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Pitkin County Environmental K-alth Department
Onsite Wastewater Treatment System (OWTS) USE PEF
Permit for Continued Use of an Existing OWTS
76 Service Center Road, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5077
www.asDenr)itkin.com/EHNR
Parcel ID #: 2649-291-01-006
OWTS Use Permit #: 0026.2012.powu
Date Issued:
08/9/12
Issued By:
Bryan Daugherty
Expiration Date:
08/09/13
Owner(s): I Michael and Jennifer Hackney
Property Address: 155 Cherokee Lane
Legal Description: Tract 9, Metes and Bounds, Crystal River Estates
Licensed Inspector: Roger Maynard
Inspection Date(s): 11/9/11
SYSTEM INFORMATION
Components
Type
Capacity/Size
Primary Treatment Unit
Concrete 2 Compartment tank
1250 gallons
Secondary Treatment Unit
N/A
N/A
Absorption ,Area
Unknown
Unknown size
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 #: 95038 Date of Issuance: Unknown Date of Final Approval: Unknown
# of Bedrooms or fixtures served by OWTS: The system was designed to serve 3 bedrooms
Operational Status: According to the inspector's observations, the system was functioning properly at the time of
inspection. No septic system files were available for this property but a building permit search found that the system
was permitted and built in 1995. The 1250 gallon 2 compartment tank was in good working condition and both the inlet
and outlet tees were in place. This then flowed to a distribution box to evenly distribute effluent to the absorption area
of unknown size. The field area did not show any signs of failure and there was no liquid in the observation ports.
Inspector Recommendations: N/A
Department Recommendations: The department recommends adding an effluent filter to the outlet of the tank to
prevent solids from entering the absorption area.
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.
itkin County Environmental Healt.. Jepartment
�OprjKJN Onsite Wastewater Treatment System (OWTS)
71 COX) N lr� USE PERMIT APPLICATION
76 Service Center Rd
* + Aspen, CO 81611
Website: www.aspenpitkin.com/ehnr/
Annlirafinn fnr Cnn+iniiprl L)Sp_ of an EXlstina OWTS
Parcel ID# (available from the Pitkin County Assessor's Office
Company:
970-920-5160 or at www.pitkinassessor.org):
C
1
Purpose of Use Permit:
EJ�PROPERTY
TRANSACTION ❑ REMODEL/ADDITION
ty, State, ip
Property Address:
,�el
r
3
ot: lock:`
Filing: Subdivision
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Email Address:
i
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(yam
Residenc s: ,r
Other
# of Bedrooms:
fixtures/uses:
Property Owner(s)*: tA itAddr� A C,
Owner's Mailing Address: ity, State, Zip:
e
Home Phone: Business P ne:
*Contact information must be provided for the owner signing this application.
Primary Contact Person/Ap li it (if not owner)(
Company:
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1
Contact/Applicant Mailin A rens.
ty, State, ip
,�el
3
Cell Ph
9 � 0 — - 3
Business Phon
.
Fax Numb r. qM _ IIUn q s -7
Email Address:
i
Indicate Preferred Method of Permit Receipt:
Email ❑ Fax
❑ US Mail
Licensed SyAe,ms Inspector: Phone Number: Email Address: Fax Number:
i �'t
Mailing Addres �,,,, _ \ `ty, State, Zif:
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.
Please allow 3-5 business days f&procAsing of Use Permits.
F�t3Fh =
Received by EH Staff: Fee & Receipt #: Date:
I
--�" onsite WastewaterTreakm nt 5ysteM (t�V� T lyse
" a i PPI'Ittltt inspection �Qit71
Fitkln County EnvirQnmentai Health Departmr?nt
0405 Castle Creek Road, Suite lit, Aspen, CO 91.61x.
< phot1c:970-920.5070 Fan: 97D-920-5077
website: uwww.. en ;tes n shot
tnsoeetian Form for tantir�uec3 use of an exi5t{ng
OWNERS Ivarne:
Address:
Parcel Number.
Records.
Were system records avail?bte fr6m the departritent?
If Yes: permit aumber:
Date of Installation:
AbSor- Inion area Si7e: e !_47•47-
1-,
��rTllliiet� I.iSC:
is `hi. sy5tem permItt ed for its Curre
If no, describe the change in Use.
Yes No
Tank size:.
use?�
'Alas an As-Bullt drawing available?
15 the ids -Built Drawing Actur=?
if NO: Complete G drerwirig of the system on lost ptsgc tnf chis fo(rn as occurorely as
passible tf os_bU7): ,v= nat vvailable or is not accurore.
site Conditions:
Erosion
QASS,)
FAIL
Improper Vegetative cover
Yfi5
Evidence of Campartion
_
YFS
Improper Discharges
r�PRS
FAIL
High (iround \Vat^r
YES
Snow Cnuer
NO �1
YES
Property Vacant
NOt
YES UNKNOWN
TANK:
Was the tank purnped as part of the inspe tlon? If No, skip to Tank Components.
