box must be accessible from grade and must have flow equalizers, or similar product, installed on each outlet pipe in the distribution box to assure equal flow to each bed. OWTS Component Minimum Elevation Primary Tank Outlet lnvert EX|ST|NG (BM 100',) Distribution Box Approximate horizontal distance 72' I min. 1% fall I min.9" fall lnfiltrative Surface Approximate horizontal distance to furthest trench 35'/ mín. 1%'nall / min. 4.375" fall Page 5 Each trench will consíst of 18 'ADS' ARC 36 Low Profile chambers for a total of 72 chambers and 1080 square feet of infiltrative area. There must be at least 4-feet of undisturbed soil between each trench. Due to the density of the soils, we recommend a shallow installation of the chambers at approximately 2- feet below native grade. lnspection ports must be installed at the beginning and end of each trench. Ports may be cut to grade and placed in sprinkler boxes for access. lf diversion of drainage from above the proposed SïA is necessary, a shallow swale should be excavated. COMPONENT SPECIFICATIONS The component manufacturers are typical of applications used by contractors and engineers in this area. CBO lnc. must approve alternative components prior to installation of the OWTS. Requests must be submitted, in writing, to our office for approval prior to installation. Component technical data sheets are available upon request. Construction must be according to Garfield County On-Site Wastewater Treatment System Regulations, the OWTS Permit provided by Garfield County Building Department, and this design.' INSTALLATION CONTRACTOR CBO lnc. expects that the installer be experienced and qualified to perform the scope of work outlined in this design. The installer must review this design thoroughly and coordinate with our office in advance of installation. Any additional conditions in this design or county permit must be completed and documented prior to final approval of the OWTS installation. Communication between the installer and this office is expected throughout the installation. INSTALLATION OBSERVATIONS CBO lnc. must view the OWTS during construction. The OWTS observation should be performed before backfill, after placement of OWTS components. Septic tanks, distribution devices, pumps, dosing siphons, and other plumbing, as applicable, must also be observed. CBO lnc. should be notified 48 hours in advance to observe the installatíon. ln an effort to improve the accuracy of the record drawing, we request that the installer provide a sketch of the installation, including path of the sewer lines, water line installation (if applicable), septic tank location, STA location, and measurements from building corners or another fixed objects on the property. This sketch is most easily provided on Sheet W2.0 of the OWTS Design Packet. Photographs of the installation and final cover are also requested to supplement our installation documentation. COMPONENT MANUFACTURER MODEL NO COMMENTS Tank Risers and Lids Copeland Concrete Contact Tim Copeland directly or substitute Valley Precast risers and lids Effluent Filter Orenco(Ð 4-¡nch d¡ameter, Full s¡ze filter Valve BullrM Run Valve BRVBULK OPTIONAL Distribution Box and Flow Equalizers Polylok Distribut¡on box with r¡sers and 4 flow equalizers Chambers ADS@ ADS@ ARC 36 Low Profile /2 ADS@ ARC 36 Low Profile Page 6 REVEGETATION REQUIREMENTS An adequate layer of good quality topsoil capable of supporting revegetation shall be placed over the entire disturbed