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Permit
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Please See Building and Land Use Approvals Files for additional information
J�l Pitkin County Environmentallth Department
nsite Wastewater Treatment Sys (OWTS) USE PERMIT
C� ry j 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 #: 2467-344-00-549
OWTS Use Permit #:
0020.2011.POWU
Date Issued: 5/12/2011
Issued By: Bryan Daugherty
Expiration Date: 5/12/2012
Owner(s): I Michael! Mines
Property Address:
0075 Capitol Creek
Legal Description:
Gravelless chamber bed
Licensed Inspector:
Roger Manard - B&R Septic
Inspection Date(s):
4/4/11
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
Concrete 2 compartment
1500 Gallons
Secondary Treatment Unit
N/A
N/A
Absorption Area
Gravelless chamber bed
9'x78' 701 sq. ft.
Other System Components
Pump Tank
Pump
1000 Gallon
Hydromatic .4 HP
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 #: 96002 Date of Issuance: 5/31/1995 Date of Final Approval: 3/27/1996
# of Bedrooms or fixtures served by OWTS: The system was designed to accommodate 3 bedrooms. The office was not
intended to be used as a bedroom.
Operational Status: The inspectors observed that the system was working properly at the time of the inspection.
Accumulation of scum and sludge did not warrant pumping at the time of inspection for either tank. Both the 1500
gallon primary tank and 1000 gallon pump tank were in good working condition. The pump in the pump chamber was
working and the high water alarm was functioning as well. The absorption bed was covered in snow during the
inspection and the home had been vacant for some time before the inspection but the area is not show any signs of
surfacing effluent or failure.
Inspector Recommendations: None
Department Recommendations: None
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 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. I � � _
E
Ll
Pitkin County Environmental Health Department
p `f flu t N Onsite Wastewater Treatment System (OWTS)
a USE PERMIT APPLICATION
�„47t 1 li't'
;I 0405 Castle Creek Road, Suite 10 Aspen, CO - 81611
` Phone: 970.920.5070 Fax: 970.920.5077 Websitewww.aspenpitkin.com/ehnr
Application for Continued Use of an Existing OWTS
Parcel ON (available from the Pitkin County Assessor's Office ( �7
970-920.5760 or at www,oilkinassessor.one : oZ h� ` v / • 3
00
yA
Contact/Applicant Mailing Address:
City, Slate. Zip
1
Purpose of Use Permit:
pROpERTY TRANSACTION ❑ REMODEUADDITION
Fax Number.
Email Address:
Property Address:
75 CAP ttot_ cQe-K s1%416"1mx-zs
co
8tv�
Loi
Block: Filing: Subdivision:
( E(rkk. vilf5c-f-kiT1on1 . 0
5�1e1
Residences.
# 01 Bedrooms:
Other
3 fixtures/uses:
0Email
Licensed Systems Insrk: Phone Number:
Email Address:
Fax Number:
g BPilt 411*g�3
b1
70 V3• e 0
Mailing Address:
City. Slate, Zip:
0 0 �►gaok V4%VS
Property Owner($)':
Addreu:
M%C.IrAA6 L- J PA%NJ ES NKkOG
C51 FaNa.AlCLAL, ca ,114
Owners Mailing Address.
City, Stale, Zip:
11_l -S NDee-x
Y
8`t w?
Home Phone :
Business Phone:
hod �9`- .���3
accurate Information in all of the documents
included in my application package. I acknowledge that thls department may revoke any permit I am Issued N my application is found to contain
'Contact inromiat ion must be provided for the owner signing this appficalion.
Primary Contact PersordApplicanl it not owner}.
Company:
Contact/Applicant Mailing Address:
City, Slate. Zip
Cell Phone:
Business Phone:
Fax Number.
Email Address:
/^
Indicate Preferred Method of Pennil Receipt:
El Email ❑Faz
I j US Mail j
Licensed Systems Insrk: Phone Number:
Email Address:
Fax Number:
g BPilt 411*g�3
b1
70 V3• e 0
Mailing Address:
City. Slate, Zip:
0 0 �►gaok V4%VS
cfktGboNoaLc
o 81��
PLEASE READ BEFORE SIGNING:
1 rarefy 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 thls department may revoke any permit I am Issued N my application is found to contain
any inaccurate, false, or misleadlrg Information.
Owner Signature(Requined): -
Date:
/
Applicant Signature. -
Date:
Please allow 3-5 business days for processing of Use Permits.
d Receipt #:
I
Date:
05/08/2011 07:23
SEP. 22, 2010
9636070 B R SEPTIC
9:57AP2 INS HEALTH NAT RESOURCE
ixYflN
COUNT4J
ov JCC l
OWNERS Name:
• PAGE 02
N0, 502 ?, 1
nt
Permit Inspection Form
Pitkin County Environmental Health Department
0x05 Castle Creek Road, Suite 10, Aspen, CO 91611
Phone: 970.920-5070 Fax: 970.920-5077
Address:
Parcel Number co — r�
Inspection Date; -- — / /
Records:
were system records available from
vt�hee department? No
If Yes: Permit number-�,`i Gq_ p
Date of Installation: -,2%f— r /,/-7+ Tank size; 16-66 ( fc� �L�
Absorption area sem: p 1
Permitted Use: T 7/
Is this system perms d for its cur44t use?
