Sewage System Permit

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TETON AND PONDERA COUNTY HEALTH DEPARTMENT

Individual Sewage Disposal System Installation Permit


Installation For:____________________________________________Phone:_______________


Mailing Address:________________________________________________________________


Property Address:_______________________________________________________________


Legal Description:  Qtr Section_________Sec_________Twp__________Rge_______________


Type of Structure(s) to be Served:_______________New:___________Existing:_____________


Total Number:           Living Units:_______________Bedrooms:   _______________


NON-DEGRADATION: Provide information that this system is nonsignificant under the
non-degradation rules.


If subdivided Parcel, has sanitary restrictions been lifted?   Yes___________No______________


Method of water supply to the structure(s):  Well_____Cistern______Public______Spring______


Septic Tank Construction with Filter: Concrete_____Other_________No. of Gallons____________


Drainfield: Type of tile_________Length of tile_________Effective Area_________(in square feet)


Describe Soil Depth to 8 Feet:______________________________________________________

     (soils data may be needed)


Depth To First Ground Water:__________________Percolaton Rate:__________________Min/in


Distance Of Installation From:  Property lines:  Front_________Back_________Side__________
                                               Foundation(s)______Well_____Surface Water_____Cistern_____



This system must be inspected before final covering. Please call the Health Department at
406-466-2150 or 406-271-4036 to schedule a time. If new or more restrictive conditions are found
before or during installation, the Sanitarian must be notified before progressing.


I CERTIFY THIS SEPTIC SYSTEM HAS BEEN INSTALLED ACCORDING
TO CURRENT SEPTIC SYSTEM REGULATIONS


Signature of Applicant:_____________________________________________________________


Signature of Installer/Contractor:_____________________________________________________


Plan Approved By________________________________________________Date_____________

                                                              Sanitarian


Installation Inspected By:__________________________________________Date_____________

                                                              Sanitarian


THIS PERMIT IS VALID FOR ONE YEAR FROM DATE OF ISSUANCE

Provide a diagram of the completed septic system. Show the location of the proposed/existing building, the septic system and the drainfield replacement area. Show distances from: wells, cisterns, surface water, water lines, slopes greater that 15%, roadways, property boundaries, and, if applicable, the 100 year flood plain.

 

NORTH

 

WEST

 

 

EAST

 

SOUTH

 

Draw a vertical view of the drainfield trench. Show depth of trench, depth of washed gravel, type of perforated pipe, indicate type of soil barrier used and amount of backfill.

 

 

 

 

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