If No. When was the tar:k last pumped? -
I` the tank has not been Pumpers in more than 2 years, please attach additional inforinatlon
far justification, Information to be included ill justification : Depth of scrim layer, Depth
of sludge layer and%or verification of limited occupancy
;"Yes; Pumping Cnrnpany;
Elsr`harge/Ieaka�e PASS FAIL
Infiltration, PASS FAIL
5acK nuw dRvr purnplrig NO YES
Tank Components: Tank I
'FAlL
If Yes: make/model-
i, PA FAIL
ADV Accessible from grade?
P
PASS
FAIL
LadsFAIL
P
FAIL
Media Container
Tank Integrity
PASS
FAIL
f
NP
Mid -Tank Baffles
PAS?
FAIT,
PAIL
Sanitary Tees / Inlet & ClutIct Baffles
PASS
FAU, Expires:
Maintenance Agreement
Effluent Filter/Screens
55
FAIL
Provider Phone Number
Water Tight
PASS
FAIL
��_��•,,
Siphon
Pump/Dosing,
PASS
fAIL
!v'1
Tank Material .S
FAIL
PumAAlarm
e5
ivo
Tank components: Tank 2
Lids
PASS
FAIL
Tank Integrity
PASS
FAIL
vtid Tank Baffles
PASS
FAIL
NP
sanitary Tees / Inlet & Outiet Baffles
PASS
FAIL
Effluent Fitter/Screens
PASS
FAIL
NP
Water Tight
PASS
FAIL
Pump/Dosing Siphon
PASS
FAIL
NP
Tank Material
PASS
FAIL
Pump Alarm
Yes
ND
If additional tanks are present, include reports for each.
SECONDARY TREATMENT'-
is;
REATMENT:
!$ a secondary treatment unit part of the sysLern design? _..,
Yes Ntt NP
If Yes: make/model-
i, PA FAIL
ADV Accessible from grade?
Lids
PASS
FAIL
Tank Integrity
PASS
FAIL
Media Container
PASS
FAIL NP
Media Condition
PASS
FAIL NP
MQc;,anica13ystems
PASS
PAIL
Controls/Alarms
PASS
FAU, Expires:
Maintenance Agreement
PASS
FAIL
Provider dame
Provider Phone Number
ASSORBTIOM AREA:
Ustribution aox Accessible from grade?
Yes Ntt NP
Distribution Sax
i, PA FAIL
ADV Accessible from grade?
Yes IUD
Automatic Distributing Valve (ADV)
PASS FAIL
observation Ports
PAS FAIL
Effluent SurFacing
FAIL
Evidence of Past Surfacin€;
YES
Surface Nkmpness
YES
Excessive odors
YES,
�fr,
Liquid in observation Hort
-1 �encFYui3
BL Y 5M E96 OLE
11scb4 : z 1� :r'j-bCl-l:
09/02/2012 06:56 9636070 B R SEPTIC
—+ PAGE 01
Any problems with the System that were not addressed in the inspection checklist?
Please list any recommend tions for the system to continue its current usage.
;2 _
Were any repairs done as a result of this inspection? i1d$ YES
If Yes, please describe the repairs.
To the best of my knowledge and training, th information collected in this inspection is accurate as of
Inspector's 5ignat
Business Name:
Phone Number
Address:
Email:
Pitkin County Insp
Additional Notes:
A copy of thls inspection report will be remitted to pirkin County E»vironmento/ Health with 60 detys
Of the inspection,
61. /96 # 600 E96 Mf
�
CERTIMA
'
as
THLs cum
THE DA TE Of WUANC& THE mwucn)RE M
BELOW WAS Iff 09
Use classM;�ttlon: Single Family Residence
Building Permit:, 5-362
Legal Descripti OW.. Lot 9, Crystal River Estates
Building Address: 0155Cherokee.L.ane__..
owner of Building: Judith Elting
owner Address: 5�77$.LouthanSt.
Group: R -3/U-1 Type Cons"etion: V -N.
Use Zone: RS -30
Description: 2,827 square feet �in u in three bedrooms, one
full bath, two 3/4 baths, one kitchen, and an attached two -car
Spectrum Super 27. Minor 10,41 BK 36 PG:.8.51
cial Date
Note: In all occupancies, except R. this certificate iftust be posted
in a conspicuous place near the main exit an the premises for
premises or portion thereof. without the Yrritte.n aPP-roval-of the
Building Official shall negate this C.O. and subject it to revocation.
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