HomeMy WebLinkAboutDISTRIC 7 INSPECTION 2 - 23-00848 - Bear World - Jurassic Creek Gift Shopr'n," lO
HEALTH D
ON RTREPO
Activity Codc;
/oTravel Time:
INSPECTION CONDUCTED FOR N,.e VEII.o!\lrfaelE Srel r,tAn-r-.>. -F-e>Gor6 s,g 3ooWE^-AN-PernfiNo398O6;3
ci
Block
LOCATION OF INSPECTION
Legal Description:
Subdivision:
Street Address
% Section Section 28 Tonnship SN Range
Lot
Capacity of Seplic Tank Installcd
Was Septic Tank construction in compliuce with Statc regulatios and was tank Statc approvcd?
Werc inlet and outlet prop€rly sealcd?
Did Septic Tank meet minimum scparation rcquircmentsqr rcquired by permit?
was extcnsion of manhole requirei? Y; [;'
" oefO tom nnu grade to manholc. () fcct
)yr^4('a--
lohs. Septic Tatrk capacity = or greatcr than p€turit requirements?f"D<rlEB r
E5
No N/A
No
No
No
SUBSURFACE DISPOSAL @RATNTTELD) INSPECTTON
o
o
o
o
o
N
N
N
N
N
Type ofDisposal S
Disposal Area Size 'Ter'"Sq Feet
Meets permit requiremcnts?
In compliance with Permit Issued?Ycs
N/A
Did Disposal System meet the minimum sepsration distance as rcquircd by the Permit?
Was Disposal System constructed in compliance with the State Technical Cuidancc Manual?
Maximum depth ofDisposal System / Feet. In compliancc with Permit tssued?
DRAWING: (Show buildings, septic systcm components, water lines, surfacs waters, & wells lvithin 300 fcet ofseptic syst4m. lmponant to show distances,
North
West
East
SELF-INSPECTION; If given approval for self inspection Installer cenifies that information provided is accurate and system was
Lic€nse #:Dale:
Have M!I9!_&l9krek!. which could cause premature failure, but still in substantial compliance with Intent of Rules
Recommend that deficiencies be corrccted which could improve your system, but system is still approved.
Have Malor dellclencles which violate the Intent of Rules and must be corected, system not approved.
Official Use Only
Comments:
DATEINSPECTED/REVIEWED BY EHS
J
#
Be rn Substantial Compl v/ith permit and is approved.
This System appears to:
Installed by
Yes
Yes
l.
2.
1t96
SEPTIC TANKINSPECTION
installed as shown.
Installers Sigtrsture X
So" A{+r"}d
South
@
License #:
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DISTRICT SEVEN HEALTH DEPARTMENT
SEPTIC PERMIT
*NOTE* THIS P'RMIT IS ONLY YALID FOR ONE YEAR FROM DATE OF ISSUE
't t96
Installation shall comply with oll the requireDeJats oj[1Le-Eeqllh D] Xict snd ldaho's lndividual Subsurface SelydAe Disposal Regulalions as stated
below. Failure to inslall system in cotnpliance with wmil w'ill cause disapprcval bv Dislricl 7 and possible leEal action
CDP No laet/41 t-code:Z3.F Permit N
Receipt No_-
Permit lssued To: Name \htl_aJsTo^L( Ernn u/oarD Phone@@Rn
6010 S. 'l%v)City
Section 2A ro,rnsmp StrJ R-s" t1 g
Lot Block
For Location: Address
-zip-
Legal Description: % Section
SuMivision
SEPTIC TANK SPECIFICATIONS (minimums)
Size of Septic Tank:-51o gallons
gallons
Multiple trnk (lfusing or required): _ Total gallons
First tank: _ gallons Second tank: _ gallons
Pump Chamber ( ifrequired)
Type(s) ol Slandad Sewage Disposal System Permitted: Trench _
Bqsic Abernqtive Pri
Bed _Graveltess la1Pir
Extra Drain-rock Trenchvy_ Steep Slope Systcm _Capping Fill
Type(s\ of Complex Ahemallve Disposrl Syst€m Permitt€d: Sa[d Filter Intermittent _ Sand Filter lntrench _
Sand Mound _ Lagoon _ Extendcd Treatrnent Systcms _ Large Soil Absorption Systems
Other
*Complet Alternative Disposal Systems are rcquired to be inslalled by a licensed complex instaUer,
DISPOSAL AREA SIZE:MAXIMUM DEPTH OF EXCAVATION:Feet
SEWAGE DISPOSAL (DRAINFIELD) SPECIFICATIONS (minimu ms)
tt
it
e issralI hereby agree that the
ApplicanUAgent Si Date:
per the permit and will not m
to for purpose of inspection
ISSUED BY EHS lrl Dat€:#a (
s
irements on tse .t etmit:
r +- i .
