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Pitkin 7€. Environmental Hi I t Department
Onsite PERMIT
Permitfor Continued Use 1
76 Service Center Road, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
www.aspenpitkin.com/EHNR
Parcel ID #: 2643-161-00-026
OWTS Use Permit #: I 0018.2017.POWU
Date Issued: 3/13/2017
Issued By: Kurt Dahl
Expiration Date: 3/13/2018
Owner(s): I Kevin Patrick
Property Address:
7950 Upper River Rd
Legal Description:
Absorption Area
Licensed Inspector: Jason Daubs
Inspection Date(s): 1/31/2017
Components
Type
Capacity/Size
Primary Treatment Unit
Two-compartment septic tank with
pump (main house)
2000 gallons
Secondary Treatment Unit
Two-compartment septic tank with
pump (studio)
1000 gallons
Absorption Area
(2) Gravelless chamber soil
treatment beds
195 Quick -4 chambers total (1795
ft2)
Other System Components
Distribution box
®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 #: 08002B Date of Issuance: 9/16/2009 Date of Final Approval: 06/05/2009
# of Bedrooms or fixtures served by OWTS: The system was designed to serve 6 bedrooms. There are currently 3
bedrooms in the main house and 1 in the studio
Operational Status: The inspector indicates the system is in good condition and there is no evidence of failure. Both
septic tank manhole lids were replaced and a light on the control box.
Inspector Recommendations: none
Department Recommendations: Annual Maintenance
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 T h I N Pitkin County Environmental Health Department
Onsite Wastewater Treatment System (OWTS)
�,' USE PERMIT CHECKLIST
CO N f
Permit for Continued Use of an Existing OWTS
,
` 76 Service Center Rd • Aspen, CO • 81611
Phone: 970.920.5070 Fax: 970.920.5374
http://pitkincounty.com/248/VVastewater-Treatment
Some items listed on this checklist may already exist in the Department files. Please contact
this department to collect any necessary documentation, using the parcel ID# to identify the
property, prior to scheduling an OWTS Use Permit inspection and/or submitting the OWTS Use
Permit application packet.
A complete application package must be presented at the time of your pre -application
conference for acceptance. To schedule a pre -application conference, please call (970) 920-
5070.
PLEASE INITIAL EACH ITEM TO INDICATE COMPLETION
Only one copy of each item is necessary. Electronic versions of any or all of the documents
identified below may be emailed to ehnrCa_co.Pitkin.co.us before the date of the pre -application
conference.
OWTS Use Permit Application (completed)
Site Plan
❑ Should include general location of each OWTS, buildings, water
courses, domestic water source(s), and other pertinent
information.
Building Floor Plans
E rcurrent floor plans for a property transaction; or
E] Proposed floor plans for an addition/remodel that does not
increase potential bedroom count or water usage of the structure
served by the existing OWTS.
Inspection report by a Licensed Systems Inspector
[] A list of Licensed Systems Inspectors can be found at
http://pitkincounty.com/DocumentCenter/HomeN!ew/rol7
An inspection report is good for one year.
Applicable Fee
F] OWTS Use Permit: $100
Please make checks payable to Pitkin County Environmental
Health Department.
Save Form Clear Form Print Form
Effective Date 1/12/17
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Pitkin County Environmental Health Department
Onsite Wastewater Treatment System (OWTS)
USE PERMIT APPLICATION
76 Service Center Rd
Aspen, CO 81611
http://pitkincounty.com/248ANastewater-Treatment
Application for Continued Use of an Existing OWTS
Parcel ID# (available from the Pitkin County Assessor's Office
Sue Howarth
970-920-5160 or at htt :// itkinassessor.org/assessor/search.
Compass (Real Estate)
Purpose of Use Permit: FE I PROPERTY TRANSACTION
REMODEL/
Property Address:
State, Zip:
Owner's Mailing Address:
Waterlaw, 197 Prospector Rd
7950 Upper River Road, Woody Creek
Aspen
Lot:
181611
Block:
Filing:
Business Phone:
Fax Number:
Subdivision:
(970) 379-5458
Email Address:
M/B
I
I
I
F
Residences:
# of Bedrooms:'
Other
3 fixtures/uses:
r
\
Property Owner(s)":
Sue Howarth
Email Address:
Compass (Real Estate)
Contact/ApplicantMalling Address:
Kevin Patrick
patrickCCwaterlaw.com
State, Zip:
Owner's Mailing Address:
Waterlaw, 197 Prospector Rd
City, State, Zip:
Aspen
CO
181611
Home Phone:
(970) 925-6063
Business Phone:
Fax Number:
(970) 925-6064
(970) 379-5458
Email Address:
(970) 920-1030
*Contact information must be provided for the owner signing this application.
Primary Contact Person/Applicant (if not owner):
Sue Howarth
Company:
Compass (Real Estate)
Contact/ApplicantMalling Address:
�7City,
[117 S. Monarch St
State, Zip:
Aspen
CO
181611
Cell Phone:
1(970)
379-8334
F -s - k. \-X
Business Phone.
