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Permit
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Second System on property
Third System etc.
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Please See Building and Land Use Approvals Files for additional information.
Pitkin County Environmental With Department
nsite Wastewater Treatment Syst (OWTS) USE PERMIT
Permit for Continued Use of an Existing OWTS
0405 Castle Creek Road, Suite 10, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
www.aspenpitkin.com/EHNR
Parcel ID #: 2467-174-03-002
OWTS Use Permit
#: 0009.2011.POWU
Date Issued:
2/25/2011
Issued By:
Bryan Daugherty
Expiration Date:
2/25/2012
Owner(s): I Carol Carbone
Property Address:
40 Units, 892 sq ft
0265 Adams Way, Basalt, CO
Legal Description:
N/A
Lot 2, Block 1, Bishop Subdivision
Licensed Inspector:
Roger Maynard
Inspection Date(s):
2/15/2011
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
2 Compartment Poly Tank
1250 Gallons
Secondary Treatment Unit
N/A
N/A
Absorption Area
Gravelless Chambers
40 Units, 892 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 #: 98069 Date of Issuance: 10/19/1998 Date of Final Approval: 1/26/1999
# of Bedrooms or fixtures served by OWTS: System designed for 3 bedrooms
Operational Status: According to the inspector's observations, the system appeared to be working properly at the time
of inspection. The 1250 gallon 2 -compartment poly tank was in good physical condition and the field did not appear to
have any problems with surfacing effluent and there was no standing water in the observation ports.
Inspector Recommendations: N/A
Department Recommendations: The department recommends adding an effluent filter to the outlet side of the tank to
prevent any solids from reaching the field area.
Issuance of this OW73 Use Permit is based solely on the conditions observed on the date of the inspection(s) and on Department records at the time of permitting.
The issuance of this permit does not constitute o guarantee, warranty, or representation by the Department that the system will operate property or will not Jail.
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.
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to -23-2011 22:30
FROM:OEUHRNICK 9709638279 TO:9205077
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Pitkin County Environmental Health Department
Onsite Wastewater Treatment System (OWTS)
USE PERMIT APPLICATION
0405 Castle Creek Road, Suite 10 -Aspen, CO 81811
Phone: 970.920.5070 Fax' 970.920.5077 Websile. www.aspenpitkin.coMehnr
Aoolication for Continued Use of an Existina OWTS
P.1/1
Parcel IDs (available from the PItkln County Assessors Office
970.820-3160 or at Wrn..bltklnsas96sOr.oral:
-/ ' /
..2q (L / 1 7'j
�. Z
O'3
Purpose of Use Permit (PROPERTY TRANSACTION
n REMODEUADDFT ION
Busineae Phone.
Pmparty Addie
rS
Email Oreee.
InatC le Pretomad Memod of Permit Peovat:
LS}Enull (9FaY
Lot Block' I F'Irryw
gVt5divison
RosrdencesOther
a of Bedrooms. fixtufesluses'
Email Address. Fax Number
Mailing Addram
City, Stale, Zip:
Property Ownegep 1 'T
Email Address
OwneQ ailing Addreaa. n -City.
Slate, Zip'
Co _
Home Phone:
Bllsineag Phone'.
'Gontnar inrormnfi,, must oe pmoo er mr rhe nwne/ signing this eppbreroon
Pr maty Gonlea PersonlA t (If pot owner):
Company .
v
OontacVAPplKanl Malling Ad rens.
i
ity, Stale,
l t lL
Call Phone.
r r�
Busineae Phone.
FOX Number
ok
Email Oreee.
InatC le Pretomad Memod of Permit Peovat:
LS}Enull (9FaY
❑ US Mall
Licensor Systems Inspector: Phone Number
Email Address. Fax Number
Mailing Addram
City, Stale, Zip:
PLEASE READ BEFORE SIGNING-
I eorlify that the above Information Is complete and accurate and that I have pmvlded complete and accurate Information In all of the documonb
ineludad in my appllCalton paekago, I acknowledge that this depertmant may revoke any Perrot I am Issued if my application le lound to contain
any Inaccurate, false, or misleading Intormallon.
Owner S nature (ReQurrodl: Onto
Applicant r9 if, l
Please allow 3-5 business days for processing of Use Permits.
USE ONLY
EH Staff:
L�
Foo a R000ipl a
Date.