area of the OWTS installation. A mixture of native grass seed that has good soil stabilizing characteristics (but without taproots), provides a maximum transpiration rate, and competes well with successional species. No trees or shrubs, or any vegetation requiring regular irrigation shall be placed over the STA. Until vegetation is reestablished, erosion and sediment control measures shall be implemented and maintained on site. The owner of the OWTS shall be responsible for maintaining proper vegetation cover. OPERATION INFORMATION AND MAINTENANCE The property owner shall be responsible for the operation and maintenance of each OWTS servicing the property. The property owner is responsible for maintaining service contracts for manufactured units, alternating STAs, and any other components needing maintenance. Geo-fabrics or plastics should not be used over the STA. No heavy equipment, machinery, or materials should be placed on the backfilled STA. Machines with tracks (not wheels) should be used during construction of the STA for better weight distribution. Livestock should not graze on the STA. Plumbing fixtures should be checked to ensure that no additionalwater is being discharged to OWTS. For example, a running toilet or leaky faucet can discharge hundreds of gallons of water a day and harm a STA. lf an effluent fìlter or screen has been installed in the OWTS, we recommend this filter or screen be cleaned annually, or as needed. lf the OWTS consists of a pressurized pump system, we recommend the laterals be flushed annually, or as needed. The homeowner should pump the septic tank every two years, or as needed gauged by measurement of solids in the tank. Garbage disposal use should be minimized, and non-biodegradable materials should not be placed into the OWTS. Grease should not be placed in household drains. Loading from a water softener should not be discharged into the OWTS. No hazardous wastes should be directed into the OWTS. Mechanical room drains should not discharge into the OWTS. The OWTS is engineered for domestic waste only. ADDITIONAL CONSTRUCTION NOTES lf design includes a pump, weep holes must be installed to allow pump lines to drain to minimize risk of freezing. The pump shall have an audible and visual alarm notification in the event of excessively high- water conditions and shall be connected to a control breaker separate from the high-water alarm breaker and from any other control system circuits. The pump system shall have a switch so the pump can be manually operated. Excavation equipment must not drive in the excavation of the STA due to the potential to compact soil. Extensions should be placed on all septic tank components to allow access to them from existing grade Backfill over the STA must be uniform and granular with no material greater than minus 3-inch. LIMITS: The design is based on information submitted. lf soil conditions encountered are different from conditions described in report, CBO lnc. should be notified. All OWTS construction must be according to the county regulations. Requirements not specified in this report must follow applicable county regulations. The contractor should have documented and demonstrated knowledge of the requirements and regulations of the county in which they are working. Licensing of Systems Contractors may be required by county regulation. Page 7 Please call with questions. Sincerely, CBO lnc. Carla Ostberg, MPH, REHS (øn{a-"üstú"<ng Reviewed By: Romeo A. Baylosis, PE ¿ 8-1 6-2022 3St?3 3-BEDROOMRESIDENCEGARAGE1Hanson Residence416 Mineota DriveGarfþld County, ColoradoPrcjectNumber: C1731Date: 08/06/2022Designed by: CBOReviewed by: RBDrawn by: DDSCALE: 1 = 50'=0"N""Ñ".