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Please See Building and Land Use Approvals Files for additional information.
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Pitkin County Environmentardealth Department
Onsite Wastewater Treatment System (OWTS) USE PERMIT
Permit for Continued Use of on Existing OWTS
0405 Castle Creek Road, Suite 10, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
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Parcel ID #: 2463-273-00-010
OW75 Use Permit #: I 0018.2011.powu
Date Issued:
4/15/2011
Issued By:
Carla Ostberg
Expiration Date:
4/15/2012
Owner(s): I Stephen and Stacey Degouveia
Property Address:
6601 Hwy 133
Legal Description:
Click here to enter text.
Licensed Inspector: Roger Maynard 007
Inspection Date(s):
April 13, 2011
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
Concrete two compartment
1000 gallons
Concrete single compartment
1000 gallons
Secondary Treatment Unit
n/a
Click here to enter text.
Absorption Area
Gravelless chamber bed
651 sq ft
Other System Components
Click here to enter text.
Click here to enter text.
OWTS Use Status:
® In use at the time of the inspection.
[—]Not in use at the time of the inspection.*
*If the OWTS was not in use at the time of the inspection, it is recommended that the system be re-evaluated when itis in use for a
more accurate evaluation of the system.
System Records:
Permit #: 98048 Date of Issuance: 8/24/1998 Date of Final Approval: 12/30/1998
# of Bedrooms or fixtures served by OWTS: 2 bedrooms, although the system was designed to accommodate 3 bdrms.
Operational Status: The system appeared to be working properly at the time of the inspection. Both tanks were pumped
as part of the inspection.
Inspector Recommendations: none
Department Recommendations: Recommend periodic (yearly) maintenance inspections by a Pitkin County Licensed
Systems Inspector of the pump and entire system to assure proper functioning. Effluent filters should be cleaned as
needed.
Issuance of this OWTS Use Permit is based solely on the conditions observed and reported by the inspector to the Deportment on the date of the inspection(s) and
on Department records at the time ofpermitting. The issuance of this permit does not constitute a guarantee, warranty, or representation by the Department
that the system will operate properly or will not fail or that the system will not be subject to future enforcement action to correct non-compliant conditions.
Estimated capacity of the system has been listed on the permit and we recommend that you monitor and/or meter water use to prevent overuse and possible
failure.
NON /�
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Pitkin County Environmental Health Department
10ITKIN Onsite Wastewater Treatment System (OWTS)
Gr USE PERMIT APPLICATION
�OUNT�
0405 Castle Creek Road, Suite 10 • Aspen, CO - 81611
Phone: 970.920.5070 Fax: 970.920.5077 Website: www.aspenpitkin.corrdehnr
Annlication for Continued Use of an Existina OWTS
Parcel ID# (available from the Pitkin County Assessor's Office
970.920.516D or at www.oitkinassessor.ornl: 6A
Purpose of Use Permit: XPROPERTY TRANSACUON ❑ REMODEL/ADDITION
Property Address:
Lot: Block: Filing: Subdivision:
Residences: Other
# of Bedrooms: fixturesluses:
Property Cwner(s)': Email Address:
s�h"75W o r`T7zJy o�4ouv�i<f �&ll A" .
Owner's Mailing Address: City, State, Zip:
6�0/ /nvl'133 corc/1vr✓O� Co fS//z3
Home Phone: Business Phone:
379—/7 VI
'Contact information must be provided for the owner signing this application.
Primary Contact PersonlApplicam (if not owner):
Company:
Contact/Applicant Mailing Address:
/a, O?X /371
City, State, Zip:
If 071" co
Cell Phone:
Business Phone:
G/g- 3 S9fl
Fax Number:
?'•Z �-537
Email Address:
srz�e�/�i.1�F��ilit�-�orr�.ai�9 cvr>"
Indicate Preferred Method of Permit Receipt: XEmall
❑ Fax ❑ u5 Mail
Licensed Systems Inspect r. Phone Number Email Address: Fax Number
N2 SSG/4,0,ou �/rill�Afte %4 -;,W /Lsc'I'AGUlIflLGvJH 7 3--t(07d
Mailing Address:
0403 pr ",
City, State, Zip:
PLEASE READ BEFORE SIGNING:
I certify that the above Information is complete and accurate and that I have provided complete and accurate Information In all of the documents
Included In my application package. I acknowledge that
this department may revoke any permit I am Issued if my application is found to contain
any Inaccurate, false, or misleading Information.
Owner Signatu � equired): Date:
Date: ` ' // L
Applicant Sig i
Please allow 3-5 business days for processing of Use Permits.