(970) 925-6063
FOR OFFICE USE ONLY
Fax Number:
(970) 925-6064
Date:
Email Address:
v J� J��, r
1� C
Indicate Preferred Method of Payment ■ Check Credit/Debit
Cash
Licensed Systems Inspector: Phone Number: Email Address: Fax Number:
Jason Daubs (970) 471-0913
Mailing Address: Ci State Zi
altitudeseptic@gmail.com
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):
Date:
j
Applicant Signature:
Date:
F -s - k. \-X
Please allow 3-5 business days for processing of Use Permits. Save Form
Clear Form Print Form
FOR OFFICE USE ONLY
Received by EH Staff: Fee & Receipt #:
Date:
Effective Date 1/122017
�, KIN Onsite Wastewater Treatment Systems (OWTS) Use
i Permit Inspection Form
CouNTN 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: Kevin Patrick
Address: 7950 Upper River Rd
Woody Creek, CO 81656
Parcel Number: 2643-161-00-026
Inspection Date: 1/31/2017
Inspector's Name: Jason Daubs
Business Name: Altitude Septic, LLC
Phone Number 970-471-0913
Email: altitudeseptic@gmail.com
Pitkin County Systems Inspector License Number:
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
passes or fails.
QUESTIONS FOR PROPERTY OWNER PRIOR TO INSPECTION:
Is the home currently occupied? YES NO
If NO, how long has the home been vacant? J
How many bedrooms are in the home? 04 t A k-*O,-3��
If secondary treatment is used, who is the
maintenance provider?
RECORDS:
Were system records available from Pitkin County? YES NO
If YES: Permit number: 08002B
Date of Final Approval: 6/5/09
# of bedrooms permitted: 6
Was an as -built drawing available? YES NO
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? PASS FAIL
Improper vegetative cover? NO YES
Evidence of compaction such as heavy machinery or livestock? NO YES
Improper discharges such as straight pipes?
Evidence of high ground water?
Snow cover present?
Page 1
PASS FAIL
NO YES
NO YES
TANK:
Tank 1
NO
Tank 2
PASS
Tank 3
Does the pump/wiring/dosing siphon appear to be in good condition?
Tank capacity
2000
gallons
1000
gallons
SECONDARY TREATMENT:
gallons
Tank material
Concrete
NO
Concrete
If YES, does the unit appear to be in good working condition? YES
NO
# of compartments
NO
UNKNOWN
Maintenance Provider: Phone:
Date of last pumping
Lids/risers in good condition
PASS
FAIL
PASS
FAIL
PASS
FAIL
Risers to grade
YES
NO
YES
NO
YES
NO
Riser height
41
31
Riser condition/watertightness
Pass
Pass
Inlet sanitary T/baffle
PASS
FAIL
PASS
FAIL
PASS
FAIL
Outlet sanitary T/baffle
PASS
FAIL
PASS
FAIL
PASS
FAIL
Effluent filter (if part of design)
PASS FAIL
N/A
PASS FAIL
N/A
PASS FAIL
N/A
Condition of tank material
PASS
FAIL
PASS
FAIL
PASS
FAIL
Tank was pumped for inspection
YES
NO
YES
NO
YES
NO
If YES, list the pumping company
Altitude Septic, LLC
If NO, when was the last pumping
Scum level (1st compartment)
inches
011
inches
inches
Sludge level (1st compartment)
inches
311
inches
inches
Scum level (2nd compartment)
inches
0"
inches
inches
Sludge level (2nd compartment)
inches
0"
inches
inches
Backflow (if pumped)
PASS
FAIL
PASS
FAIL
PASS
FAIL
Midtank baffle
PASS FAIL
N/A
PASS FAIL
N/A
PASS FAIL
N/A
Watertightness
PASS
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:
Is a secondary treatment unit present? YES
NO
UNKNOWN
If YES, does the unit appear to be in good working condition? YES
NO
Does the owner have a current maintenance contract for the unit? YES
NO
UNKNOWN
Maintenance Provider: Phone:
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.
ABSORB u ON AREA:
Effluent surfacing?
Evidence of past surfacing?
Surface dampness?
Excessive odors?
Field location verified by observation ports or probing
Liquid in observation port?
If YES, record depth:
Distribution Box or ADV part of original design?
If YES, is it accessible from grade?
Is it level and in good condition?
PASS
NO
NO
NO
Ports
NO
FAIL
YES
YES
YES
Probing
YES
inches
YES NO
YES NO
PASS FAIL
Page 2
UNKNOWN
Any problems with the system that were not addressed in the inspection checklist?
One of the fiberglass lids is broken and need replaced. One of the concrete lids is
broken and needs reDlaced and the loobt nn the control box at the barn 6s broken
Please list any recommendations for the continued use of the system:
Were any repairs done as a result of this inspection? NO YES
If YES, please describe the repairs.
We replaced both lids and replaced the light on the control box.
To the best of my knowledge and training, the informati n collected in this inspection is accurate as of
February_, 20�.
/I
Licensed Systems Inspector Signature: csii,
Additional Notes:
Clearly label any pictures and attach them to this form.
Page 3
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.
See attached form from Pitkin County.
Page 4
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