-"tPROPERTY LIN\*.oPROPOSED STATP1TP2+WATER LINE. \' t ...tt - 1. tEXISTING STASEPTICTANKsHED----\úDRAWINGS MUST BE USED INCONJUNCTION WITH DESIGNLETTER DATED O8I 0612022CBO lnc.129 Cains LaneCarbondale. Colorado 81 62:ìPhone 970.309.5259carla.ostbêrg@gmail.comTHE LOCAIION OF PROPOSÊD IMPROVEMENTS SHOWN ARENOT THE RESULT OF A PROPERTY SURVEY. THE LOCATIONSARE APPROXIMATE. IT IS THE HOIVEOWNERS' DUTY TOENSURE ALL CONSTRUCTION AND IMPROVEMENT LOCATIONSARE ACCURATE. PROPERTY LINËS AND SFTBACK DISTANCESSHOULD BE CONFIRMED PRIOR TO EXCAVAIION, SCALEDFOR PRINTING ON 1'1" X 17" PAPER.w1 .0Sheet 1 0F 4 $\treor¡'oft\{ÉADS ARC S LOW PROFILE4 TRÊNCHES WITH 18 CHAMEERS PERNENCHFCR A TOTAL OF 72 CHAMBERS ND 1O8O SF.4" DIA SDR.35 SEWER LINE TO EACH TRENCH(MlN. 1% SLOPE TO TRENCHÉS)+OISTRIÊUfION ÊOXWITH ACCESS ATGMDEDIA SDR"35 SEWËR I INE IO SIATP1¡" ÞIA SDR.35 INSPËCTION PORfAIBEGINNIN' AND END OF EACH TRENCHfP2+PROPERñEXCAVAÍE ShAL|OW SYJAIE IO DIVERTAROUND STA IF NËCFSSAÊ\'(MIN. 1% FALL TO SfA)1m'OPTIONALI INSTALL BULL RUN VALVÉON EXISTING SEWER LINE TOEXISIING STA4" DIA SDR¡5 SEWER LINE fO SIAlM¡N. 1% FALL rO STA)1 M-MLLON. MO.COMPARTMENTSEPIIC TANK TO REMAIN. ADD EFFLUENIFILTER. ERING RISERS ANO LIDS TO GRAOEEXISTNG SEWER LINE FROM RESIDENCE TO RÉMAIN.EXISI N(J SIA 2 TRENCHËS. EACH WTH 16 STANDARDINËI!-IRÀÏOR CHAT4BËRS PËR TRENCH.¡fì -': BE ABAN9lNED 'N FLACE OR VALVEINSIALLËD FOR FUIÚRE USEAFPROXlMAIE V'AI ER LINEÉNF:T=SCALE: 1" = 30!0"/;\ PROPoSED oWTS3.8ÉDROOMRESIDENCEGAMGEi-ffiSheet 2 0F 4CBO lnc.'129 Câins LaneCarbondale. Colorado 81623Phone 970.309.5259carla.ostberg@gmail.comDatei 0810612022Designed by: CBORev¡ewed by: RBDrawn by: DDHanson Residence416 Mineota DriveGarf¡eld County, ColoradoPrcject Number: C1731w2.0 CHAIIBçR END PI ATEDIA SDR,35 INSPFTìTONl. tMtTi XCAVATIONSCARIFYGRAVÉLLESS AÐS ARC 36 LOWPROFILE CHAMBER (5'x 3')4' DIA SDR.35 DISTRIBUIIONLINE TO EACH TRENCH(MtN. 1% SLOPÊ TO TRENCH)4'DtA SDR-35EFFLUENT PIPÊ FROMSEPIIC TANKDISTRIBUTION BOX WTHAI GRADEPLACËD INTOP PORT OFCHAMBER ENDPUESSI\,IALL VALVE COVERBOX OR IRRIGAÍIONVALVE BOX AT GRADEÞIASDR-35 DISTRIBUTIONLINE TO ADDITIONAL TRENCH(MlN_ 1% SLOPE TOTRENCH)POR I AT BEGlNNINC ANDÊND OF EACH TRCNCI]''ï'RÉCOMMEND INSTALLATION ATAPPROX. 2' BÊLOW MTIVEGRADFSOIL.DIA SDR-35INSPECTIONPORImnCOMPACTBASE TO SUPPORTBOXGRAVELLESS ADS ARC 36 LOWPROFILÊ CHAMBER (5'! 3')IJSË HOLE SAWTOCUT THRU TOP OFENDPVC PIPE CUT TOFllá\ CHAMBER TRENCH SECTION\rr--ffiÆ\ DISIRIBUTON BOX\)r-----ıirãæw3.0by:0810612022by: CBOby: RBDDHanson Residence416 Mineota DriveGarfield County, ColoradoProject Number: C1731CBO lnc.129 Cains LaneCarbondale. Colorado 81623Phone 970.309.5259carla.ostberg@gma¡l.comSheet 3 0F 4 DESIGN3.BEDROOM RESIDENCE(75 GPD x2 PERSONS/BEDROONI x 3 BEDROOIT¡S)WASTEWATER FLoW = 450 cPDTANK:¡,,IIN. lOOO GALLONSUSE ËXISTING lOOO-GALLON, TWO-COI\,4PARTMENT CONCRE']'E SEPf ICTANKSOIL TREATI\,,IENT AREA (STA):LONG TERM ACCEPTANcE RATE (LTAR) = 0.3 GAL/ SFCALCULATED STA = O/LTAR = 450 / 0.3 = 1 500 SFGRAVITY, TRENCHÊS = 1500 SF X 1.0 = 1500 SFCHAMBERS = 15OO SF X 0,7 : 1O5O SF / 15 SF 1 CHAMBER = 70 CHAN,IBERSFOUR GRAVELLESS CHAI\,,IBER TRENCHES18'ARC'ADS CHAMBERS IN EACH TRENCHTOÏAL 72 'ARC'ADS CHAMBERSFINISHED GRADEMIN.24"BOX AND COVER BROUGHT TO GRADECONCRETE LID------1\4' DIA SDR-35 SEWER LINE(MIN 2% SLOPE