FOR .OF.' --
Received bv.EH Staff: Fee 8 Recelpt #:
000002
05/15/2011 13:51 9636070 B R SEPTIC
SEP -22,2010 9:57AN ORO HEALTH NAT RESOURCE
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COUNT4
Wastewater
N0.502 P. 1
Permit Inspection Form
Pitkin County Environmental Health Department
0405 Castle Creek Road, Suite 10, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
Website: www.asoenortkin.com/ehor
,Z _
Address: �'%/�/ .r G'/r, . �E . � _� �'/y�•i
Parcel Number; lf�G 7t — Ln�j G 10 7
Inspection Dom: /0
Records:
were system records available from the department? ves` No
If Yes: Permit number
��., � �
Date of Irimllation:�y Tank size'
A sore ion area r e- .
Permitted Use:
Is this system permitted for its cudent use?
If no, describe the change in use.
Was an As -Built drawing available?
Is the As -Built Drawing Accurate?
if No: Complete a drawing of the system on lost page of this form as occurarely as
possible if as -built woo not available or is not accurate.
Site Conditions:
TANK;
Erosion
FA1L
Improper Vegetative cover
qPAS
YES
Evidence of Compaction
:)
YES
Improper Discharges�
FAIL
High Ground Water
YES
Snow Cover
D
YES
Property Vacant
it))
YES UNKNOWN
Use
was the tank pumped as part of the inspection? If No, sk;pto Tank Componems.
If No: When was the tank last pumped? %
If the tank has not been pumped in more than 2 years, please attach additional information
for justification. Information to be included in Justification: Depth of scum layer, Depth
of sludge layer and/or Verification of limited occupancy
If Yes: Pumping Com E
P g Panv�
Discharge/leakage rASL
fnfittratiun P FAIL
Back flow after pumping YES
05/15/2011 13:51 9636070 B R SEPTIC
SEP -22-2010 9:58AM E®RO HEATH NAT RESOURCE
Tank Components: Tank /[ C/(/ 74/-
Lids v
Tank Integrity
Mid Tank Baffles
5anitaryTees / Inlet & Outlet Baffles
Effluent Filter/Screens
Water -Fight
Pump/Dosing Siphon
Tank Material
Pump Alarm
Tank Components. Tank 2 � J�
Lids
Tank integrity
Mid -Tank Baffles
Sanitary Tees / Inlet & Outlat Baffles
Effluent Filter/Screens
Water Tight
Pump/Dosing Siphon
Tank Material
Pump Alarm
u
If additional tanks are presont, include reports for each.
PACE 04
NO. 502 P, 2
FAIL
Na
FAIL
Lids
FAIL
NP
FAIL
PASS
FAIL
NP
FAI L
FAIL NP
FAIL
PASS
FAIL
Mechanical Systems
FAIL /
FAIL
r
FAIL NP
FAIL
FAIL NP
FAIL
FAIL NP
FAIL (r
No NP
SECONDARY TREATM ENT:
Is a secondary treatment unit part of the system design? —,41za__
If Yes: Make/Model:
Na
�Sr�
Lids
PASS
FAIL
Tank integrity
PASS
FAIL
Media Container
PASS
FAIL NP
Media Condition
PASS
FAIL NP
Mechanical Systems
PASS
FAIL NP
COrrtral5/Alarms
PASS
FAIL EXl ires:
Maintenance Agreement
PASS
FAIL
Provider Name
Provider Phone
Number
ABSORBTION AREA:
Distribution Box Accessible from grade?
Distribution Box
ADV Accessible from grade?
Automatic Distributing Valve (ADV)
Observation Ports
Effluent Surfacing
Evidence of Past Surfacing
Surface Dampness
Excessive odors
Liquid in observation port
000001
yes
Na
�Sr�
FAIL
Yes
No
PASS
FAIL
P
FAIL
ASS
FAIL
Nq
YES
�N,
YES
N ,
VES
NP
I
J
inches
05/15/2011 13:51 9636070 B R SEPTIC PAGE 05
JUN. 21, 2010 1:42PM GIRO HEALTH NAT RESOURCE ny NO. 417`P.
Any problems with the system that wee not addressed in the inspection checklist?
Please list any recommendations for the system to continue its current usage.
Were any repairs done as a result ofthis inspegion? NO YES
If Yes, please describe the repairs.
/I%!172
To the best of my knowledge and training, the Information collected in this inspection is accurate as of
Inspector's Signature:
Business Name:
Phone Number
Address:
Email:
P Itkiin County Inspector license Nu tuber:
Additional Notes:
A copy of this inspection report wi!!be remitted to Pitkin County En vironmental fieahh with 60 days
aj the inspecuon.
