sewer lines, separation distances, lot boundaries,

1 5 This -application for'' New constructionReplacementRepair Existing System ;.. II. APPLICANT INFORMATION (please print or type) .Name \x/ xv' [ a< (r~4 (\\.<^, f" PhoneHome Address \< .. ^ city ./r.^, Zip ($7? Q& &. ^ ^- 1 III' SITE INFORMATION ('Attach- a .copy1 of USGS '' or 15' location map)Property Location Lot SizeCsubclivisi-bn , ' lot numbfer1, .Type of Building)Number of Bedrooms'Full Basement?(house, trailer ,etc.)v^ YPC; . NnHave Sanitary Restrictions been lifted?jwi^iMwmffii^wnB! ^IV. SITE EVALUATION (attach copy of 'Sanitary .Restrictions) -SeeTest pit excavated to a 'depth- of .Depth to bedrock .is- ' _ ..feet . ' .' ' ' , 4 Depth to seasonal' high groundwater. table isfeetSlopeFlo'odp-larn? 'Yesfeet__ NoBrief soil description("boulders ,sand , ;lay , etc ) ' test' performed byPercolation Ratea wuiiwotmt wtwtniu mma imilnwii n BIOWUI utuw* rmaan wawiKiiUMiiiiivBimdiMwawmwomnmrewiinnre* IB wuwMMmrJWIK^CTJ eV.))]

2 DISPOSAL SYSTEM'(.see general requirements on back of application)' Septic Tank 1000. gallons ' -Length '. ^>:3^~ 'Disposal Y- Y/N?- Dishwasher' Y Y/N? / - '/Distance' from Septic" 'Tank 'to.: ''; Foundation ..J$r~& " . feet. ' - /.,.;.'- ' ' ' ..- Well- ' J:- gS"'":g>" feet.' Line g-Z'-g?'! feet.'. ^-^ I,,. -/,-..- . --v- ../. ->..- .. *..w^t'erc' 'e ' ^'-^M ..feet .. :. - ' '.viu/^.-u.'. ' : [ - '' ' " =. Distance from Drainfield to:, ;Fb'' noratibh' \- ' fcl^'c?^ feet Well -- .''5go'-0tiitviMiiMiiiwnivin>uiBccivuncc ni9Ki>n SPECIAL REQUIREMENTS property Line 3'~e>'' Watercourse . \-gg'-g"i uoa iiarmiui uu uuunn raTOmnw wi 1 1 nnu 1 1 1 > umeifeetfeetfeetcnmsui i nawajrawirrjua u itumt B suu Wti nanuin enoii miima irenwsicufflwwwuiwiwjuus i intnntnin i-nuttcairffa&*t einAin nKaumitni unnaMutmtraxntiuHnuuiwitiiVII.]

3 SKETCH PROPOSED. DISPOSAL 'SYSTEM ON'. BACK OF mmwn cwni>evncixotuuniiM i^n ninm BKiitn bin uimumtiiiu a itVIII, ACKNOWLEDGEMENTi I declare that the information is true , complete andand correct to the best of my knowledge .' The sys-tem will bo .installedin accordance with the Carbon County Regulations' for On-sitoJWastewater. Treatment Systems -and the terms1 of the acknowledge .that ' County .has not designed my -system and. that-these requirements do. not^bind or obligate the -County to guarantee thissystem's operation. I further agree to give a 24- hours noticefor inspection of the system before it1, is .covered-. ' -FOR OFFICE USE ONLYDate Rec 'd (&Application ApprovedDeniedDate ____ _/ :-Inspected by JhfifDate 7-/7-g?-CommentsiiiiKiBi |mia(c i(wi offlirtnnwnii tmmrjonnruinmi,Applicant 'Signature'Date 'Installer~'Carbon County planning/Sanitarian's Officep,o / BOX 466.)))

4 Red Lodge, MT 59063 Phone : 4'46 lines, separation distances, lot boundaries, septic tank and draihfield', and 'a north arrow. -,pv -' -' " ''' ''"'. r?.'(n'."i'- ' ? '*""< ;;!." Minimum dl cunccBjn fccj' ' .From ToFkMd ..Well ..':so--:.'> ;/ :.; loo";Propcrcy. Ui\ ,..,.., '..-..;.,. t5 . ,,;..Founditlon will .. ; . v .-;:,' :''."* 5 ' "- "' - :'-S / *Water linen ..'.. '10'\- JA'. ' ' lO'H- ,;Scrc^mn, Ixycp-. ditches,' etc-;,".". ; .50 t'.' .'"!."..J'\0" .., '.-i : -t r.'.; . ;- '.>. ! .. L , ,.t;, Liquid CapacityT- ; ; ; ; ; - * f1-2 Dcdroomo ,,,..- .. TiO Gil:-** 3 -Dcdroomn..,..,..;. 900 Gal,.'.4 /.'.- ..'.. VTVJOQG'Gal: "".5 D'cdrooma .. 1250 Dcdrobmc ..1, J3W.)