TO TANK,t\¡¡N. 1% TO STA)SCREENEDGRADEOR SAND FORBEDDING3'MtN.8" MlN.BAFFLE ORANGLED PIPETO BE USEDAT INLETI01234567I910SOIL PROFILE TEST PIT NO. 1SOIL PROFILE TEST PIT NO.2MEDIUI\¡ BROWN SANDY CLAY LOAN1 WITT1MODERATE STRUCTURF GRADEI\4EDIUII1 BROWN SANÐY CLAY LOAI\¡ WITHMODERATE STRUCTURE GRADEMEDIUM BROWN SANDY CLAY LOAM WITHWEAK STRUCTURE GRA.DFMEDIUM BROWN SANDY CLAY LOAM WITHWEAK STRUCTURE GRADEÆ\ DIS]RIBUTION BOX DEIv----ffiAILOWTS COMPONENTS ANDPHYSICAL FEATURÉSMINII,4UM REOUIREDSETBACKAPPROXIMATE PROPOSEDSETBACKHOUSE TO EXISTING SEÞTIC TANK39'SEPTIC TANK TO WELL50'N/ASEPÏIC TANK TO WATER COURSE50'N/ASTA TO HOUSE20'STA TO WÊLL100'N/ASTA TO WATER COURSE50'NiANO GROUNDWATER OR BEDROCK ENCOUNTERÊDDURING EXCAVATIONLEGENDnsandy clayloamw4.0BACKFILLOUTLETSil:ooooHanson Residence416 Mineota DriveGarfield County, ColoradoProjectNumber: C1731by: RBDDDesigned by: CBODate: 08/0612022ReviewedDrawn by:CBO lnc.1 29 Cains LaneCarbondale, Colorado 81 623Phone 970.309.5259carla.ostberg@ gmail.comSheet 4 0F 4 a I ¡ trIt,t Ti it t T i' ìI GARFTELO COUNTY BUILDING AND SANITAÏION DEPARTMENT 109 8th Sfreet Sullc 303 Glcnwood SPrlngt, Colortdo 01ô01 Phone (gos) els-aa2 Pe¡rnll Ag¡e¡¡or'B Parcel No. Thls does not conslitute a bullding or use permil. 625-3584 '[b 2? lg lNDtvtþuAl SEÙACç DISPOSAL PERMIT PROPERTV o*n"r'S.t"Jon Stonck Present Address 819 Rsnltolph üBr R:Lflo Ph t 0416 Mlneota Drlvo. lïíneota BetaÈoat tot 3¡ gllt System¿pcation oJiror.-\r"rcer No. ( i ¡ ì I I i I : I I ì Legal Descript¡on ol SYSTEM DESIGN /liâ h Soptic Tank Capacity (gallon) Percolation Bate (minutos/¡nch)Number of Bedrooms (or olher) .'tl. i I 3 Required Absorption Area .'See Special Selback Requiromenls: ntt"t"o l9 06 ',.'^r(äf¡,rÞu . L 0o [, ÇooL) 'df orî¡.+-l ea¡)ç'P "1..' /,? þ:,;('-t;' tF-'' /^ ß.. ;o - I-,Ì' 1f,' t' a+ 0 I1A Ul ..r. t o( 2.. 'ri ': ll t al I I Dåte lnsp€ctor FINAL SYSTEM lI,¡SPECTION AND APPROVAL (as installed) Call for lnspection (24 hours notice) Before Coveri¡g lnstallati \ oh *;\"'- r+n tÖur a-ô^'4 System lnstall€r t f It .! S€ptic Tank Capacity Sepl¡c Tånk Manulactur€r or Trade Name f t ¿ $ f È III { r I fr I( tt ¡ t t t l I {1, f ç f I f;ï TIÍ r /"._-- I ) { f tI { T ¿ t I \ J ;, t I rt I I ). ,rr Septic Tank Access wilhin 8" ol surface - *-t -, Aþgorplion Arga Abgorplion Area Type andlor Manufactur€r or TrSde Nams Ad€qu8te compliance with County and Stâtê r€gulat lnsp€ctor Othor a Dal6 RETAIN WITH RECEIPT BECORDS AT CONSTRUCTION SITE TCONDIÍIONS: i. Alt installation mugt comply with all rêquiremonts of thú Colorado Stats Board of Hoalth lndividual Sewage Oisposal Systems Chapter 25, Articfe 10 C.R.S' 1973' Revisod'1984' 2. This perm¡t is vaf id only lor connection to structuree whlch have fully complied with County zoning and building requiremenls. Con' n6ct¡on to or use with ány dwelling or atructuros not approved by the Bullding and Zoning.olt¡co shall sutornaticelly b€ a violOtion or a roquiremenl ol the p€¡m¡l and cãuse lor bolh logal tct¡on and revocation of the permit. 