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?))]

2 (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.

3 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 .. :. - ' '.

4 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.]

5 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.

6 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 ; .Red Lodge, MT 59063 Phone : 4'46 lines, separation distances, lot boundaries, septic tank and draihfield', and 'a north arrow.)))

7 -,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.'.; . ;- '.>.)

8 ! .. L , ,.t;, Liquid CapacityT- ; ; ; ; ; - * f1-2 Dcdroomo ,,,..- .. TiO Gil:-** 3 -Dcdroomn..,..,..;. 900 Gal,.'.4 /.'.- ..'.. VTVJOQG'Gal: "".5 D'cdrooma .. 1250 Dcdrobmc ..1, J3W .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=.)))

9 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 . : ' - '.

10 : . ; ..': ;.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,.'.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, '.]