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Onsite Wastewater Treatment System (OWTS) USE PERMI
P I , Continued
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76 Service Center Road, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
www.aspenpitl<in.com/EHNR
Parcel ID #: 2465-272-00-004
OWTS Use Permit #: I 0065.2016.POWU
Date Issued: 11/18/2016
Issued By: Bryan Daugherty
Expiration Date: 11/18/2017
Owner(s): I Bill Lueck
Property Address:
2555 West Sopris Creek Rd
Legal Description:
Licensed Inspector: Doug Warren
Inspection Date(s): 10/14/16
Components Type Capacity/Size
Primary Treatment Unit 2 compartment concrete tank 2500 gallons
Secondary Treatment Unit
Absorption Area Gravelless chamber beds 1018 ft2
Other System Components
®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 M 99003 Date of Issuance: 1/12/99 Date of Final Approval: 2/29/00
# of Bedrooms or fixtures served by OWTS: This system is designed to serve 5 bedrooms
Operational Status: After repairs were made to the lids and risers of the tank, the system was operating as designed at the time of
inspection. The tank was in water -tight condition and tees were in place. The tank gravity flowed to a distribution box that was not
accessible from grade and distributed to 2 chamber beds. There was no standing effluent in the observation ports and no evidence
of failure in the field area.
Inspector Recommendations: Continued maintenance.
Department Recommendations:
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.
Pitkin County Environmental ealth Department
1 Onsite Wastewater Treatme t System (OWTS)
'USE PERMIT APPL CATION
C4111k !Ai`t't
76 Service Gen er Rd
Aspen, GO 81 11
Website: www.aspenpit} in.com/ehnr/
Annlirratinn Mr r--nntinttpri I lcr- of an ExIistino OWTS
Parcel ID# (available from the Pitkin County Assessor's Office�}A
970-920-5160 or at wwwm4kinassessor.oral: Q� ��
vL,/
Contact/Applicant Mailing Address:
City, State, Zip:
Cell Phone:
Purpose of Use Permit.
PROPERTY TRANSACTION ❑REMODEL/ADDITIO
Fax Number
Email Address:
Property Address:
,z�� r
❑ Us Mail
Lot. Block: Filing: Subdivision:
!yl fP
t�QSCri
ar/y�/ ( s
Lf G�S'
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Residences: Other
# of Bedrooms: A(t fixtures/uses: /
/ foil �� S
Property Owner(s)': Eail
mAddress:
Owner's Mailing Address: City, Stat ip:
�22�f--04��.%� ems_ v a
Home Phone: _ Business Phone:
'Contact information musl be provided for the owner signing this application.
Primary Contact Person/Applicant (if not owner)
Company.
i
Contact/Applicant Mailing Address:
City, State, Zip:
Cell Phone:
Business Phone: i
Fax Number
Email Address:
Indicate Preferred Method of Permit Receipt: XEmall ❑ Fax
❑ Us Mail
Licensed Systems Inspe,or Phone Number: Email Address: Fax Number
Marling Ads: City, State, Zi
PLEASE READ BEFORE SIGNING:
I certify that the above information is complete and accurate and that I have provided complete an accurate information in Al of the documents
included in my application package. I acknowledge that this department may revoke any permit I m issued if my application is found to contain any
inaccurate, false, or misleading information.
Owner Signature (Required): Date 10/20/2016
44116 luec,�
Applicant Signature: Date:
Please allow 3-5 business days for processing of Use Permits.
FOR OFFICE USE ONLY
Received by EH Staff: ree & Receipt #: Date:
i
Z�w
f h IN Onsite Wastewater Treatment Systems (OWTS) Use
a Permit Inspection Form
Co 11 1 i N, Pitkin County Environmental Health Department
76 Service Center Rd, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5374
Website: www. aspenoitkin.com/ehnr
Inspection form for continued use of an existing OWTS
Owner's Name:
Address:
Parcel Number:
Inspection Date:
Inspector's Name:
Business Name:
Phone Number
Email:
Pitkin County Systems Inspector License Number: "
A coi2v of this inspection re ort will be remitted to Pitkin County Environmental Health Department b
the Licensed Systems InsgaMr within6 rd a ether the system
R„ussgs or fails.
QUESTIONS FOR PROPERTY OWNER PRIOR TO I PE ION•
Is the home currently occupied? NO
If NO, how long has the home been vacant?
How many bedrooms are in the home?
If secondary treatment is used, who is the
maintenance provider?
RECORDS:
Were system records available from Pitkin County? YE5 NO
If YES: Permit number:
Date of Final Approval?
4 of bedrooms permitted:
Was an as -built drawing available? ES NO
Is the as -built drawing accurate? YES NO
If NO: CompleFe 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? ASS FAIL
Improper vegetative cover? YES
Evidence of compaction such as heavy machinery or livestock? YES
Improper discharges such as straight pipes? A S FAIL
Evidence of high ground water? YES
Snow cover present? I� YES
Page 1
TANK:
Tank 1
Tank 2
Is a pump or dosing siphon present?
Tank 3
NO
Tank capacity
gallons
FAIL
gallons
PASS
gallons
Tank material
p✓tlrCi��
FAIL
SECONDARY TREATMENT:
# of compartments
NO
UNKNOWN
If YES, does the unit appear to be in good working condition? YES
NO
Date of last pumping
+J,n A,
UNKNOWN
Maintenance Provider: _ Phone:
Lids/risers in good condition
S FAIL
PASS
FAIL
PASS
FAIL
Risers to grade
NO
YES
NO
YES
NO
Riser height
Riser condition/watertightness
Volk
Inlet sanitary T/baffle
S FAIL
PASS
FAIL
PASS
FAIL
Outlet sanitary T/baffle
ASS FAIL
PASS
FAIL
PASS
FAIL
Effluent filter (if part of design)
PA FAIL
PASS FAIL
N/A
PASS FAIL
N/A
Condition of tank material
P FAIL
PASS
FAIL
PASS
FAIL
Tank was pumped for inspection
YES O
YES
NO
YES
NO
If YES, list the pumping company
If NO, when was the last pumping
ibC1c.N.-
Scum level (1st compartment)
inches
inches
inches
Sludge level (1st compartment)
inches
inches
inches
Scum level (2nd compartment)
Q inches
inches
inches
Sludge level (2nd compartment)
inches
inches
inches
Backflow (if pumped)
PASS FAIL
PASS
FAIL
PASS
FAIL
Midtank baffle
CIAW FAIL N/A
PASS FAIL
N/A
PASS FAIL
N/A
Watertightness
AS FAIL
PASS
FAIL
PASS
FAIL
PUMPS/DOSING SIPHONS:
--inches
YES
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.
ABSORBTION 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?
FAIL
YES
YES
YES
Probing
YES
UNKNOWN
--inches
YES
NO
r V
PASS
FAI L'
Page 2
Any problems with the system that were not addressed in the inspection checklist?
Please list any recommendations for the continued use of the system:
Were any repairs done as a result of this inspection? NO YES
To th be of my knowledge and training, the information coll ed in this inspection is accurate as of
,� zo
1-ic nse Systems Inspector Signature:
If YES, please describe the repairs.
Additional Notes:
Clearly label anv pictures and attach them to this form._
Page 3
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