3. Anypersonwhoconstruct6,altors,orinstallsanind¡vidual sewagedisposal syst€minamannerwhichinvolve¡aknowing-endmatetlal variÀtion lrom the terms or spocilìcations containEd ¡n lho applicålion of permit commils a Class l, Potty Ollense ($500.00 line - 6 months ¡n ja¡l or both). Applicant: Gteen Copy Dopertm€nt: P¡nk Copy ot'lNE ADDRESS CONTRACTOR ADDRTSS PTRMIT REQUE$T F0R: () New Instal 1 Attach sepðrate sheets or report shovri topography of area, habitable buildingtest holes, soiì profiles in test hoìe ION OF PROP F ILITY : County Near what Cl ty of Tow Legal Oescrlption I ND IV IDU EI'IAGT DIS AL YS APP ICATTON P}IONE llpplication Âpproval by County 0fficial: lfa.ap L I'HONE ation ( ) Alteration ng entíre area wìth resp , locatlon of potable vras. (See page 4.), 6 çn,{t'e ¿V 8)5=s_sg/ ( ) RepaÍr ect to surrounding areas, ter wells, soíl percolatÍon /é:. g Çc,Lot Si ze Lor /¿//t/6 2- H{SJES TYPE-,{ ) owelling ) Conunercia'l or InstÍ tutiona'l 0ther - Describe ( ) Transient Use ( ) l{on-domestic t,lastes ( ( () BUILDING OR SENVICE TYPE: Number of bedrooms ber of persons Íc washer (À) Dlshwasher ( zY ) well ( ) spring ( ) stream or creek ( ) Garbage grinder (.{) Automat SOURCE AND TYPE OF I.IATER SUPPLY: Glve depth of all welìs within 180 feet, of system: If supplied by conmunlty water, gíve na¡ne or suppl GROUND CONDITIONS: Í er: Depth to bedrock: Depth to first Ground Water Table: Percent ground slope: DISTANCE TO NIAREST COÎ'IMUNITY SEI.IER SYSTTM: l,las an effort maie to connect to comrunity sy stem? n O TYPE OF INDTVIOUAL SEI^IAGE DISPOSAL SYSTEM PROPOSED: (,-f) septlc Tank ( ) Vault Privy ( ) PÍt Privy ( ) Chenrical Toilet FINAL DISPOSAL BY: ) Aeration Plant ) Compostlng Tollet ) Incineratìon Toilet ( ) Vault ( ) Recycllng, potable use ( ) Recyc'ling, other use ( ( ( ( å Rbro.ption Trench, Bed or Pit ) Underground Dlspersal ) Above Ground Dispersal ) Other - Descri be: ( ) Evapotranspìration ( ) Sand Filter ( ) l,{astewat,er Pond ( ( ( () Other - DescrÍbe: I.IILL EFFLUINT BE DISCI{ARGED DIRICTLY INTO HATERS OF T}IT STATE? Paon 2 e S0IL PERC0LATI0N TEST RESULTS: (To be conrpletecl by Regìstered Professional En gineer. ) 14 i nu tes per inch in hoìe No. I Minutes per inch in hole No. 3 l'linutes per inch in hole No. 2 l[inutes per lnch in hole llo._ Nante' address anrl telephone of RPE who ¡rrade soll absorption tests: Name, address and telephone of RPt responsible for design of the system: Applicant acknowledges thafurther mandatory and addi department to be nrade and purposes of the evaluation such terms and conditions adopted under Article 10,that all statements made, submltted by the applicantof my knowledge and belieffn evaluating the same for stand that any falsíffcatior revocation of any permÍ Jury as provided by law. t the conrpleteness of the appf icat'ion is condÍtional upon suchtional tests and reports as may be required by the local healthfurnÍshed by the applicant or by the local health department forof the appl ication; and the lssuance of the pernrlit. i.S subJect to as deemed necessary to insure compìiance with rules and regulatlonsTitle ?5, C.R.S. 1973, as amended. The underslgned hereby certlfles information and reports submítted herewith and requlred to be are or wilï be represented to be true and correct to the best and are clesigned to be relied on by the local department of health purposes of issuing the permlt applied for herein. I further under- on or misrepresentation may result ín the deníal of the applicatlont granted based upon sald application and ìn legal action for per- I \ {Date q- l)' ?/ PLEASE DRA}I AND /\CCURATE MAP TO YOUR PROPERTY Si gned Page 3 'Ta4,( ßyY,, ( '''{*J6nIe-4>¿-. -Loçah" v+1¡ =7þ¿+?@-t6t,, /bl¡.olltlþtLqtt | 'r"¡trtol .t þóq,{(ns1vß\ 416 Mineota DriveLegend{? 41ô t\fineota Dr ;y, c0Phryrkal Á,&ircss 4 i6 f"1,\¡gTÅ CRlrLl ::i::Cfra¡nerAdress ¡1å\Sfi\i, ËljRî \' ¡ì \rÅUî Êi\ R4:d ¡.t,\:t'iÅ. f R'1cTfåst 2 SâlesDde Pr2û19 Tcrtal Àctr¡al \bh*ë Í47t.,5 i,-l