Time:
Sq. Ft.
DISTANCE TO NEAREST SURFACE WATER (explanation): _
approval from District 7.
(,)
1
DISTRICT SEVEN HEALTH DEPARTMENT
SEWER APPLICATION
Shaded Area - OFFICE USE ONLY
NAME"lZro*.ou,
Eo^* Llr-,
PHONE
PROPERTY ADDRESS
STREET
CITY (ilto J! 4su a)
zlP
onrcr6Lo,JvN ER'S NAME
f-Zl\ rarrS Cel\
tor srze 6cees1 17!%z
LEGAL OESCRIPTION
SUBDIVISION
TOWNSHIP RANGE sEcTtoN _ 1i4 SECTTON _
LOT # BLOCK g
BRIEr DIRI;( l IoNs t'o P[()P]SRTT.|/ 4/ad 6."u// Lat
TYPE OF USE
SINGLE FAMILY() MULTIPLE FAMILY
0{IcoMMERCTAL'( )oTHER "
# BEDROOMS
# EMPLOYEES
TYPE OF INSTALLATION WATER SUPPLY
x) PRIVATE
PROPOSED DISPOSAL SYSTEM
(X) DRATNFTELD ( )ptr() ABSORPTION BED() BASIC ALTERNATIVE
l COMPLEX ALTERNATIVE
t (X NEw
REPLACEMENT ( )PUBLrc
SYSTEM NAME
'Additional inlormation may b€ needed =t
5'tF co MMERCIAUOTHER EXPLAIN
PI.li^sl (l()MPl.ll IE l Hf Gl:()L(X;l(l^l. lNIORMATION
HIGHEST NORMAL GROUNOWATER DEPTH L,FT. OEPTH TO BEDROCK +ROCK OUTCROPS( ) YEs( )NoDESCRIBE SOIL (AT PROPOSEO OEPTH OF DRAINFIELD)( }HILLSIDE
(h FLAr
NEAREST: SURFACE WATER
lo
wett l@1' sEPnc
-The information provided on this application is accurate to the best of my knowledge. I understand that any false
statements may result in disapproval of this permit. lf this subsurrace sewage disposal installation is constructed by
anyone other than the home/landowner or a licensed septic installer, the installation will not be inspected or
approved. Section 1-3006.01 - 1-3007.0'1.
ss to this property for the purpose of performing the requested
Sfil n,' 4- Buitdinscontracr", fl,L^s{
I hereby authorize the health autho
APPLICANT SIGNA
lam the: Landowner
is accurate
to have
infservices and I cerlify that all th
Licensed Septic lnstaller
lnstaller License #
SEE BACK FOR FURTHER I RUCTIONS AND DIAGRAM OF PROPERTY...APPLICATION WLL NOT BE ACCEPTEO W/O DIAGRAM ON BACK*'
COUNTY cIlPtr
oH-$ITECONDUCTED{ )AFP ( }DlsAPP
EHS #___./_
TRAVEL Tr E _DATE / /
olrt€trE T|ME _/______J__
MAILING ADDRF,SS
STREET/P.O. BOX
CITY STATE ZIP
oarc |-lo-X{
YELLOWSTONE
BEAR WORLD
6010 s.4300 w
REXBURG, ID
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ADDMON
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