5 Absorpdon Field Oftcf^n Area. Kcqulrcd Arc^..;.' ' , ' , . -' " ': V. - -.'..,'i "-' ' '-'"* ' '/ * >': .. ' (.$quirc Ft. of.^bcorptlon' trench bouom'pcr bedroom)percolation(Time required (orVHcr 10 (all one 'inch InV/Ubouc E2jrbag= .. With .grinder or i\no- " ' 'cr- . grinder'Wtih .. automatic\ THAN 5 min/inchUNSUITABLE FOR STANDARD SYSTEMS eptic TankUft'StationUfripgAreaLower Fbon ,Upper Floor. , <ty Ga-age: ; PorchiHarnish LaneHot Plan1":=20'-0".. < -'..'jt^si": Carbon County .." '.: ..,." .'.. ' . /'- :,.' . - ',' ; ' *. ',; ;.:'^ ' :./:- Red Lodge, Montana . : ' - ' . : . ; ..': ;.THIS IS TO CERTIFY THAT the;;plans. and'supplemental, 'information, relating; .tor'.thesubdivision known as Lots 13, 14 o-f Block 5 & Lots 1, 2 of Block' 4.)))

6 '.NW 1/4 SW 1/4 Section 9, T 8 S, R 20 E, Red Lodge Estates,: Red Lodge,- MT, Carbon Countyconsisting of 4 lots, have been reviewed by personnel of the Water Quality Bureau,and, THAT the documents .and' data- required/by \7:6.^ ~4-131J:'MCA- [1979 and the rules of the Department' of Health and Environmental Sciences made 'and promulgated have-been submitted and found'to be in compliancetherewith, and, '.' .. THAT the lot size as '. the- Plat 'on .file -with-the .county 'dark and. recorder will not .be'. ; altered'.without .approval;, arid, - 'THAT each lot shall be. used for one single-family dwelling,- and', ;THAT the individual water will consist of a well drilled to a minimumdepth of 25 feet constructed in accordance with the- .criteria established inTitle 16, Chapter IS/ Sub-Chapters 1, .3 6 ARM-and the-most current standardsof the-Department of Health'and Environmental Sciences.]

7 And,THAT data provided indicates an acceptable .water .source at a depth of 38 feet,and, .'-,." 'THAT the individual sewage -treatment^system-will .consist .o a septic- tank and!'. '.subsurface drainfield of such size and description-'.as will comply with CarbonCounty Septic System Regulations; and Title 16-, Chapter 16, Sub-Chapters 1, 3 s 6. ARM, and, .. ' . ' ..THAT 'each subsurface drainfield. ^hall1 have -'an -absorption area 'of "-sufficient, sizeto provide 220 square' feet per, bedroom/ and,THAT the bottom 'of .the. drainfield :-be .at least four. 'feet'' aboye'-the-'fw'ater1'.. ^ f "t vtable, and, , ' , ' .ft' ';.' . 'THAT no sewage treatment system shall be constructed within 100 feet of 'themaximum highwater level of a-' 1,00 year 'flood o'f any stream, lake, watercourse, orirrigation ditch, not within.

8 100 fe&t -of any. domestic water supply source, and,THAT water supply and sewage treatment . systems will -be located as shown on theapproved plan's, and; . '''' THAT plans for the propose'd.' water .ahd^1 individual 'sewage! treatment ': systems' '.will 'be reviewed .and .approved, by the Carbon County' Health Department before constructionis started, and, . THAT the developer 'shall, proyi'de^ each" purchaser of -property; with- a;cppy-;. of rthe -..Plat, approved location of ; water supply and seyage' treatment -system 'and '.a ''copyof this- document, and, - . , ' -' ' " '*' ''*' '"' '"r ;- '* * .*- .. -. THAT instruments of transfer--- t?r this ^rbperty^sliall1 contain referencejto these-" : " conditions, arid, ' -.." '* ' . ' ..- ""' ; , .."''' '' "''' *!

9 ? THAT departure from any criteria, 'forth- in the approved plans and .specifications'and Title 16, Chapter '16, 'Sub-Chapter 1, 3 & ,6 ARM 'a structure andappurtenant facilities'in subdivision without Department approval, isgrounds for the injunction by'.the Department-of Health and Environmental Sciences,NOW,.THEREFORE, ' restriction imposed by said Section 76-4-101 through76-4-131, MCA 1971 upon said fcract is'hereby and herewith ARE- REQUESTED to record this, removal of sanitary restriction within certificate -to the Plat; p said subdivision filed in your 'office asrequired 'by law.. ' . -1 .. ' .-'.'. - ' ' 'DATED this 23rd day of December, .THE'DEPARTMENT OF HEALTHENVIRONMENTAL SCIENCESBy: Steven'-:'L..Pilcher.;' ': ', ;'.. ;'Water 'Quality 3'ureau ' ..": :'.' -^Environmental'-Sciences DivisionOwners Name:John ;a'Vera Koastad'.. i'ri-'-V^xv/-'''' -. ': :--"r ''^;3?

10 >!- 'X VVi'^f^' '. "': ' $$}'*''&"ty $