000005
05/15/2011 13:51 9636070 B R SEPTIC PAGE 06
6601 HIG14WAY 133
TRACT 14, SECTION 27, TBS,
R88W, 61H P.M. I
P17KIN COUNTY, COLORADO iI i 4
1 ` i
lr` F NORTH
--� SCALE
7" = 30'
f ----"" CONTOURS = 2'
EXIS7ING W£LL _~-^
y 1
Il i7 1
t
i
OPTIONAL 5EP71C TANK AND UFT
TATION LOCA77ON
PROPOSED 3
BEDROOM ' a
RESIDENCE t OR n
MINIMUM 500 GALLON
UFT STA7ION MTH
PUMP: RECOMMEND
1 1000 GALLON TWO
J COMPARTMENT
4' PVC PIPE j PRECAST CONCRETE
! SEPTIC TANK WITH
,PUMP
1000 GALLON TWO COMPARTMENT
PRECAST CONCRETE SEP71C TANK
WITH AN FFFLUENT FILTER j i O
2' PVC PIPE
NOTES:
l 1 1, PROPOSED FIELD MUST BE GREATER THAN
t
PRESSURE DIS7RiBU1Li7 CHAMBER FIELD 1 i loo FEET FROM DUS7INC WELL
6 ROWS OF 7 CHAMBERS 12. SEPTIC TANK AND UFT STATION MUST BE
42 CHAMBERS TOTAL 'GREATER THAN 5 FEET. FROM RESIDENCE
18'X43 75', l AND b FEET FROM PROPOSED FIELD.
` . A 1500 GALLON TWO COMPARTMENT
I P ECAST CONCRETE SE'PAC TANK W17H A
t `MP IN A 0107UBE FILTER MAY BE
11Lf19• tBSIMTEU FOR THE YP17C TANK AND
L#1 STATION.
I LOCATION OF PROPOSED �e
FTG. 2
JOB NO. 9926
b0000s C99 ON MV -18 1VN HllV3H WAN3 W1:01 MZ -8 '8dV
05/15/2011 13:51 9636070
•
B & R Septic Service, Inc.
Rooter & Jetting Service
Video Inspection Service
0603 Handy Drive
Carbondale, CO 81623
Bill To
Steven De Gouveia
6601 Hwy 133
Carbondale, CO 81623
B R SEPTIC
N
PAGE 02
Invoice
Data Imroics #
4/12/2011 5832
000007
P.O. No.
Terms
Project
Due on receipt
Quantity
Descxiptlon
Rate
Amount
Septic Inspection
250.00
250.00
2,000
Pumped 2 septic tanks & lift station
0.23
460.00
2,000
Dump Fee
0.15
300.00
Sales Tax
3.90%
0.00
Thank you for your business.
Carbondale Aspen
Fax
Total $1,010.00
(970) 963-3814 (970) 920-2059
(970) 963-6070
000007
05/15/2011 13:51 9636070 B R SEPTIC PAGE e
0
0--j�en/pktkdn Environmental Health Depr -'ment
p'
tit for an Individual Sewage Disfacsa, /stem
130 S. Galena St. Aspen, Colorado 91611
Phone 970-923-5070.; PAX 970.920-5197
Permit # rlE t Parcel ID of 0'U
Type of permit LMi,�
Name of Owner �j FCYLV
p�
1l
i�W
D
Street Address
Property legal description
- ��
��'f �G par-QL�'
-ltoy 1 a3 -
Size of lot
Total square footage of the house
Wamr source
# of bedrooms in Mouse
`� -
# of offices, lofts & Similar seed rooms m house I
Caretaker unit
Total square footage of the caretaker unit
ft of bedrooms in caretaker unit
# of offices, lofts. & similar sized
rooms in caretaker unit
Designed for what : bedrooms. i2�
Permit information
Designed by �4P Fes' YT �.C�, l�`.uiYC� r•- .
Mailing Address
Pero rate Z_ Profile hole depth ` -- Depth to groundwater or bedrock N(t�
Septic tank caaacity C-t'?)4 S Absorption area aLSoR.,�
U r°,�.cxl-iovl -�Y
� -ayjglvae.el-'s. )'es n JtveS 3 a l°12+ na�tu2
.s -(ter-� r�'k �P�t�-E- 'mow f�'t�tsMUP✓I G`tr 0., Iia �,al(4yt '�`;�..vl�
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4
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Permit approved b !i f { fQ I� /n r. /Date: _
Plans and specificab m&oL*t proposed Individual sewage disposal system have been reviewed and are considered
satisfactory, Permission is hereby granted to the owner or the agent to perform the work indloated in aecordanee with the Pitkin
County ISDS Regulation in effect at the time of issue. This permit becomes invalid 6 months from the date that the permit was
issued unless system construction has commenced or an extension has been approv9d in wli5ng by the Department.
