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40 Pitkin County Environmental alth Department
Onsite Wastewater Treatment System (OWTS) USE PERMIT
Permit for Continued Use of an Existing OWTS
76 Service Center Road, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5374
www.aspenpitkin.com/EHNR
Parcel ID #: 2467-174-01-039
OWTS Use Permit #: I 0015.2013.powu
Date Issued:
4/23/2013
Issued By:
Bryan Daugherty
Expiration Date:
4/23/14
Owner(s): US Bank National Association
Property Address:
45 Crossland Drive
Legal Description:
Lot 4, Holland Hills at Basalt
Licensed Inspector:
Carla Ostberg
Inspection Date(s):
4/11/13
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
Concrete Two-compartment tank
1500 gallon
Secondary Treatment Unit
N/A
N/A
Absorption Area
Gravelless Chamber Trenches
1950 sq. ft.
Other System Components
N/A
N/A
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 it is in use for a more accurate
evaluation of the system.
System Records:
Permit #: 89081 Date of Issuance: 10/31/89 Date of Final Approval: 8/24/90
# of Bedrooms or fixtures served by OWTS: System was designed for 5 bedrooms
Operational Status: According to the inspectors report, the system was functioning as designed at the time of
inspection. The 1500, 2 compartment tank was in good working condition with the baffle intact and both inlet and
outlet Ts in place. The tank was pumped after the inspection. The tank flowed to a gravelless trench absorption field.
There were no signs of failure or surfacing effluent in the field area.
Inspector Recommendations: The inspector recommends adding an effluent filter to the outlet of the tank to prevent
solids from reaching the field area.
Department Recommendations: N/A
Issuance of this OWTS Use Permit Is based solely on the conditions observed and reported by the inspector to the Department on the date of the Inspection/s) and
on Department records at the time of permitting. the issuance of this permit does not constitute a guarantee, warranty, or representation by the Department
that the system will operate property 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 andlor meter water use to prevent overuse and possible
failure.
J C/
0
Mike Jenrette Services LLC
Bx 9932 • ASPEN CO, 81612 • Cell 970-456-6005 fax 970-429-8118
Submitted to: Lani WebbDate
proposed:
45 Crossroads Basalt
4-18-13
ALL WORK IS GUARANTEED FOR ONE YEAR AFTER COMPLETION
This bid includes all materials and labor necessary to complete the job described below, and as
described in the PLANS AND SPECS, if any.
Pump and dispose septic tank
All materials will be as specified or of comparable quality as initially
specified and as approved by both parties. Payments will be made:
Draws as work is completed and invoices are submitted
upon signing contract
Bid / Estimate
$600
Contractor/Owner agrees to pay according to the following schedu
Invoice 2399
Owner's signature Date
M
Pitkin County Environmental Health Department
111YIN Onsite Wastewater Treatment System (OWTS)
(', urrr ( USE PERMIT APPLICATION
iii 76 Service Center Rd
Aspen, CO 81611
Website: www.aspenpitkin.comfehnrf
Application for Continued Use of an Existing OWTS
Parcel IDN (available from the Pitkin County Assessor's Office
970520-5160 or at www.oitkinassessororal:
Purpose of Use Permit: I
PROPERTY TRANSACTION
❑ RWODH/ADDMON
Property Address:
145
T
VrtV
Lot: Block:
Filing:
Subdivision.
Residences:
Other
# of Bedrooms: 5
fixtures/uses:
Property Owner(s)':
Email Address:
5
i
til
ice r
Owner's Mailing Address:
-7-301
City, State, Tip.
a1 j i
n'L 3
lll
Home Phone:
Business Phone:
Contact information must be prowled for Me owner signing this application.
Primary Contac PersentApplicant (f not owner) Company:
a 11+
Contact/Applicarn Mailing Addre{s: City, State, Tip.
3� t s a��e
Cell Phone. Business Pho1Le
Fax Number Email Address(':I)
R --O' O r
Intlicate Prefemetl Method of Permit Receipt. YErnall ❑Fax F1 us Mail C6 M
Licensed Systems In r:O I Phone Number Email Address: Fax Number
Meiling Address: City, Stale, Zip:
3 Fol, Ly -h' r
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. 1 acknowledge that this department may revoke any permit I am issued if my application is found to contain any
Inaccurate, false, or misleading information.
Please allow 3-5 business days for processing of Use Permits.
ryy
i T H IN Onsite Wastewater Treatment Systems (OWTS) Use
Permit Inspection Form
COU N TY Pitkin County Environmental Health Department
76 Service Center Rd, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920.5374
• Website: www.asoenpitkin.com/ehnr
Inspection form for continued use of an existing OWTS
Owner's Name: "`{y Hyl � kAA_ }'j 0 , NR"f 42:+a W AA(D (sl- TCt(9 --
Address: e..}�1 C,frY l CI to A l ( 1 gr
YaLsa-Ur t^) 81h21
Parcel Number. Z_q(„—I—r]Q-01_n
Inspection Date:
Inspector's Name:
Business Name:
Phone Number
Email:
Pitkin County Systema Inspector License Numbek" a 01-1
A copy of this inspection resort will be remitted to Pitkin County Environmental Health Department by
the Licensed Systems Inspector within 60 days of the inspection regardless of whether the system
Passes or fails.
QUESTIONS FOR PROPERTY OWNER PRIOR TO INSPECTION:
Is the home currently occupied? YESNO
If NO, how long has the home been vacant? ,5j r\ (e 2011
How many bedrooms are in the home?
If secondary treatment is used, who is the
maintenance provider?
