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GARFIELD COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
2014 ,Blake Avenue
Glenwood Springs, Colorado 81601
REPAIR PERMIT k S 122 cQ. (this does not constitute
abuilding it
or permit)
�°-f•'6'k%,) use P )
Owner Joel Bouchard
System Location Cabin /2 - Hideout •• Glenwood Springs
Licensed Contractor Colter Excavating
* Conditional Construction approval is hereby granted for a c r gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows,:
Pere rate / inches in minutes /.? s sq. ft.
absorption area per bedroom ge , c.
R of bedrooms . -r> x !1 'r sq. ft. minimum requirement „a 4 c SC / /'< r✓ .t- - , ,�;• N ,,.
May we suggest /j+ /r � T / < , y , �,. /e Y 1. .:,•.', , '�t > �;; /G.yt.:.y.;:.;;r! i; ��.. ..v! r 7
Date a 2 _ j., Inspector ;•y =�.'�l"
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FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system
is approved prior to covering any part.
Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly.
,•,e= Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
_Adequate compliance with County and State regulations /requirements.
Date Inspector Z t
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations,
adopted pursuant to authority granted in 66.44.4, CRS 1968, amended 66.8.14, CRS 1968.
2. This permit is valid only for connection to structures which have fully complied with County Zoning and
building requirements. Connection to or use with any dwelling or structures not approved by the building
and Zoning office shall automatically be a violation of a requirement of the permit and cause for both
legal action and revocation of the permit.
3. Section III, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal
system in a manner which involves a knowing and material variation from the terms or specifications con.
tained in the application of permit commits a Class I, Petty Offense ($500.00 fine • 6 months in jail or
both.
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COLOR DO DEPARTMENT OF HEALTH
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Water Pollution Control Division
4210 Eart filth Avenue •
Denvier•,• Colorado 80220
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NOTIFICATION OF PROPOSED DISCHARGE WATERS OF THE STATE*
INDIVIDUAL HOiIE SEWAGE TREATMENT SYSTEM **
Owner: j 4 fie (/ e/14 -R0 • CaWn2:14
City t �L coet:5 Z i p WS Phone yy� rel l
Mall Address: 1,2_97 �'V �/] p� f � A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitable buildings, location of potable w::ter wells,
soil percolation test holes, soil profiles In test holes.
1. Location of facility: County altAa n .City or town al-Faia
Legal description (74 -(7/v/ ,/-jppoa7 tot size /Q .9
2. No. of bedrooms et Sep:ic tank capacity /4A4 Aeration unit capacity_ _
3. Source of domestic water: Public (name):
Private: Well 2 Depth /�- Other_ Depth to first ground water table 34
4. Is facility within boundaries of a city /town or sanitation district?_
5. Distance to nearest sewer system :_ 3 /t'/ 7- —__—
Have you attempted to arrange a connection with the system? �Q _
If rejected, what was the reason ?_ — •
6. Rate of absorption in test holes shown on the location map, in minutes per inch
of drop in water level after holes have been soaked for 24 hours •
7. Name, address, and telephone of person who made soil absorption tests:__
. . rS rztiez
8. Name, address, and telephone of person responsible for design of the system: ^_
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Date Or Signature of liner
*Required by Article 66- 28- 12(CRS, 1963, 1967 Perm. Sum. Supp.)
* *Required in areas which have been identified as areas in which da.nuer of pcilutur'
of waters of the State may occur (Art. 66- 28 -8(5), CRS) and /or areas in .+.`.id. then:
1s no local septic tank ordinance.
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B. SIGNATURES OF LOCAL OFFICIALS: The undersigned have reviewed the notification' i
described on the front of this sheet and recommend approval or disapproval of
the discharge as shown- below:
Date Approval Disapproval
Signature for Local Health Department
Signature for City /Town Official (Title
— Signature for County Official TTitic
Comments:
Signature and Title
Note: The Notifier (front of this sheet) must obtain comments and signature of at
least one of the above.
C. FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer:
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D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
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VP-3300-72-2)