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Pitkin County Environmental Health Department
Onsite Wastewater Treatment System (OWTS) USE PERMIT
Permit for Continued Use of an Existing OWTS
K
llD #: 2467-342-17-003
Use Permit #: 0060.2017.POWU
ssued: 9/8/17
Issued By: Bryan Daugherty
Expiration Date: 9/8/18
Owner(s): I Mark and Karen Johnson
Property Address: 53 Gateway Road (Main Home)
Legal Description: Lot 1 Sky River
Licensed Inspector: Joe Zamora
Inspection Date(s): 8/19/17
76 Service Center Road, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5374
www.aspenpitkin.com/EHNR
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
Concrete two-compartment tank
1250 Gallons
Secondary Treatment Unit
Absorption Area
Seepage Bed
1200 ft2
Other System Components
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 #: 89089 Date of Issuance: 12/21/89 Date of Final Approval: 8/29/90
# of Bedrooms or fixtures served by OWTS: System is designed to serve 3 bedrooms in the main home.
Operational Status: After repairs were made to the risers on the tank the system was functioning as designed at the
time of inspection. A new effluent filter was also installed at the repaired outlet of the tank. The field area was found
by probing and did not have any signs of failure such as surfacing effluent.
Inspector Recommendations:
Department Recommendations: Continue annual maintenance or as needed
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.
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16:49 FAX Q001
Onsite Wastewater Treatment Systems (OWTS) Use
k Permit Inspection Form
% Pitkin County Environmental Health Department
76 Service Center Rd, Aspen, CO 81611
9
Phone: 970-920-5070 Fax: 970-920-5374
Website; I hllp://pilkincounty.com/248=ariewater-Treoirnent
Inspection form for continued use of an existing OWTS
Owner's Name
Address:
Parcel Number:
Inspection Date:
Inspector's Name:
Business Name:
Phone Number
Emalk
jG__
on
Road
Colorado 81634
Zamora
cavatio Inc.
171
ra msn.com
Pitkin County Systems Inspector License Number. 11M3 ITC
A copy of this Inspection report will be remitted to Pltkin County Environmental Heath Department by
the Licensed Systems Inspector within 6Qdays. of the Inspection regardless of whether the system
sasses or falls,
QUESTIONS FOR PROPERTY OWNER PRIOR 70 INSPECTION:
Is the home currently occupied? ❑YES EINO
If NO, how long has the home been vacant?
How many bedrooms are in the home? 3
If secondary treatment Is used, who is the
maintenance provider?
RECORDS:
Were system records available from Pitkin County? OYES ONO
If YES: Permit number:
Date of Final Approval:
# of bedrooms permitted:
Was an as -built drawing available? DYES ❑ NO
is the as -built drawing accurate? MYES [:]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? PASS ■ FAIL
Evidence of high ground water? ■ NO YES
Snow cover present? ■ NO YES
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09/11/2017 16:49 FAX
TANK:
Tank 1
FAIL
YES
YES
Tank 2
Excessive odors?
Tank 3
YES
Tank capacity
1,250
allons
Liquid in observation port?
YES
HN
gallons
Tank material
concrete
Distribution Box or ADV part of original design?
NO
If YES, Is it accessible from grade?
# of compartments
2
FAIL
Date of last pumping
8/16/17
Lids/risers In good condition
Fall
Select One
Select One
Risers to grade
Yes
Select One
Select One
Riser height
12"
Riser condition/watertightness
Inlet sanitary T/baffle
Outlet sanitary T/baffle
Pass
Fell
ElSelect
w
One
Select One
Select One
Select One
Effluent filter (if pant of desl n)
Fall
Select One
SeleAut One
Condition of tank material
Pass
Select One
Select One
Tank was pumped for inspection
if YES, list the pumping company
Select One
B & R Septic
Select One
Select One
If NO, when was the last pumpin
Scum level 1st compartment)
inches
inches
1
inches
Sludge level (lst compartment)
2
inches
Inches
Inches
Scum level (2nd compartment)
Sludge level (2nd compartment)
1
Inches
Inches
Inches
Inches
Inches
Inches
Backflow (if pumped)
Midtank baffle
Select OneASelect
ass
Select One
Select One
Select One
Select One
Watertightness
Pass
One
ISelect One
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? HYES NO ®UNKNOWN
Maintenance Provider: 1 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?
FAIL
YES
YES
Excessive odors?
YES
Field location verified by observation ports or probing:robing
Liquid in observation port?
YES
HN
If YES, record depth:
hes
Distribution Box or ADV part of original design?
NO
If YES, Is it accessible from grade?
NO
Is It level and in good condition?
FAIL
Q002
UNKNOWN
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M
09/11/2017 16:49 FAX
Please list any recommendations for the continued use of the system:
Were any repairs done as a result of this Inspection? ❑ N0 M YES
It YES lease descrfoe the repairs.
Risers on the Inlet and outlet manholes were deteriorating and both were replaced. Outlet side of
lid was broken and was replaced. Outlet T was pitched to the outside of the tank and tight to the
corner. It was not visible. Outlet T was replaced with a new biotube fliter.
To the best of my knowledge and training, the information collected in this Inspection is accurate as of
u ust 19 1, Z 17
Licensed Systems Inspector Signature: FZ ,4y
Additional Notes:
This Inspection was completed for the main house.
Clearly label any pictures and attach them to this form.
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Page 3
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Effective Date 1/12/2017