HomeMy WebLinkAboutpitkin.eh.246315200003 (2010)(CDU 2)Document Layout
(From Most Recent to Oldest Permit)
Permit
Application
Log Sheet/Notes & Photos
Communications
As -built Design
Engineer Design
Soil Information
Water Permit & Information
Second System on property
Third System etc.
Floor Plans
Please See Building and Land Use Approvals Files for additional information
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9706252149 TO:19709205077
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,O % T K I N Onsite Wastewater Treatment Systems (OWTS) Use
6T Permit Inspection Form
COUNT Pitkin County Environmental Health Department
0405 Castle Creek Road, Suite 10, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
Website: www,aspengitkin.com/chnr
Inspection Form for continued use of an existing OWTS
OWNERS
A
Parcel N
Records:
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Were system records available from the department? Yes No
If Yes: Permit number:
Date of Installation: Tank size:
Absorption area site:
Permitted Use:
Is this system permitted for Its current use?
If no, describe the change in use.
Was an As -Built drawing available?
Is the As -Built Drawing Accurate?
If No: Complete o drawing of the system on last page of thisform as accurately as
possible if as built was not available or is not accurate.
Site Conditions:
Erosion
FAIL
Improper Vegetative cover
YES
Evidence of Compaction
IN
YES
Improper Discharges
FAIL
High Ground Water
YES
Snow Cover
S
Property Vacant
NO
yF 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?
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 occypancy
If Ye Pumping Company: T� p w 'PC,Y
Discharge/leakage DA FAIL
Infiltration � FAIL
Back flow after pumping ® YES
P.1/4
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Tank Components: Tank 1
9706252149 TO:19709205077 P.2/4
Lids
FAIL
Tank Integrity
FAIL
PASS
Mid -Tank Baffles
PASS
FAIL
NP
SanitaryTees / Inlet
(ODFAIL
Media Container
PASS
Effluent Filter/Screens
PASS
FAIL
PASS
Water Tight
ejAU
FAIL
PASS
Pump/Dosing Siphon
PASS
FAIL
PASS
Tank Material
FAIL
PASS
Pump Alarm
Yes
(Vo
Provider Phone Number
Tank Components: Tank 2
ABSORBTIONAREA: —J
Lids
PASS
FAIL
Tank Integrity
PASS
FAIL
FAIL
Mid -Tank Baffles
PASS
FAIL
NP
Sanitary Tees / Inlet & Outlet Baffles
PASS
FAIL
FAIL
Effluent Filter/Screens
PASS
FAIL
NP
Water Tight
PASS
FAIL
FAIL
Pump/Dosing Siphon
PASS
FAIL
NP
Tank Material
PASS
FAIL
YES
Pump Alarm
Yes
No
YES
If additional tanks are present, Include reports for each.
SECONDARY TREATMENT:
Is a secondary treatment unit part of the system design? A10
If Yes: Make/Model:
Lids
PASS
FAIL
Tank Integrity
PASS
FAIL
Media Container
PASS
FAIL
NP
Media Condition
PASS
FAIL
NP
Mechanical Systems
PASS
FAIL
Controls/Alarms
PASS
FAIL Expires:
Maintenance Agreement
PASS
FAIL
Provider Name
Provider Phone Number
ABSORBTIONAREA: —J
Distribution Box Accessible from grade?
Ye�
NP
Distribution Box
PASS
FAIL
ADV Accessible from grade?
Yes
No
NP
Automatic Distributing Valve (ADV)
PASS
FAIL
Observation Ports
PASS
FAIL
Effluent Surfacing
PASS
FAIL
Evidence of Past Surfacing
NO
YES
Surface Dampness
NO
YES
Excessive odors
NO
YES
Liquid In observation port
NO
inches
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9706252149
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TO:19709205077
FF
Of no as -built drawing exist for this system or the as -built was inaccurate, please diagram the system as
accurately as possible, being sure document all parts of the system, well locations and accurate
dislonces.
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