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Pitkin County Environmental H, zh Department
Onsite Wastewater Treatment System (OWTS) USE PERU
Permit for Continued Use of an Existing OWTS
76 Service Center Road, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
www.aspenpitkin.com/EHNR
Parcel ID #: 2645-042-00-003
OWTS Use Permit #: I 006.2012.powu
Date Issued:
4/10/2012
Issued By:
Bryan Daugherty
Expiration Date:
4/10/2013
Owner(s): I John and Susanne Clark
Property Address: 5809 E Sopris Creek
Legal Description:
Licensed Inspector: Tim Petz, All Service Septic
Inspection Date(s): 3/27/12
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
2 compartment Concrete tank
Single compartment Concrete tank
1250 gallons
250 gallons
Secondary Treatment Unit
n/a
n/a
Absorption Area
E.T.A. bed
2595 sq. ft.
Other System Components
Dosing Tank
500 gallon tank w/ pump
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 #: 88033 Date of Issuance: 6/28/1988 Date of Final Approval: 8/23/1988
# of Bedrooms or fixtures served by OWTS: This system was designed to accommodate 5 bedrooms.
Operational Status: According to the inspectors report, the system was functioning properly at the time of inspection.
The first 2 tanks were pumped as part of the inspection and both tanks were in good working order with both inlet and
outlet tees in place. This series of tanks flowed into a 500 gallon pump vault that was also in good working order. The
tank did not need pumped because the solids and scum had not accumulated in the tank. The pump dosed the evapo-
transpiration/absorption bed that did not show any signs of failure or surfacing effluent.
Inspector Recommendations: None
Department Recommendations: N/A
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 He -"h Department
Onsite Wastewater Treatment System (OWTS)
USE PERMIT APPLICATION
N lr'�
+ice Center Rd - Aspen, CO - 81611 Phone:
'0.920.5070 Fax: 970.920.5374 Website:
www.aspenpitkin.com/ehnr
Anniicatinn fnr ICnntinuPcl USP of an Existina OWTS
Parcel ID# (available from the Pitkin County Assessor's Office
Company:
970-920-5160 or at www.oitkinassessor.org):
City, State, Zip:
Purpose of Use Permit:
PROPERTY TRANSACTION
❑ REMODEL/ADDITION
Property Address:
a � * 5
e -w
Lot: Block: Filing:
Subdivision.
Residences: Other
# of Bedrooms: fixtures/uses:
Property Owner(s)`:Email Address:
�.I t �� C,� ,1G � a rl ru 6 Cl
Owner's Mailidress: Ci y, State, Zip:
511, R, o V l �.J�i n /ww y7-)41.r1,X-1 ('.o 'kl �
Home
uj r� 1 --- r--)-L9U l
'Contact information must be provided for the owner signing this application.
Primary Contact Person/Applicant (if not owner):
Company:
Contact/Applicant Mailing Address:
City, State, Zip:
Cell Phone:
Business Phone:
Fax Number:
Email Address:
Indicate Preferred Method of Permit Receipt:
❑ Email El Fax
❑ US Mail
Licensed Systems Inspector: G� Xe Number: Email Address: Fax Number fil 4,
/ �l+h PL 1 00
Mailing dress: City, State, Zip:
1 a�t�i� �� (/l i �rxxxf� r �, CD 1Gr1_ a
PLEASE READ BEFORE SIGNING:
I c i that the above information is complete and accurate and that I have provided complete and accurate information in all of the documents
in
m
I my application package. I acknowledge that this department may revoke any permit I am issued if my application is found to contain any
ina u te, false, or misleading ir"rmation.
er gn re (Requi d): Date:
Aoolican Signature: Date:
Please allow 3-5 business days for processing of Use Permits.
FOR OFFICE USE ONLY
Received byS{taafff- Fee & Receipt #
1",l ". iL770—
) _21A `lt,5
Date: /I
Onsite Wastewater Treatment Systems (OWTS) Use
Permit Inspection Form
Pitkin County Environmental Health Department
0405 Castle Creek Road, Suite 10, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
Website: www.aspenpitkin.com/ehnr
Inspection form for continued use of an existing OWTS
Owner's Name:
Address: Cg Selp Cie. 1K.J645
Parcel Number: A&P''ib" O`iL-Ce� -00
Inspection Date: .Z "Z 2012'
Inspector's Name:
Business Name: , 4 c- LLC
Phone Number qw) 618. 50.3a
Email: -1-7peT`1-t & C0AtC-AST
. Pitkin County County Systems Inspector License Number:
A copy of this inspectic , 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 INS C ON:
Is the home currently occupied? YES NO
If NO, how long has the home been vacant?
