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Home My WebLink Aboutpitkin.eh.264321100002 (2015)1 0 iTK I N Onsite Wastewater Treatment System (OWTS) '�TOUNTUSE PERMIT APPLICATION � 76 Service Center Rd �� . "`•r.", - Aspen, CO 81611 Website: www.aspenpitkin.com/ehnr/ Annlication for Continued Use of an Existina OWTS Parcel ID# (available from the Pitkin County Assessor's Office _ _ _ 970-920-5160 or at www.pitkinassessor.orq): c>O '�Z Purpose of Use Permit: PROPERTY TRANSACnON ❑ REMODEL/ADDITION Property Address: C 09 R1�i�%Z R �00 er -* oak Lot: Block: Block: Filing: Subdivi on: Residences: Other # of Bedrooms: fixtures/uses: Property Owner(s)*: Email Address: Viet Owner's Mailing Address: City, State, Zip: 13r x &-3(-) (,civ dt. P4I ev 8 1619L Home Phone: R7D- 379-1Business Phone: 2q? -170 - q2S'-,9060 *Contact information must be provided for the owner signing this application. Primary Contact Person/Applicant (if not owner): Company: Tm me- ILer Co ntact/Applicant Mailing Addressl. City, State, Zip: .fix 630 W%o Cell Phone: Business Phone: y 70 - . 74 - 1247 q70 Fax Number: Email Ad ress: .3 33 Indicate Preferred Method of Permit Receipt: mail [:1 Fax ❑ US Mail icensed Systems Inspector: Phone Number: Email Address: Fax Number: -'j 7j0 -14 j j- (3! ,To6dVt 1j1x4s (p q7D- 328-017 M, S!ptr-r'vices &-!2W44dAh failing Address: City, State, Zip: BOY- 3&$1 CD '�t(, 3( 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 1 am issued if my application is found to contain any inaccurate, false, or misleading information. )wner Signature (Required): Date: applicant Signature: Date: Please allow 3-5 business days for processing of Use Permits. IFOR OFFICE USE ONLY c) 1 'J � t U � T K I N Onsite Wastewater Treatment Systems (OWTS) Use Permit Inspection Form Tou f 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: Tom Melberg Address: 8863 Upper Ranch Rd NAloody Creek C0 91656 Parcel Number: 2643-211-00-002 Inspection Date: 6/8/2015 Inspector's Name: Jason Daubs Business Name: D&D Septic Services Phone Number 970-471-13330 Email: DDSepticServices@gmail.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 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? How many bedrooms are in the home? 5 If secondary treatment is used, who is the maintenance provider? RECORDS: Were system records available from Pitkin County? ES NO If YES: Permit number: 97074 Date of Final Approval: 9/gA/fl() # of bedrooms permitted: rj Was an as -built drawing available? 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? AS FAIL Improper vegetative cover? ® YES Evidence of compaction such as heavy machinery or livestock? NO YES Improper discharges such as straight pipes? AS FAIL Evidence of high ground water? ® YES Snow cover present? NO YES Page 1 r TANK: Tank 1 NO Tank 2 FAIL Tank 3 Tank capacity 1250 gallons 1250 gallons SECONDARY TREATMENT: gallons Tank material CnnrrptpConcrete ® UNKNOWN If YES, does the unit appear to be in good working condition? YES NO # of compartments 2 UNKNOWN 2 Date of last pumping 3 yrs ago 3 yrs ago Lids/risers in good condition ® FAIL ® FAIL PASS FAIL Risers to grade NO YES NO YES NO Riser height 24" 24" Riser condition/watertightness good good Inlet sanitary T/baffle ® FAIL PASS FAIL PASS FAIL Outlet sanitary T/baffle PAS FAIL PAS FAIL PASS FAIL Effluent filter (if part of design) PASS FAIL N/ PASS FAIL PASS FAIL N/A Condition of tank material ® FAIL ®S FAIL PASS FAIL Tank was pumped for inspection (Z�> NO YE 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 ® FAIL PASS FAIL Midtank baffle ASS FAIL N/A PAS FAIL N/A PASS FAIL N/A Watertightness PASS FAIL ® FAIL PASS FAIL PUMPS/DOSING SIPHONS: Is a pump or dosing siphon present? YE NO If YES, is the pump/dosing siphon functioning properly? FAIL Does the pump/wiring/dosing siphon appear to be in good condition? ® FAIL Is the high water alarm working, both visible and audible?PEAS FAIL SECONDARY TREATMENT: Is a secondary treatment unit present? YES ® 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? AS Ports NO FAIL YES YES YES ro i YES inches NO YES NO PASS FAIL Page 2 UNKNOWN Any problems with the system that were not addressed in the inspection checklist? No Please list any recommendations for the continued use of the system: I would recommend that the inlet side of the 2nd tank be brought up to the surface eventually. Were any repairs done as a result of this inspection? NO ES If YES, please describe the repairs. In our inspection, we discovered that the pump and high water alarm were not functioning. Young Services was called and they repaired it. All is now working. To the best of my knowledge and training, the information collected in this inspection is accurate as of June 8 , 2015 Licensed Systems Inspector Signature: QLj 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. Page 4