HomeMy WebLinkAboutDISTRIC 7 INSPECTION 3 - 23-00848 - Bear World - Jurassic Creek Gift ShopPERMIT NO.SEPTIC SYSTEM INSPECTION HEPOBT
. District Seven Health Department
ENVIRONMENTAL SECTION
2s4 E Streel . ldaho Falls, lD 83402-3597
(208) 523-5382
A.lirrity
-
Adion
-xtrBqcqm?33 O
COUNTY <
t9to
SEPTIC TANK (see Note)
Was Ownar/lnslaller advised that sewer trom buildin g to tank must be i
Capacity Gallons 3. Manutactured
Batlles OK?&b. lnleuoutet sealod?o NNA
1.
2.
4a
Plumbin g lnppaclor? k
P,'<-Cc < 7_"
Nl?tt o
N
Final Depth to ii'lanhoi€
Oistance in ta€t from Tank to: Well
ABSORPION AREA (see Note)
Type System lnstalled
Disposal Araa sq. tt.
ls Sewer Rock properly
Soil Banier used
sized and inslalled?UA-/+YN
5. Eltsnsion lenglh
watsr une rq +t Fmperty une 3 O /t Buiuing /0
Absorption Ar€a- Surlaca Water
-
q l.r s o P+-
,fr1
3
4
5
6
2a. Maximum Final Excavation Oepth
b. Soil Profile observed
Distance in feet from absorption area to: Lake/River Scarp _
Clossst Drinking water Source/vvoll- Water Ljne /G, {TBuilding eC Property Une 65 l'f
DRAWING: Show Buildin_'r
signilicanl items within 300 ft. radius of
septic syslem. tMPoRTANT: Show
measurements, especially for locating
Septic Tank Manhoie
SIGNATURE OF PEBSON CEFTIFYING THAT
INFORMATION SHOWI! HEBE IS ACCUFATE.
(I,E. INSTALLER OB OWNEB)
System Comp
Wells, Trees, S
gs, Septic
ter Lines,onents, wa
urface Water, and othe
x
HEALTH DEPARTMENT USE ONLY
INSPECTION/REVIEW SUMMARY
Tho System app6a6 to:
bo in substantral clmplhne wih
Slrndads and Spocjlirto.B.
havo MINOR dollciencid whi.rt
c,ould decrees€ capacty/l o
ol lht Syslern.
hav6 MAJOR dofici6noo3
which ar€ viclatiotu thsl must
bo conodod.
(list violalon3 below)
E
!l
2
3.
.?
I
DATE
qEVIEW EHS
INSPECTED BY
^{
INSTALLEO BY .15\ Eval-r '*t f,)4 trou i-1-s
[our t,NAME
cll-\I
TOWNSHIP
31
RANGE
E
suBolvtsroN olvrsloN BLOCK
STREET NUMAEB, CIry STATE, ZIP OF SEPTIC SYSTEM SITE LOCAT]ON
N
IgI !
I1l
t;\
\{/
I
I !i I I'i-l
1 ,I,4t
(1I
I \
----.7
I
I I
i
Iii
IIl
I
S
ITIIIII
IM
IS
Pink Copy - lnstaller Yellow Copy - OTHD Files 'Finalized While Copy 'Ownor ol Syslom
OATE
sslNSP2 tr loo'
INSTALLER.INSP€CTION
AUTHOBIZED BY
-
v1119$
N
N
N
6i)s sec,, o* )(
LOT
lL
t
t'
)N
lI
I
DISTRICT sEvEN HEALTtr,.DbpaRrvrBNr
SEPTIC PERMM
4/99
below. Failure to install th it ible
Permit No
Receipt N
Phone
CDP No
Permit Issued To: Name
For Location: Address
T-Code: _aTime
fq
City zip-
Subdivision Lot Block
SEPTIC TANK SPECIFICATIONS (minim ums)
Size of Septic Tank:looo gallons Multiple tank (lf using or required):Total gallons
First tank: _ gallons Second tank: _ gallons
Pump Chamber ( ifrequired): _ gallons
SEWAGE DISPOSAL (DRAINFIELD) SPECIFICATIONS (mlntmums )
'lype(s) oI Slanda Sewage Disposal System Permitted: Trench _ Bed
Basic Allernative Privy_ Steep Slope System _Capping Fill 7)+E\tra Drain-rock Trench
Type(s) of Comolex Alternative Disposal System Permitted: Sand Filter Intermittent _ Sand Filter Intench _
Sand Mound _ Lagoon _ Extended Treatment Systems _ Large Soil Absorption Sysrems
Other
*Complex Altemative Disposal Systems are required to be installed by a licensed complex installerr
MAXIMUM DEPTH OF EX ATION:Feet
Pit- c*c.,.o@ 4yq
DISPOSAL AREA SIZE:
APPLICATION RATE:
Sq. Ft
galslday/ft2SOIL TYPE:
DISTANCE TO NE SURFACE WATER (explaration ):
UK.ltr UJf, VI. L\
the permit and will not make any changes from the permit without written
te
lo this ofinspection.
I hereby agree that the
approval from District 7.
