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Permit
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Please See Building and Land Use Approvals Files for additional information.
��P1 1- H IN Pitkin County Environmental H•th Department
Onsite Wastewater Treatment System (OWTS) USE PERMIT
COU N T � Permit for Continued Use of an Existing OWTS
76 Service Center Road, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
www aspenpitkin com/EHNR
Parcel ID p: 2643-162-00-011
OWTS Use Permit q: I 0036.2012.powu (2)
Date Issued: 11/6/2012
Issued By: Bryan Daugherty
Expiration Date: 11/6/13
Owner(s): I Karen Wells
Property Address:24
Liberty Lane
Legal Descri tion:
Absorption Area
Licensed Inspector: Jeff Warren
Inspection Date(s): 6/1/12
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
Concrete 2 Compartment tank
1000 gallons
Secondary Treatment Unit
N/A
N/A
Absorption Area
Dry well
Minimum 346 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 N: 93060A Date of Issuance: 9/23/93 Date of Final Approval: N/A
N of Bedrooms or fixtures served by OWTS: This system was designed to serve 2 bedrooms In the caretaker unit.
Operational Status: According to the inspector observations that system was working properly at the time of
inspection. The 1000 gallon, 2 compartment tank was water tight and in good condition. Both the Inlet and outlet tees
were In place. The lids and risers were repaired so they are now water tight. This tank flowed into a dry well 11' deep
and 10' around. The dry well showed no signs of surfacing effluent or other indicators of failure.
Inspector Recommendations: N/A
Department Recommendations: We recommend adding an effluent filter to the outlet tee on the tank to prevent solids
from entering the dry well.
luwme of this OWTS Use Permit is based solely an the conditions observed and reported by the Inspector to the Department on the dme of the Inspecuor4s/ and
on Deportmentrecords at the time of permitting. the issuume of this permit does trot constitute a guarantee, warranty, orrepresentation by the Department
that the system wfa operate properly w will not fall or that the system will not be sub/cct to future enforcement action to correct non< mjauant candalons.
Estimated caporty of rite system has been listed an the permit and we recommend that you Monitor and/or meter water use t0 prevent overuse and possible
failure.
Witkin County Environmental HAh Department
/ T K I N Onsite Wastewater Treatment System (OWTS)
V GUNTUSE PERMIT APPLICATION
76 Service Center Rd
Aspen, CO 81611
Website: www.aspenpitkin.com/ehnr/
Application for Continued Use of an Existing OWTS
Parcel ID# (available from the Pitkin County Assessors Office
Company:
970-9205160 or at www.oitkinassessor.ora):
- - -
Purpose of Use Permit:
PROPERTY TRANSACTION ❑ REMODEUADDIrfON
Property Address:
e (ti�tr�J G„ e
,.rod J GRIL C
Lot: lock: Filing:
Subdivision:
Residences: Other
# of Bedrooms: 1 fixtures/uses.
1
Property Owner(s)':
'
a6 LSdun,1 &Z
Email Address:
p,r
L/ ejVN
Owners Mailing Address:
1325 :tUnnA 6 Fifa
City, State, Zip: p
Ppu vie&
1-71)Home Phone:
ry - Lill- yo73
Business Phone:
17- -
-contact inrormanon must oe provided ror the owner signing this application.
Primary Contact Person/Applicant (if not owner):
Company:
Contact/Applicant Mailing Address:
City, State, Zip:
Cell Phone:
Business Phone:
Fax Number:
Email Address:
Indicate Preferred Method of Permit Receipt:
,Email Fax
❑ US Mail
Licensed Systems Inspector: Phone Number: Email Address: Fax Number:
SSOd C176'1.171 -133G D05,tE!)iStnw[l1
Mailing 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.
Signature
Please allow 3-5 business days for processing of Use Permits.
FOR OFFICE USE ONLY
Received by EH Staff Fee & Receipt #: Date:
I
'53.7.0 . pew 0
L
0
(�11' K I N Onsite Wastewater Treatment Systems (OWTS) Use
�Y Permit Inspection Form
r �
OLI N rY Pitkin County Environmental Health Department
76 Service Center Rd, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5374
Website: www.aspenpitkin.com/ehnr
Inspection form for continued use of an existing OWTS
Owner's Name: Ken Stiller
Address: 24 Liberty Lane
Woody Creek, CO
Parcel Number: 2643-162-00-011
Inspection Date: 2/25/2015
Inspector's Name: Jason Daubs
Business Name: D&D Septic Services
Phone Number 970-471-13330
Email: DDSepticServices(cDgmail. com
Pitkin County Systems Inspector License Number: 19
A copy of this inspection report 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
posses or fails.
