HomeMy WebLinkAbout76 Green Mountain Dr - 210904104001EAGLE ( AUNTY DEPARTMENT OF ENVIRONC,'TAL HEALTH
Box 811 6th & Broadway
Eagle, Colorado 81631
PERMIT0 16 (this does not constitute
a building or use permit)
Owner Kenneth J. Wiencek
System Location Lot 22, Kaibab Subdivision
Licensed Contractor . Owner
* Conditional Construction approval is hereby granted fora 1, 000 gallon
XX Septic Tank or Aerated treatment unit. PERMIT MUST BE POSTED ON PROPERTY
Absorption area (or dispersal area) computed as follows: PLEASE CALL FOR FINAL INSPECTION
Perc rate 1 inches in 20 minutes 720 sq. ft.
absorption area per bedroom
240
# of bedrooms 3 x 240 sq. ft. minimum requirement
May we suggest 720 sq. ft. of drainage field (122 x 60)
Date ��' 77 Inspector I �.4
_ c T- r
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.
ok Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
ok Proper materials and assembly.
ok Adequate absorption (or dispersal) area.
ok Adequate compliance with permit requirements.
ok Adequate compliance with County and State regulations/requirements.
Date September 27, 1977 Inspector Erik W. Edeen, R.P.S.
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 25-10-104, CRS 1973 amended 25-1-614, CRS 1973
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
LOLL
ENVIRONMENTAL HEALTH
PERMIT NO. `I& P.O. BOX 811
EAGLE, COLORADO 81631 PERMIT FEE $25.00
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Name of Owner:
Kenneth J. Wiencek
Phone:
Address of Owner: 6750 W. 91st St.,Oak Lawn Ill 60453
Is facility within boundaries of a city/town or sanitation district? No
Distance to nearest sewer system: 1 mile
Location of Proposed System: Lot 22, Kaibab Seib.
Legal Discription:
Type of Structure: Single Family Dwelling ( X3 Other:
Water Supply: Private Well ( ) Location:
1\ • 384
312-599-9058
No. Bedrooms 3
Distance From leach field:
Size of Lot: Public Water Supply: Yes - Eagle
An appropriate plat plan must accompany site inspection for this application showing required information. (See
attached sheet.) The individual sewage disposal system will be constructed and installed in accordance with the
regulations governing individual sewage systems within Eagle County, and shall comply with House Bill 1553 CRS
66-14, 1973. Payment shall be made to the Eagle County Treasurer. Permit, upon approval of this application, may be
obtained at the Eagle County sanitarian's office.
Appointment for final inspection must be made prior to construction by contacting the inspecting sanitarian. [Phone
328-7718 between 8:30 and 9:00 AM.] Refer to permit number. No approval will be given on any system without final
inspection.
,. Name, address, and telephone of person responsible for design of system:
The undersigned acknowledges that the above information is true and that false information will invalidate the
application or subsequent /permit.j}�i) �%
SIGNATURE OF APPLICANT: ✓ AM `i u Date: ajWL R I q 77
(This application becomes1invalid 6 mont s from above date.)
HEALTH DEPARTMENT USE ONLY
Percolation Information: ���16'0
Tank Capacity: zt4) gal. (minimum)
Absorption Area: 7��X �� /fin Sq. ft. (minimum)
REMARKS:
APPLICATION IS: APPROVED (X.X) DENIED
Permit No.
Fee Recei is �b'a
File: e /D� 1'77
The above individual sewage disposal system was installed by
AND HAS BEEN INSPECTED AND APPROVED BY A REPRESENTATIVE OF THE EAGLE COUNTY HEALTH DEPT.
Date: September 27, 1977 Sanitarian: Erik W. Edeen, R.P.S.
,r
/r et
. Pr11COL.ATION TEST
FCC: $51O.00
f pnlicatior_ No. Perna t No.
Owner:
LeI-nl Description:.
Tyre of Dwelling; No. of Bedrooms:
Date of Test:J� Denth of Holes:
Diameter: 12—
�/ Tine of Soil: /�SA"�
i
Loc:'.tion of Test Holes.:
Test hole was nresoaiced from: _ �r C �tlT06I �
i�ne `J Dsto Time ' Date
3LE .
TIME
WATER DEPTH
� INCHES OF FALL
RATE
1
L_
1_
2-
3_
l
2
3
1
2
3
7; ,O
Percolation Rate:
•Site has been reviewed -and tests foz• ,:crcolation. rate."•-
We recommend: IPPROWL DISFPPI;OVAL DITE:
EI)vil.'On'IIentttl Iieclth
h-� Ba. le CounLy
ram' V�5 - I/ % CA11 - / () n
EAG LC"'COUNTY ENVIRONMENTAL HEALC
INDIVIDUAL SEWAGE DISPOSAL SYSTE11 PERMIT
ROUTE FORM
NAME
4w
ate Refered Permit Number
LOCATION
Please review the attached application and return it and this completed form to
the Environmental Health Office within 6 working days.
PLANNING: File No. Yes No Reviewed by Date
Complies with:
Subdivision Regulations
Zoning Regulations
Recommend Approval
comments:
C0
UVTY ENGINEER: Roads -.-
Grading
Drainage
Recommend Approval
Comments -
BUILDING DEPARTMENT:
Set backs
Site
other
Comments:
Access
Recommend Approval
0176-Lot 22 Kaibab Subdivision
'JOB NAME. 0076 Kaibab Road WIENECK[%y�ri I� JOB NO.
JOB LOCATION
I`
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
Z012�o
i
"Pm14/1 2) 0q-- 04
k 04 _
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
OI'Z- Scxv i "
PERMIT # 176Z/ '
OWNER: Kenneth J . Wi encek��E-iVi/v�'I I�
LOCATION: Lot 22 - Kaibab Subdivision
Green ►W&TQ ' IV
INSTALLER: Owner
SIZE OF TANK: 1,000 gallons
DWELLING: Residential - 3 bedrooms x 240 sq.ft.
PERC RATE: one inch/20 minutes (720 sq.ft.)
i
(720 sq.ft. of drainage field (12 x 60)
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OOVERHEAD COSTS
F SELLING PRICE
NET PROFIT
Printed in U.S.A
Finalized: September 27, 1977 By: Erik Edeen