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Pitkin County Environmental Health Department
Onsite Wastewater Treatment System (OWTS) USE PERMIT
Permit for Continued Use of an Existing OWTS
76 Service Center Road, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5374
www.aspenpitkin.com/EHNR
Parcel ID #: 2465-361-00-001
OWTS Use Permit #: 0040.2017.POWU
Date Issued: 06/28/2017
Issued By: Bryan Daugherty
Expiration Date: 6/28/18
Owner(s): Estate of Francis Xavier Gina Sr.
Property Address: 2651 Bear Ridge Road
Legal Description:
Licensed Inspector: Jason Daubs
Inspection Date(s): 6/8/17
SYSTEM INFORMATION
Components Type Capacity/Size
Primary Treatment Unit Concrete two-compartment tank 1500 Gallons
Secondary Treatment Unit
Absorption Area Gravelless chamber Trenches 66 units
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 #: 99060 Date of Issuance: 8/4/99 Date of Final Approval: 10/25/99
# of Bedrooms or fixtures served by OWTS: System is designed to serve 4 bedrooms. 2 bedrooms in the main house
and 2 in the cabin
Operational Status: According to the inspector’s observation the system was functioning as designed at the time of
inspection and there was no evidence of failure.
Inspector Recommendations: Annual maintenance or as needed. No not use wet wipes or other disposable wipes.
Department Recommendations:
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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Permit Inspection Farm
4,0UNT81 Pitkin County Environmental Health Department
76 Service Center Rd, Aspen, CO 81611
Phone: 970-920-5070 Fax: 970-920-5374
Website: www.asaenpitkin comlehnr
Inspection form for continued use of an existing OWTS
Owner's Name: 4 �" je f S (4le� r
Address:AIR
Parcel Number: Q4j (e l+
Inspection Date:
Inspector's Name:
Business Name: d_ Z1, e__
Phone Number
Email: -~-
Pitkin County Systems Inspector License Num r:
A copy of this lnsaection rennr# will be remitted #a Aitkin County Environmental Health D�parirnent by
the Lrcensed 5vs ems Inspector wlthrn 60 days of the InsnecA.� regardless of whether the systern
Posses or falls
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?
If secondary treatment is used, who is the
maintenance provider? .1W
RECORDS:
Were system records availab from Pitkin County? NO
If YES: Permit number: 060
Date of Final Approval/ �►y'�
# of bedrooms permitted:
Was an as -built drawing available? I Y NO
Is the as -built drawing accurate? E 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 OMITS Use permit is issued.
SITE CONDITIONS:
Proper grading, no evidence of erosion? ASS FAIL
Improper vegetative cover? YES
Evidence of compaction such as heavy machinery or livestock? YES
Improper discharges such as straight pipes? A FAIL
Evidence of high ground water? YES
Snow cover present? N,V YES
Page 1
PUMPS/DOSING SIPHONS:
Is a pump or dosing siphon present?
If YES, is the pump/dosing siphon functioning properly?
YES
NO
Does the pump/wiring/dosing siphon appear to be in good condition?
PASS
PASS
FAIL
FAIL
Is the high water alarm working, both visible and audible?
PASS
FAIL
SECONDARY TREATMENT:
Is a secondary treatment unit present? YES
N j
If YES, does the unit appear to be In good working condition? YES
/
UNKNOWN
Does the owner have a current maintenance contract for the unit? YES
NO
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?
Evidence of past surfacing?
Surface dampness?
Excessive odors?
Field location verified by observation ports or probing:
Liquid in observation port?
If YES, record depth:
Distribution Box or ADV part of original design?
If YES, is it accessible from grade?
Is it level and in good condition?
FAIL
YES
YES
YES
Probing
YES
----- inches
Y
PASS FAIL
Page 2
UNKNOWN
Any problems with the system that were not addressed in the inspection checklist?
/1 I.-, . .
Please list any recommendations for the continued use of the system:
.4 d g% , _
Were any repairs done as a result of this inspection? NO YES
If YES, please describe the repairs.
101 the st of my knowledge and training, the inform
20J2,
Lice ed Systems Inspector Signature:
Additional Notes:
in this inspection is accurate as of
Clearly label any pictures and attach -them to this fr+rm
Page 3
COMMUNITY DEVELOPMENT DEPARTMENT
130 South Galena Street
Aspen, Colorado 81611
Phone (970) 920-5526 FAX (970) 920-5439
RE:PID #
Pitkin Building #:
Date:
Inspection Results:
Accepted
Rejected (See Comments)
Signature of Applicant: __________________________________________________________
Print Name: Date:
Accepted as Noted ( See Comments)
Partial ( See Comments)
Signature of Inspector: __________________________________________________________
Print Name: Date:
Type:
Comments:
If no as -built drawings exist for this system or the as -built was inaccurate, please diagram the system as
accurately as possible. Be sure to document all system components and the location of any well on the
property. Using markers such as corners of the house, exact measurements can be used to triangulate
the location of the system components for future reference.
Page 4
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Buildlna Sketch (Page - 1)
Bonewer
Susan Levitt Personal Representative for Francis X. Gina Jr.
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2661 Bear Mae Rd
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Lender ClIant
Susan Levitt do Matthew L. Trinidad
Form SKT.BLOSKI -'TOTAL° apprafsal software by a le mode, Inc.-1-800-ALAMODE