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1)11kIN
•
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• Pitkin County Environment\health Department
Onsite Wastewater Treatment System (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.aSDenoitkin.com/FHNR
Parcel ID tt: I 21;43-093-00-008
OWTS Use Permit q: I 0027.2011.powu
Date Issued:
7/27/2011
Issued By:
Carla Ostberg
Expiration Date:
7/27/2012
Owner(s): LAWR Holdings
Property Address:
240 Doc Henry Rd
Legal Description:
Click here to enter text.
Licensed Inspector: Roger Maynard 007
Inspection Date(s):
7-2-11
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
Concrete, two compartment
1250 gallons
Secondary Treatment Unit
n/a
n/a
Absorption Area
drywell
530 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 far a
more accurate evaluation of the system.
System Records:
Permit q: 82020 Date of Issuance: 6/8/1982 Date of Final Approval: 6/9/1982
q of Bedrooms or fixtures served by OWTS: MAIN HOUSE 4 bedrooms (sitting room on upper level not considered a
bedroom)
Operational Status: The system consists of a 1250 gallon tank and a 530 square foot drywell (15' in diameter, 9' deep,
with three Tx 5' rings). The outlet baffle of the tank was replaced with a pvc tee. The tank was pumped as part of the
inspection.
Department Recommendations: Recommend installing an effluent filter on the outlet tee of the tank.
Issuance of this 0WF5 Use Permit is based solely on the conditions observed and reported by the inspector to the Deportment on the date of the inspection/sl 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 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.
Carla Ostberg
From:
Carla Ostberg
Sent:
Wednesday, July 27, 2011 10:24 AM
To:
winnie@zynga.com'
Cc:
'bryanmurray_nz@yahoo.com'
Subject:
240 Doc Henry
Attachments: 20110727221830672.pdf�S
Hi Winnie,
I am working on an OWTS Use Permit for 240 Doc Henry Rd. I need an owner's signature. If
you have signing power on behalf of owner, could you sign this application? Just send it
back to me electronically. I will try to get this issued today. Thank you,
Carla Ostberg, MPH, REHS
Environmental Health Manager
Pitkin County Environmental Health
970-920-5438
-----Original Message -----
From: carlab rmailto:carlab(&co.pitkin.co.usl
Sent: Wednesday, July 27, 2011 8:19 PM
To: Carla Ostberg
Subject:
This E-mail was sent from "RNPFIA588" (Aficio MP 5000).
Scan Date: 07.27.2011 22:18:30 (-0400)
W 1
Pitkin County Environmental Health Department
�� t t h ► Onsite Wastewater Treatment System (OWTS)
' USE PERMIT APPLICATION
0405 Castle Creek Road, Suite 10 Aspen, CO 81611
Phone: 970.920.5070 Fax: 970.920.5077 Website: www.aspenpitkin.com/ehnr
Ai)Dlication for Continued Use of an Existina OWTS
Parcel ID# (available from the Pitkin County Assessor's Office
970.920-5160 or at www.oitkinassessor.oral: %61j 3' fl 3
- o000$
Purpose of Use Permit:
❑ PROPERTY TRANSACTION
❑ REMODEUADOMON
Property Address :
40 roc, enrs
L fl
/
t/aoo{_ Cyt�k
Lot Block:
Filing:
Subdivision.
Indicate Preferred Method of Permit Receipt:
Resicienws:
Other
# of Bedrooms:
fixturesluses.
Phone Number: Email Address :
76 3 38/
Fax Number:
Mailift Address :
City, State, Zip:
Property Owner(s)':
h f9 W' 2
No l� ^,y�
Email Address:
) nr hoz. ,
orlti
Owners Mailing Address
V !45
IV`-tSWf 4T/9
City, State, Zip:
/4u-=�4
o CA 211107
Home Phone:
Business Phone:
'Contact information must be provided for the owner signing this application.
PrimContact Person/Apphfjant (if not owner):
P" VC, 'A /,7/u MA
Company:
o/1 2./ 1114 lid
/
0/) riuc o Ait c
ContacUApplicant Mailing Address:
6 hci %ne
City, State, Zip:
6a l
Cell Phone:
10 241
Business Phone:
Fax Number. ri
0 � 7 6
Email Address:
fflG'I mu Il _/)
/
an QC •cc/I'l
Indicate Preferred Method of Permit Receipt:
Email ❑Fax ❑ US Mail
Licensed Systems Inspector.
R c.
Phone Number: Email Address :
76 3 38/
Fax Number:
Mailift Address :
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 Signature (Required): r Date:
tiQ. Q'YJW...f$ �Kb1l�tC7'1l/\! ti'`!� P.1n,IM,t
Applicant Sign Date:
Please allow 3-5 business for processing of Use Permits.
3 00 2-1.2 011. P 0 Vv (,
PITKIN CIAINTY COMMUNITY DEVELO14ENT
Permit Receipt
RECEIPT NUMBER 00031225
Name: Wonderland Construction, Inc. Date:7/27/2011
Project Address: 240 DOC HENRY RD
Type: check # 1418
Permit Number Fee Description
0027.2011.POWU OWTS Use Permit Fee
dotal:
�-1
Amount
100.00
100.00
03;14/2011
05: 54
SEP, 22. 2010 HAM
9E3S®70
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R SEPTI!:
• It:b.501
mater Treatment Systems
Permit Inspection Form
Ptkdn County Environmental Health Department
tt40scatte Creek Goad, Suite 10, Aspen, CO 81611
Pho. e:9%0 92G +7"0 FaX: 970-V20-5077
OWNERS Name:
Addrem:
Parcel Numbers --
InspeclMn Date:
Records: .---y-.