How many bedrooms are in the home?
When was the tank last pumped? :3-Z-7-1 7 -
Name
Name of pumping company: ff-fC VP1 CK9-!S s4✓Q�
If secondary treatment is used, who is the
maintenance provider?
RECORDS:
Were system records available from Pitkin County? NO
If YES: Permit number: 803
Date of Final Approval: .% -2_3 -$9
# of bedrooms permitted: -
Was an as -built drawing available? NO
Is the as -built drawing accurate? S NO
If NO: Complete a drawing of the system on las ge 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?�
FAIL
Improper vegetative cover?
YES
Evidence of compaction such as heavy machinery or livestock?
YES
Improper discharges such as straight pipes?
r—jA:S)> FAIL
Evidence of high ground water?
YES
Snow cover present?
YES
Page 1
V 4
TANK:
Tank 1
Tank 2
Evidence of past surfacing?
Tank 3
YES
Tank capacity
150 gallons
Z Q
gallons
10
gallons
Tank material
C.oWC .
cerwc .
Liquid in observation port?
CON G.
YES
# of compartments
a
inches
Distribution Box or ADV part of original design?
l
coUNKNOWN
Date of last pumping
• n 26
zo iZ
OPt1 40LU
Lids/risers in good condition
PAS FAIL
&1S2
FAILP
FAIL
Risers to grade
Y NO
E
NO
NO
Riser height
9
'
Riser condition/watertightness
d�
Inlet sanitary T/baffle
SS FAIL
FAIL
AS
FAIL
Outlet sanitary T/baffle
=A
ASS F
AS
F6LL.,
PASS
FAIL
Effluent filter (if part of design)
PASS FAIL
PASS FAIL
N
PAS FAI
N/A
Condition of tank material
FAIL
PASV
FAIL
PASS
FAIL
Tank was pumped for inspection
YES NO
ES
NO
YES CND.2
Scum level (1st compartment)
" inches
M
inches
Q
inches
Sludge level (1st compartment)
inches
inches
inches
Scum level (2nd compartment)
inches
G
inches
D
inches
Sludge level (2nd compartment)
inches
inches
inches
Backflow (if pumped)
Midtank baffle
PAS FAIL
S FAIL N/A
PASS
PASS FAIL
FAIL
A
ASS
FAIL
FAIL
N
Watertightness
ASS FAIL
AS
FAIL
AS
FAIL
PUMPS/DOSING SIPHONS:
Is a pump or dosing siphon present? YES NO
If YES, is the pump/dosing siphon functioning properly? S FAIL
Does the pump/wiring/dosing siphon appear to be in good condition? PAS FAIL
Is the high water alarm working, both visible and audible? ASS FAIL
SECONDARY TREATMENT:
Is a secondary treatment unit present?Nd ,� 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'?
AS
FAIL
Evidence of past surfacing?
YES
Surface dampness?
YES
Excessive odors?
YES
Field location verified by observation ports or probing:
Probing pp(Z'i�j
Liquid in observation port?
NO
P
YES
If YES, record depth:
inches
Distribution Box or ADV part of original design?
YES
coUNKNOWN
If YES, is it accessible from grade?
YES
NO
Is it level and in good condition?
PASS
FAIL
Page 2
ow�can.ET'
TeE5
Any problems with the system that were not addressed in the inspection checklist?
NONE
Please list any recommendations for the continued use of the system:
N CW Q�'
Were any repairs done as a result of this inspection? y Z YES
If YES, please describe the repairs.
To the best of my knowledge and training, the information collected ' is inspection is accurate as of
3 -Z? 2 IZ'
14
Licensed Systems Inspector Signature: •-+�—+' C�
Additional Notes:
IRE W6RION& FtEc,'D 1N1kS
Ged)z) m tX tO1J
Clearly label any pictures and attach them to this form.
Page 3
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