As -built drawings must be included with this permit before the final approval will be issued.
Installer.
Final ins
-0000031
Date: 12- .3D.4,�
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HOBG00
IMPROVEMENT SURVEY
A PARCEL OF LAND IN THE SW1/4 OF SEC. 27, T.8S., R.88W., OF THE 6TH P.M.,
COUNTY OF PITKIN, STATE OF COLORADO.
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PROPERTY DESCRIPTION
A toot Of land sltuated In Ne SWI/4 of Section 27, To eontp 8 South. Range SB Wast of Me Sixth Principal M.Idlan.
County of Makin. State of Colorado. ly/ng Westerly of Ne Weslarly right of way Has of Calnodo Stale Hi,hway No. 133
and bear, more particularly deecnbed as (dines
Commencing at a point on Me Southerly boundary Me of sold Seclin 27, when a Braes Cap frond In place and
properly marked for Me South. ort comm of said Se.U. 27 bear. Wast 2272.00 feet; '
Mann. North 07'32'W Wert 428./8 feel
thence South 9228'00' West 50.00 feet
thence North OT32'00' West 225.00 Net:
Mance North 8228'00' East 50.00 feet:
Menne North 07WOO' West 90.87 feet to a paint an the W.lewy right of way line of void Highway No. 133
thaw W., the Westerly A ht of way line of said State Highway No. 133 an the fallowing courses
Man. South 2197' East 91.1?5 Net;
then. SaAh 18'52' East 188.40 fcwC
Mn. North 75W East 50.00 feet:
Mn. 225.00 Net along the arc of a 758.60 fact radius wr.W to Me righL Me chard of which bears South 0429' East
253.90 feed:
Menta South 0851'30' West 19250 fest;
Mn. South 14'4530' Wand 44.20 feet to a point at Me M.D. of 0. Southerly boundary lane of sold Seaton 27
.ad Me westerly right of way line of sold State Highway Na 133;
Mn. Inning Me Westerly right of way line of sold State Hlgbway No. 133 an a mune bearing West for 22.41 Ml
Nn, the Southerly boundary Ire of said Section 27 to Me Part of BegNlnr4
0
NOTES
- SURVEY ORIENTATION IS THE AP ON WEST UNE A ROM AND CAP PLS ,f 22580 AND
THE SE CORNER A REBAR M0 CAP LIBELED COOT OF SAID PROPERTY AS DESCRIBED.
- EASEMENTS Is ADDITIONAL INFORMATION SHOWN ME FROM TITLE COMMITMENT
PROVIDED BY PITKIN COUNTY TITLE, INC BASALT, CO ORDER NO. 83MX
- THIS DOES NOT REPRESENT A TITLE SEARCH BY THIS FIRM OR SURVEYOR.
0 - INDICATES FOUND REESM k CM UNLESS OTHERWISE NOTED.
v. - INDICATES UTIUTY POLE
-a- - INDICATES OVERHEAD UT UTY UNE
A - INDICATES CONTROL PONT
THE SEXTON SURVEY COMPANY
128 WEST 3RD STREIT
RIFIE, COLORADO 81650
870-825-3711 OR "S-4700
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GRAPHIC SCALE
(arae)
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SURVEYOR'S CERTIFICATE
I HEREBY CERTIFY N THAT THIS MAP ACCURATELY DEPICTS AN IMPROVEMENT SURVEY PLAT
PERFORMED UNDER MY SUPERVISION AND DIRECTION ON DECEMBER 19, 2003, OF THE
HEREON DESCRIBED PARCEL W LAND. THE LOCATION AND DIMENSIONS OF ALL BUILDINGS,
IMPROVEMENTS, EASEMENTS, RIGHT-OF-WAY IN EVIDENCE OR KNOWN TO ME AND
ENCROACHMENTS BY OR of THESE PREMISES ME ACCURATELY SHOWN PITKIN COUNTY
TITLE, INC. CONasITMENT CASE NO R335X WAS USED IN PREPARING THIS SURVEY.
• NARY MINE HOBIM11, KENNETH I HOBGDOD SR. b PITKIN COUNTY TITLE, INC.
iz ' $�S31944 --/ D�1ATjEz zw 3
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HOBGOOD
IMPROVEMENT SURVEY
NO.:
BY: KS
A PARCEL OF LAND IN THE SM/4 1
S 27, TAS., R.88W, OF THE 5TH P.M., of
COUNTY OF PITKIN. STATE OF COLORADO.