RECORDS:
Were system records available from Pitkin County? YES NO
If YES: Permit number: B °IO$ I
Date of Final Approval: 212-411 CID
If of bedrooms permitted: 5
�LF1_W �FY r\0 rf ct-tnl1�0
Was an as -built drawing available? YES NO
is the as -built drawing accurate? E ] NO
If NO: Complete a drawing of the system on lost page of this form as accurately as
possible.
Any question marked FAIL will require correction before an OWTS Use permit is issued.
SITE CONDITIONS:
Proper grading, no evidence of erosion?
PASS
Improper vegetative cover?
Evidence of compaction such as heavy machinery or livestock?
Improper discharges such as straight pipes?
Evidence of high ground water?
Snow cover present?
iqu
Page 1
FAIL
YES FE r tiE C°'JJI '�t
YES Sy ��tt Ci5�1 n nS.
FAIL
YES
YES
0 0
TANK:
Tank 1
NO )
Tank 2
PASS
Tank 3
Does the pump/wiring/dosing siphon appear to be in good condition?
Tank capacitygallons
FAIL
Is the high water alarm working, both visible and audible?
PASS
gallons
SECONDARY TREATMENT:
gallons
Tank material
Cpl
�1
(_��O
UNKNOWN
If YES, does the unit appear to be in good working condition? YES
NO
Liquid in observation port?
A of compartments
NO
UNKNOWN
Maintenance Provider: _ Phone:
inches
Date of last pumping
YE
NO UNKNOWN
if VES, is it accessible from grade?
YES
Lids/risers in good condition
CPASS
FAIL
PASS
FAIL
PASS
FAIL
Risers to grade
YES
NO
YES
NO
YES
NO
Riser height
Riser condition/watertightness
Go
Inlet sanitaryT/baffle
P
FAIL
PASS
FAIL
PASS
FAIL
Outlet sanitaryT/baffle
FAIL
PASS
FAIL
PASS
FAIL
Effluent filter (if part of design)
PASS FAIL
N
PASS FAIL
N/A
PASS FAIL
N/A
Condition of tank material
ASS
FAIL
PASS
FAIL
PASS
FAIL
Tank was pumped for inspection
YES ! NOS
YES
NO
YES
NO
If YES, list the pumping company
If NO, when was the last pumping
Scum level (1st compartment)
inches
inches
inches
Sludge level (1st compartment)
" k
inches
inches
inches
Scum level (2nd compartment)
"
inches
inches
inches
Sludge level (2nd compartment)
40
inches
inches
inches
Backflow (If pumped)
PASS
FAIL
PASS
FAIL
PASS
FAIL
Midtank bafflePASS
FAIL
N/A
PASS FAIL
N/A
PASS FAIL
N/A
Watertightness
PASS
FAIL
PASS
FAIL
PASS
FAIL
PUMPS/DOSING SIPHONS:
Is a pump or dosing siphon present?
YES
NO )
If YES, is the pump/dosing siphon functioning properly?
PASS
FAIT—
Does the pump/wiring/dosing siphon appear to be in good condition?
PASS
FAIL
Is the high water alarm working, both visible and audible?
PASS
FAIL
SECONDARY TREATMENT:
/ NO )
ma
VES
Probing (t
Is a secondary treatment unit present? YES
�1
(_��O
UNKNOWN
If YES, does the unit appear to be in good working condition? YES
NO
Liquid in observation port?
Does the owner have a current maintenance contract for the unit? YES
NO
UNKNOWN
Maintenance Provider: _ Phone:
inches
If there is no maintenance contract, a contract must be in place prior to occupancy of the home. A
copy of the contract must be submitted to Pitkin County Environmental Health Department.
ABSORBTION AREA:
Effluent surfacing?
�/ PASS
FAIL
Evidence of past surfacing?
_.
YES
Surface dampness?
! NNOO
YES
Excessive odors?
/ NO )
ma
VES
Probing (t
L
Field location verified by observation ports or probing:
rts
-➢ p—iry-' , Rp,q
t�tfS T ' Q
fD
Liquid in observation port?
NO
YES
L1 .C" .' f
If YES, record depth!
inches
Distribution Box or ADV part of original design?
YE
NO UNKNOWN
if VES, is it accessible from grade?
YES
Is it level and in good condition?
PASS
FAIL
Page 2
LJ
0 0
Any problems with the system that were not addressed in the inspection checklist?
Please list any recommendations for the continued use of the system:
Were any repairs done as a result of this inspection? O YES
If YES, please describe the repairs.
To the best of my knowledge and training, the information collected in this inspection is accurate as of
20-LO.
Licensed Systems Inspector Signature: � �, Ogrk)l,^4:z�,
Additional Notes:
Clearly label any oictures and attach them to this form.
Page 3
uklm (ed.
0
�
0 0 Page 1 of 1
Nancy Mackenzie
From:
Nancy Mackenzie
Sent:
Monday, May 05, 2008 2:21 PM
To:
Lance Clarke
Cc:
Rose Ann Sullivan
Subject: Mark Kwiecienski - 12 -Crossland 2467-174-01-039
H5
Lance,
Our files indicate a septic was finaled in 1990 for 5 bedrooms. The diagram of the system shows that there are
three 130 ft long trenches running parallel to Highway 82. The first trench starts about 80ft from the house. Each
trench is 3 ft wide with 6 ft inbetween. So they take up a width of about 21 feet. It looks like the last trench is 10 ft
from the property line along Hwy 82. There should be nothing bermed on top of the trenches .... oops
The last note in our file is from 10/1/07. Mark called and said he is planning to demo the house and he wanted to
be able to use the old system
Nancy
Nancy MacKenzie
Environmental Health Specialist
970-920-5076
Pitkin County Environmental Health & Natural Resources
0405 Castle Creek Rd, Suite 10
Aspen, CO 81611
5/5/2008
0 0
Pitkin County Environmental Health Department
Contact Log Sheet