If no, describe the change in use. 01
Was an As -Built drawing available?
Is the As -Built Drawing Accurate?
If No: Complete o drawing of the system o lost page of this form as accurately as
possible if as -built was not available or is not accurate.
Site Conditions:
TANK:
Erosion
P S FAIL
Improper Vegetative cover
YES
Evidence of Compaction
N YES
Improper Discharges
PAS FAIL
High Ground Water
O
Snow Cover
N6 OTS7
Property Vacant
NOES UNKNOWN
Was the tank pumped as part of the inspection? If No, skip to Tank Components.
If No: When was the tank last pumpetl?6
If the tank has not been pumped in more than ears, please attach additional information
for justification. Information to he included in justification! Depth of scum layer, Depth
of sludge layerand/orC Verification of Iimk d occupancy Y
If Yes: Pumping Company: �fq�,
Discharge/leakage PASS FAIL
Inftltrdtioo PASS FAIL
Beck flow after pumping NO YES
05/08/2011 07:23 9636070
'SEP, 22.2010 9;58AM
C)
B R SEPTIC
ENS HEALIH NAT RESOURCE
TankComponetdw Tank
Lids
Tank Integrity
Mid -Tank Baffles
SanitaryTees / Inlet & Outlet Baffles
Effluent Filter/ScreW
water Tight
Pump/Dosing Siphon
Tank Material
PumpAlann
Tank Components: Tank 2
Lids
Tank Integrity
Mid -Tank Baffles
Sanitary Tees / Inlet & Outlet Baffles
Effluent Fiker/Screens
Water Tight
Pump/Dosing Siphon
Tank Materiyl
Pump Alarm
de?aerl
PAGE 03
40 00. 502 P. 2
FAIL
FAIL
FAIL NP
FAIL
FAIL
FAIL
FAIL NP
FAIL
No NP
If additional tanks are present, include reports for each.
SECONDARY TREATMENT:_
Is a secondary treatment unit part of the system design?
FAIL
If Yes: Make/Model;
A
FAIL
Lids
PASS
FAIL
NP
P
FAIL
Media Container
PASS
FAIL
NP
PASS
FAIL
Mechnnkal Systems
P
FAIL
NP
PA
FAIL
Maintenance Agreement
PASS
No
NP
If additional tanks are present, include reports for each.
SECONDARY TREATMENT:_
Is a secondary treatment unit part of the system design?
_azo_
If Yes: Make/Model;
Lids
PASS
FAIL
Tank Integrity
PASS
FAIL
Media Container
PASS
FAIL NP
Media Condition
PASS
FAIL NP
Mechnnkal Systems
PASS
FAIL NP
Controls/Alarms
PASS
FAR Expires:
Maintenance Agreement
PASS
FAIL
Provider Name
Provider Phone Number
ABSORSTION AREA:
Distribution Box Accessible from grade?
Yes
N NP
Distribution Box
`PA r
FAIL
ADV Accessible from grade?
Yes
No
Autornatk Distributing Valve (ADV)
P
FAIL
Observation Ports
4P
FAIL
Effluent Surfacing
FAIL
Evidence of Past Surfacing
®
YES
Surface Oampness
NO
YESw�
Excessive odors
YB5
Liquid in observation part
;spa
05/08/2011 07:23 9636070 B R SEPTIC PAGE 04
• JUN. 21. 2410 1:42PM ENO HEALTH NAT RESOURCE N0. 411—P.
Any problems with the system that were not addresed in tie inspection checklist?
Please list any recommendations for the system to continu rcs ge.
5current usa
- ..
were any repairs done as a
If Yes, phase deseribe the repair.
To the
Inspector$ Signature:
Business Name:
Phone Number
Address:
Email:
Pitlan County ["pada
Additional Notes:
accurate as
20,Lj .
A copy of this inspection report Why he remitted 00 Rtidn County Envfionnerrm! Health "Oft 60 days
of theiaspecditn.
5
I
05/08/2011 07:23 9636070
B & R Septic Service, Inc.
Rooter & Jetting Service
Video Inspection Service
0603 Handy Drive
Carbondale, CO 81623
Bill To
Micbael Mines
c/o Levericb & Carr
555 E. Durant Ste. 4A
Aspen, CO 81611
B R SEPTIC • PAGE 01
Invoice
Date Invoice
4/4/2011 1 5797
M
P.D. No.
Terms
Project
Due on receipt
Quantity
Description
Rate
Amount
Septic inspection @ 75 Capital Creek Rd.
250.00
250.00
Locate & dug up lids
125.00
125.00
Sales Tax
3.90%
0.00
C�1^JOP .
Tkitw4 Lr-o'vl C-
CD KO CDK.
Thank you for your business.
Carbondale
Aspen
Fax
Total $375.00
(970) 963-38141(970)
920-2059
(970) -963607()
M