HomeMy WebLinkAboutPitkin.EH.264310100002 ()Owner's Name:
Address:
Parcel Number:
Inspection Date:
Pitkin County Systems Inspector License Number:
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?
RECORDS:
Were system records available from Pitkin County?YES NO
If YES:Permit number: ___________
Date of Final Approval: _________
# of bedrooms permitted: ___________
Was an as-built drawing available?YES NO
Is the as-built drawing accurate? YES NO
If NO:
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
Any question marked FAIL will require correction before an OWTS Use permit is issued.
If secondary treatment is used, who is the
maintenance provider?
Complete a drawing of the system on last page of this form as accurately as
possible.
Email:
Inspector's Name:
Business Name:
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.
Onsite Wastewater Treatment Systems (OWTS) Use
Permit Inspection Form
Inspection form for continued use of an existing OWTS
Website:
Pitkin County Environmental Health Department
76 Service Center Rd, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5374
Phone Number
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TANK:
Tank capacity gallons gallons gallons
Tank material
# of compartments
Date of last pumping
Lids/risers in good condition
Risers to grade
Riser height
Riser condition/watertightness
Inlet sanitary T/baffle
Outlet sanitary T/baffle
Effluent filter (if part of design)
Condition of tank material
Tank was pumped for inspection
If YES, list the pumping company
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)
Midtank baffle
Watertightness
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?YES NO UNKNOWN
Maintenance Provider:_______________________________________Phone:________________________
ABSORBTION AREA:
Effluent surfacing?PASS FAIL
Evidence of past surfacing?NO YES
Surface dampness?NO YES
Excessive odors?NO YES
Field location verified by observation ports or probing:Ports Probing
Liquid in observation port?NO YES
If YES, record depth:inches
Distribution Box or ADV part of original design?YES NO UNKNOWN
If YES, is it accessible from grade?YES NO
Is it level and in good condition?PASS FAIL
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.
Tank 1 Tank 2 Tank 3
Page 2
Any problems with the system that were not addressed in the inspection checklist?
Please list any recommendations for the continued use of the system:
Were any repairs done as a result of this inspection?NO YES
If YES, please describe the repairs.
Licensed Systems Inspector Signature:
Additional Notes:
To the best of my knowledge and training, the information collected in this inspection is accurate as of
__________________, 20____.
Clearly label any pictures and attach them to this form.
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