HomeMy WebLinkAboutpitkin.eh.264335105001 (2011)PirKIN
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Pitkin County Environmental health Department
Onsite Wastewater Treatment System (OWTS) USE PERMIT
Permit for Continued Use of an Existing OWTS
0405 Castle Creek Road, Suite 10, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
www.aspenpitkin.com/EHNR
Parcel ID #: 2643-351-05-001
OWTS Use Permit #: I 007.2011.POWU
Date Issued:
1/31/2011
Issued By:
Bryan Daugherty
Expiration Date:
1/31/2012
Owner(s): I Pelham Corporation
Property Address:
801 S Starwood Dr
Legal Description:
Lot R-64,13Iock 8, Starwood Subdivision
Licensed Inspector:
Roger Maynard B&R Septic Service
Inspection Date(s):
12/29/10
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
Concrete Single compartment
Concrete Two compartment
1250 gallons
1250 gallons
Secondary Treatment Unit
N/A
N/A
Absorption Area
Pipe and Gravel Bed (x2)
2400 + 1026 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 #: 96058 Date of Issuance: 9/3/1996 Date of Final Approval: 5/29/1998
# of Bedrooms or fixtures served by OWTS: 5 bedrooms
Operational Status: According to the inspectors observations the system appeared to working properly and was in good
condition. Both tanks were pumped as part of the inspection and appeared to be in good working order and in good
condition. The absorption area, 2 pipe and gravel beds, appeared to working correctly, there were no signs for surfacing
effluent or failure.
Inspector Recommendations: N/A
Department Recommendations: We recommend adding an effluent filter to the outlet of the second tank to prevent
solids from entering the absorption area.
Issuance of this OWTS Use Permit is based solely on the conditions observed on the date of the inspections) 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.
Pitkin County Environmental Health Department
Onsite Wastewater Treatment System (OWTS)
USE PERMIT APPLICATION
0405 Castle Creek Road, Suite 10 - Aspen, CO 81611
Phone: 970.920.5070 Fax: 970.920.5077 Website: www.aspenpitkin.com/ehnr
ADDlication for Continued Use of an Existing OWTS
Parcel ID# (available from the Pitkin County Assessor's Office
Company:
970-920-5160 or at wi. .pitkinassea ):
Purpose of Use Permit: PROPERTY TRANSACTION
❑ REMODEL/ADDITION
Property Address:
So
S ilo it
ll Phone:
Cell
,�
Lot: Block: fling:
Subdivision:
l
Residences: Other
A�*R.wvrjL gl h Id,`u c
# of Bedrooms: Jj fixtures/uses:
Property Owner(s) `: Email Address:
d -Aug. -
Owner's Mailing Address: State, Zip:
Home Phone: Bu&vmd Phone:
v 42-3 3 YG 4 --
"Contact informatiion must be provided for the owner signing this application_
Primary Contact Person/Applicant (if not owner):
Company:
Contact/Applicant Mailing Address:
City, State, Zip:
'T144
P v Iii" 11-i k G 6 P412-
4t2Ce'
ll Phone:
Cell
Business Phone:
Fax Number.
Email Address:
A�*R.wvrjL gl h Id,`u c
Indicate Preferred Method of Permit Receipt:
Email El Fax
❑tits Mai
Licensed Systems Inspector: Phone Number Email Address: Fax Number.
,!Q 0 is.Z P1 N- i N Arz d q7d
Zip:
GL
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.
1,13 ill
Date:
t1-71111
Please allow 3-5 business days for processing of Use Permits.
FOR OFFICE USE ONLY
Received by EH Staff: Fee & Receipt #: Date:
'IEP.22.2010 9:57AM ENVIR0 HEALTH NAT RESOURCE
NO. 502 P. 1
Onsite Wastewater Treatment Systems (OWTS) Use
Permit Inspection Form
C4UNT Pitkin County Environmental Health Department
0405 Castle Creek Road, Suite 10, Aspen, CO 51611
C_/_11t117 � """' Phone: 970-920-5070 Fax: 970-920-5077
Website: www.Aspeni3itkin.com/ehnr
inspection Form for continued use of an existing OWTS
OWNERS Name:
Address:
Parcel Number:
Inspection Date:
Records:
Were system records available from the department?Ye ) No
If Yes: Permit number. �-
Date of Instailation:
Tank size'ey�
Absorption area size: >Cn•
Permitted Use: f. ��u
Is this system permitted for its curre t use?
If no, describe the change in use.
Was an As -Built drawing available? ydZL
Is the As -Built Drawing Accurate? ip _
If No: Complete a drawing of the system on last page of this form 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
JPA
YES
improper Discharges
FAIL
High Ground Water
YES
Snow Cover
(�YES)
Property Vacant NO
YES UNKNOWN
TANK:Imo.
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 "mit occupancy
If Yes: Pumping Company:
Discharge/leakage ASS FAIL
Infiltration PASS FAIL
Back flow after pumping NO YES
«° 22, 2010 9:56AM
ENVIRO "EALTH NAT RESOURCE
Tank Components: Tank 1
Lids
Tank Integrity
Mid -Tank Baffles
Sanitary Tees / Inlet & Outlet Baffles
[- rIvent Filter/Screens
Water Tight
Pump/Dosing Siphon
Tank Material
Pump Alarm
Tank Components: Tank z
Lids
Tank Integrity
Mid -Tank Baffles
Sanitary Tees / Inlet & Outlet Baffles
Effluent Filter/Screens
Water Tight
Pump/Dosing Siphon
Tank Material
Pump Alarm
N0.502 r. 2
PASSE FAIL
S FAIL
VP FAIL NP
PASS FAIL
PASS FAIL
CPjAP FAIL
FAIL (JNh
(VAi'�>-- FAIL
Yes W NP
PAS
FAIL
design?
PAS
FAIL
PAS
FAIL
NP
PAS
FAIL
PASS
PASS
FAIL
�
PAS
FAIL
PASS
PASS
FAIL
PASS
PA
FAIL
PASS
Yes
No
a
If additional tanks are present, include reports for each.
SECONDARY TREATMENT:
Is a secondary treatment unit part of the system
design?
l/
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 NP
Controls/Alarms
PASS
FAIL Expires:
Maintenance Agreement
PASS
FAIL
Provider Name
Provider Phone
Number
ABSORBTION AREA:
Distribution Box Accessible from grade?
Yes
NP
Distribution Box
(tL95,J7
FAIL
ADV Accessible from grade?
Yes
No USP
Autocratic Distributing Valve (ADV)
(:j!W
FAIL
Observation Ports
rkit>
FAIL
Effluent Surfacing
FAIL
Evidence of Past Surfacing
�O
YES
Surface Dampness
N
YES
Excessive odors
Cid
YES
Liquid in observation port
(�igp
inches
JUN. '21.2010 1:42PM ENViRO HEALTH NAT RESOURCE
Any problems with the system that were not addressed in the inspection checklist?
Please list any recommendations for the system to continue its current usage.
Were any repairs done as a result of this inspection? NO YE
If Yes, please describe the reanirc.
NO. 417 P. j
i o me nest of my icnowledge and training, the information collected in this inspection is accurate as of
Inspector's Signature:
Business Name:
Phone Number
Address:
Email:
Pitkin County Inspecto
Additional Notes:
A copy of this inspection report will he remitted to Pitkin County Environmental Health with 60 days
of the inspection.