Were sWem records available fron the departmant? CY9sr' Na
If Yes: Permit number. `,:
Date of Inst*latlOn:G .t- ,5,, Tank Size:1�2'M�
Abtorpt;on PrP_a SIM
Is this system Permitted fr.'ate/!'S current use? ' t4 -
If no, describe the change In
USO
Was an As•Suilt drawing available? ..
Is the 0.s -Butts. Drawing Accurate.
It NO: complete a drnwing of thf sj: t8n1 dt) N15t page of this form os ocrt;ratelyas
poss787e if osb wilt was not ewalfahla or is not occorote.
TANK:
Sl
was the tank pumped as part of the inspection' if No, skip t, Tank Components.
If No: When was tt•e tank lest pjwed?
If thetank has rot been pumped in noro than rs p ease artpch additional Informs Jon
for jwtif4cation. Information to be included in fumification : Depth of scum layer, Depth
of sludge layer and/or Verification Vf lim d O=pancy
Wye$: PumpirgCorrePany. %` t
a..
DischarIcaka rL! ' FAIL
ge/
Intlitratlon ►ASS,.! FAIL
Back flow afterpbmping (rte YES
PAGE 04
`l+ttS'.SI I
1
Erosion
ImpropervegetaGv!cover
( ort)
VES
Fvldence of Compaction
Z�
Yes
improper Discharges
PASSE
Fat
Hitch Ground Mtsr
Yes
$now Cover
V`S
property vacant
VES UNKNOWN
TANK:
Sl
was the tank pumped as part of the inspection' if No, skip t, Tank Components.
If No: When was tt•e tank lest pjwed?
If thetank has rot been pumped in noro than rs p ease artpch additional Informs Jon
for jwtif4cation. Information to be included in fumification : Depth of scum layer, Depth
of sludge layer and/or Verification Vf lim d O=pancy
Wye$: PumpirgCorrePany. %` t
a..
DischarIcaka rL! ' FAIL
ge/
Intlitratlon ►ASS,.! FAIL
Back flow afterpbmping (rte YES
PAGE 04
08/14/2011 05:54
SEP. 22.201' 9:58AW
9635070 B' P SEPTIC
EN* HEALTh NAT RESOURCE
• NO. 502
PAGE 05
R 2
Tank Components: Tank t,
Lids
"
FAIL
Tank integrity
FAIL ,
Mid Tank auffle-.
FAIL NP
SIImIWyTeeS / Inlet & Outlet Baffles
PASS
�AR�0
Effluent Filter/Sere^_ns
P
FAIL 60
Warer Tight
PAIL
PAIL
Pump/Dosing Sjr.Mn
Tank Mater+al
_�'
PAIL
Pump Alarm
Yes
No Citi
TanlcComponents' Tank
—
Lids
PASS
FAIL
Tanklntegrity
PASS
PAit
Mid -Tank Baffles
PASS
FAIL NP
Sanitary Tees / Inlet & Outlet Baffles
PASS
FAIL
Effgient Filter/Screens
PASS
FAIL NP
WaterTight
PASS
FAIL
Pump/Dosing Siphon
PASS
FAIL NP
Tank Material
PASS
FAIL
PumpAlarrn
Yes
No NP
If additional tardai are present. inciade reports for each.
SECONDARYTREATMENT,
Is a secondary treatment unit Hatt of the system design?
if Yes: MSQ/Model: --
Lids
PASS
FAIL
Tankbnegrity
PASS
FAIL
Mecca Container
PASS
FAIL NP
Media Condition
PAgS
FAIL NP
hsechanicalSystems
PA55
PAIL NP
ControlsiAlarms
PASS
FAIL Expires:
Maintenance Agreemee:
PASS
FAL
Provider Name __
Provider phone Number
ASSOR67I0N AREA
' Distribution Bax Accessible from grade?
Yes�,NO/�
NP
Distribution Box
PASS
Zs
ADV Acce"ible from grade?
Automatic Distributing valvey (ADV}
—eS
�
FAIL
Observation Poris
i
FAIL
Whient Surfacing
'P S j
FAIL
• Evidence of Past Surfacing
'
S
Surface Dampne$$
YES
• Dceessiveodors
'
YES
Liquid In nbsewation pori
!
____inches
ro
08.14/201: 05:54
JLN, 21.211010 1:42PU
9636070 S P SEPTIC
ENV HEALTH HAT RESOURCE
Any uroblems wtth the system that were not addressed in the
PAGE e6
• .VO.41 f _P. �
Please list any recommendations for the systernto w0tinue in wrrwd usage,
424 24
At;
Were any repairs done as a result of this inspection? No
If Yes, please describe the repairs.
;
v
To the best of my knowledge and training, the infomration ca Ilected in this ins pedlun is accurate as of
7. C�, 20-I
Inspector's Signature:
Business Name'
Phone Number
Address:
Email:
Pitkin County Inspector License Number: C;�-7
Additlonal Notes:
A copy of this M;pacdi report uolt tw remitted to Pitkin write 60 day.
of the mspeCtlM.
.q
R
5536670
3 P SEPTIC PAGE C8
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