QUESTIONS FOR PROPERTY OWNER PRIOR TO INSPECTION:
Is the home currently occupied? ®E NO
If NO, how long has the home been vacant?
How many bedrooms are in the home? 4
If secondary treatment is used, who is the
maintenance provider?
RECORDS:
Were system records available from Pitkin County? ®E NO
If YES: Permit number: 93060
Date of Final Approval: 1993
# of bedrooms permitted: 4
Was an as -built drawing available? YES
Is the as -built drawing accurate? YES NO
If NO: Complete a drawing of the system on last 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?
AS
FAIL
Improper vegetative cover?
®
YES
Evidence of compaction such as heavy machinery or livestock?
YES
Improper discharges such as straight pipes?
PASS
FAIL
Evidence of high ground water?
NO
YES
Snow cover present?
NO
ES
3 Page 1
0
E
TANK:
Tank 1
NO
Tank 2
PASS
Tank 3
Does the pump/wiring/dosing siphon appear to be in good condition?
Tank capacity
1250
gallons
PASS
gallons
SECONDARY TREATMENT:
gallons
Tank material
Concrete
®
UNKNOWN
If YES, does the unit appear to be in good working condition? YES
NO
inches
# of compartments
NO
UNKNOWN
Maintenance Provider: Phone:
YES
NO
Is it level and in good condition?
Date of last pumping
Unknown
Lids/risers in good condition
®
FAIL
PASS
FAIL
PASS
FAIL
Risers to grade
®
NO
YES
NO
YES
NO
Riser height
3 ft outlet 2ft inlet
Riser condition/watertightness
Good
Inlet sanitary T/baffle
A
FAIL
PASS
FAIL
PASS
FAIL
Outlet sanitary T/baffle
49&>
FAIL
PASS
FAIL
PASS
FAIL
Effluent filter (if part of design)
PASS FAIL
PASS FAIL
N/A
PASS FAIL
N/A
Condition of tank material
FAIL
PASS
FAIL
PASS
FAIL
Tank was pumped for inspection
<:M>
NO
YES
NO
YES
NO
If YES, list the pumping company
B&R Septic
If NO, when was the last pumping
Scum level (1st compartment)
inches
inches
inches
Sludge level (1st compartment)
inches
inches
inches
Scum level (2nd compartment)
inches
inches
inches
Sludge level (2nd compartment)
inches
inches
inches
Backflow, (if pumped)
FAIL
PASS
FAIL
PASS
FAIL
Midtank baffle
AS FAIL
N/A
PASS FAIL
N/A
PASS FAIL
N/A
Watertightness
AS
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
FAIL
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:
Ports
robin
Is a secondary treatment unit present? YES
®
UNKNOWN
If YES, does the unit appear to be in good working condition? YES
NO
inches
Does the owner have a current maintenance contract for the unit? YES
NO
UNKNOWN
Maintenance Provider: Phone:
YES
NO
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?
4g
FAIL
Evidence of past surfacing?
<01
YES
Surface dampness?
®
YES
Excessive odors?
NO
YES
Field location verified by observation ports or probing:
Ports
robin
Liquid in observation port?
NO
YES
If YES, record depth:
inches
Distribution Box or ADV part of original design?
YES
If YES, is it accessible from grade?
YES
NO
Is it level and in good condition?
PASS
FAIL
4 Page 2
UNKNOWN
0
Any problems with the system that were not addressed in the inspection checklist?
No problems.
Please list any recommendations for the continued use of the system:
Install outlet filter.
Were any repairs done as a result of this inspection? 0 YES
If YES, please describe the repairs.
7o the best of my knowledge and training, the information collected in this inspection is accurate as of
February 25 2015 .
i ) {
Licensed Systems Inspector Signature:
Additional Notes:
Clearly label any pictures and attach them to this form.
i Page 3
J
0
If no as -built drawings exist for this system or the as -built was inaccurate, please diagram the system as
accurately as possible. Be sure to document all system components and the location of any well on the
property. Using markers such as corners of the house, exact measurements can be used to triangulate
the location of the system components for future reference.
Garage
and is steel
Island inI 0
driveway /
House
Page 4