Applicant/Agent S
Expiration Date:
Date Issued:ISSUED BY EIIS
ircments ott
),NOTE* THIS PEKIYIIT IS ONLY YALID FOR ONE YEAR FROM DATE OF ISSUIi
\l
LegalDescription: zsection -(F s"cion 2Q, rownsnip 5Al "^wEE-
4t1
SPECIAL CONDITIONS
for ?qqose
#
DISTRICT SEVEN HEALTH DEPARTMENT
APPLICATION FOR SEWAGE DISPOSAL PERMIT
SINGLE FAMILY RESIDENCES (This is not a permit to install)
Owner of system:Yc /[9,"-'5-.\-,.- !,"*,- l^-ir-t,,L
eceipt #
Permit #
no-
Phone # 3tt3 ;57 o"t ,
Mailing Address of Owner:
Location of actual system:
Legal Description: 1/4 Section.
Subdivision Name if applicable:
Address:
To,,vnship
{',r
P.o.Dor /bo
5^)x^s"4 e
Lot Block _
zip
-
City
Directions to properfy
Lot Size L,T Water Supply: Private Well ( ) Shared Welt ( ) Public System $(acres
Constructional Activity: New Construction () Enlargement ( ) Replacement ( )
Wastewater FIow Information :
Maximum number of potential bedrooms
Standard Systems:Trench ( ) Gravelless Dome ( ) Absorption Bed ( ) SeepagePit ( )*Note* Current rules require you to install one of the systems listed above ifyou can, however, if you cannot due to circumstqnces
such as sub-u/ater, slope, separatiot$ to surface \9ater, or other items, then you must install one ofthe alternqtiye systems lkted.
Basic Altemative System: Capping Fill Trench (X) Gray Water Sump ( ) Steep Slope ( )
Incinerator Toilet ( ) Pit Prirry ( ) Vault Privy ( )
Complex Alte Evapotranspitation ( ) Experimental ( ) Extended Treatment
Package ( ) Intermittent Sand Filter ( ) In-Trench Sand Filter ( ) Lagoon ( ) Pressure
Distribution ( ) Sand Filter- Intermittent ( ) Sand Filter-Recirculating ( ) SandMound ( )
Two Cell Infiltrative ( )
rNote* Currenl rules reguireyou to hire a septic irctaller that is licensed to install compla systems. A homeowner or an installer that
only holds a standard or basic alternotive permit cannot install cornplex systems.
for disposal of wastes? Yes (ffi
* t# (pes
I certifu that public or central sewage facilities are not reasonably accessible. I understand that if this system is
constructed by anyone other than homeowner, a licensed installer must install it. I understand that the system must be
inspected and approved prior to final cover. I understand this is an application only and that it is necessary to have a
permit before construction can begin. * Note * Once the permit has been issued, no changes can be made without
prior approval from District Seven Health Department.
Iamthe: Homeowner ( ) Owner's authorized representative: Installer ( ) license number _ Contractor ( )
I hereby authorize access to this property for the purpose ofconducting an on-site evaluation. I understand it is necessary
to have one ofthe following present during the evaluation: Homeowner, Installer or Contractor.
Signed By: X Date
ON.SITE E,VALUATION ON REVERSE SIDE
r0 99
City: RerLc,-) Zip: 9)v,/o
te- s""tion 2%
Will home have basement with bathroom, laundry or other plumbiqg
ProposedDisposalsystem: \SO/G > 4tzf
ON-SITE EVALUATION
Date(s) On-Site Evaluations Conducted
Travel Time associated with evaluation
Ar3
Insp ection Time associated with evaluation. --3O
CI,IRRENT LAND USE:
SITE SUITABILITY:
Slope: Does slope prohibit installation ofproposed system?
Soil Types:
Based on SCS maps. Type A
Based on Engineering Report. Type A
Based on Test Hole. Type A
Test Hole Information:
Depth of Test hole
Predominant soil type observed.
Bedrock encountered.
Yes
@ C Unacceptable
C Unacceptable
C Unacceptable
B
R
Any ground water encountered
Other concems.
Effective Soil Depth: Has sufficient soil depth below bottom ofproposed system to meet rules No
Depth to nearest Groundwater,Depth to nearest impermeable layer. )C O
Separation Distances: (Property has sufficient area for system and replacement to meet all separation requirements?)
t
Well location ( owners property)
Water Distribution lines
Temporary Surface Waters
Permanent or Intermittent Surface
Nearest neighbor's well
Downslope Cut or Scarp
Property lines.
No.
No
No
No
No
No
PLOT PLAN : (Show proposed building sites, well location, septic s ite, replacement area, any surface wate$, property lines,
and utilities if known.)
Comments:
i
),\
t2
t
Il
/r
(N 6(
{)6 4
5 5
tz
@
DO
ls
I@
I
\
\
81 EHS.
)a
1
I
v
9
-c
J
\
e,L
-:\r,
)^o
I
E
o
\
t
(")i
)I
---.\
P
0
i
-c
-l--
I
If
o
;
r
a
P*,l
h
N
\-rR bHU
!lIta-ra
> >?6..!
N
z
(,!t
C-)
tIt
I
cr
o
I
,