J
03/19/2611 04:37
sEP.22.2010 9:51AM
9636070
B R SEPTIC
ENV* HEALTH NAT RESOURCE
*
NO.502
PAGE 02
P. 1
K onsite Wastewater Treatment Systems (OWES) Use
fPermit inspection Form
T'QuNlr4 Pitkin County Environmental Health Department
D405 Castle Creek Road, Suite 10, Aspen, CO 81611
Phone: 970-920-5070 F= 970-920-5477
yyplte;_M-8 opitkin,cprtilehnr
Inspection Form fix mntimred use of an e%istinr OWTS
/f L�
i
6WNEItS Name:
Address;
Parcel Number: — 7
Inspection Date:
Records=
were system records available from the departme
If Yes: Permit number. q
Date of installation:/
Absorption area size:
Permitted Use:
Is this system permute for its current
if no, describe the change in use. _ _ _
It? No
i
Tank
Was an As -Built drawing available?
Is the As -Built Drawing Accurate?
If No: Complete a drawing of the systemrloost-;ge of this furor as occurorely as
possible if as -built was Trot available or is not accurate.
Site Condibons:
Eros[an
P
FAIL
Improper Vegetative rover
N
YES
Evldence of Compaction
YES
Improper Discharges
P
FAIL
High Ground Water
YES
Snow Cover
<ffD
Property Vacant
p
YES UNKNOWN
TANK:
Was the tank pumped as part of the inspection? If No, skip to Tank Components.
If No: When was the tank last pumped? ' l5 S a,+ 0 lEnS �Yr 1
If the tank has not been pumped in more than 7 years, please attach additi al information
for justification. Information to be included in justification ! Depth of scum layer, Depth
of sludge layer and/or Verificationof it oowpan
If Yes: PumpirngCompaW
Discharge/leakage FAIL
Infiltration P FAIL
Back flow after pumping YES
J
03/19/2011 04:37
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9636070
B R SEPTIC
cNY0FEA_T4 NAT RESOURCE
1 J
PAGE 03
NO. 502 P. 2
Tank components: Tank 1
if Yes: Make/Mcdel:
Lids
P
FAIL
TankirrtegrRy
Tank Integrity
(PAW
FAIL
PASS
MWTank Baffles
PASS
FAIL
NP
Sanitary Tees / inlet & Outlet Baffles
PASS
FAIL
Controls/Alarms
Effluent Fifter/Screens
PASS
FML
PASS
Wsteriight
_
C�
FML
Pump/oosing Siphon
FAIL
(Wj
Tank Materia!
PASS
FAIL
Pump Alarm
Yes
No
Tank Componerim, Tank 2
Lids
PASS
FAIL
Tanklmagrity
PASS
FAIL
Mid -Tank Baffles
PASS
FAIL
NP
Sanitary Tees / Inlet & Outlet Baffles
PASS
FAIL
FffluentFilter/Scraens
PASS
FAIL
NP
WOWTight
PASS
FAIL
Pump/Losing Siphon
PASS
FAIL
NP
Tank Material
PASS
FAIL
PurnpAtarm
Yes
No
NP
if additional tanks are present, include reports for each -
SECONDARY TRFATMENT.,
ach_
SECONDARYTRFATMENT:
is a secondary treatment unit part of the system design? 4 n.
if Yes: Make/Mcdel:
Lids
PASS
FAIL
TankirrtegrRy
- PASS
PAIL
Media Container
PASS
FAIL NP
Media Condition
PASS
FAIL NP
Mechanical systems
PASS
FAIL NP
Controls/Alarms
PASS
FAIL Expires:
Maintenance Agreement
PASS
FAIL
Provider Name
Provider Phone Number
ABSORBTION AREA:
Distribution Box Accessible from grade?
Dish Mlon Box
ADV Accessible from grade?
Automatic Distributing Valve (ADV)
Observation Port
Effluent Surfacing
Evidence of Past Surfacing
Surface Dampness
Excessive odors
Liquid in Observation port
11
Yes (A) NP
PAS FAIL
as No a -'
PAS ^ FAIL
P FAIL
P FAIL
YES
)% YES
B1CfIe3
03/19/2011 04:37
"MI
JUN, 21. 2010 1:41PM
S R SEPTIC
EN O HEALTH NAT RESOURCE •
Any problems with the system that were not addressed in the inspection Checklist?
pease us any remmmenaatrons Tor the system to continue its Current usage.
Were any repairs done as a result of this inspection? yFS
If Yes, please describe the repairs.
PAGE 04
NO. 411 P.
To the best of my knowledge and tra iniing, the hrfornWon collected in this inspection is accurate as of
mo^i...._ 26-4)—,
Inspector's Signature:
8usinesa Name:
Phone Number
Address:
Email:
Pitkin County Inspectar License Number,
Additionir Notes:
A copy of thts inspedfoa report Wilike remitted to Pitkla County environmenmf Health with ED days
of the inspection.
03/19/2011 04:37 9636070
FEST 2011
20:55 FFOM: CBA-PNI!
B R SEPTIC
9789638279
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