Laserfiche WebLink
APPLICATION TO <br /> DEPARTMENT OF ENVIRONMENTAL QUALITY set. no. 9-75-1 <br /> FOR <br />STATEMENT OF FEASIBILITY FOR PROPOSED SUBSURFACE SEWAGE DISPOSAL <br /> <br />rec. no. 5255 <br /> <br />RETURN TO: <br />Marion County Health Depertment <br />Salem~ Oregon 97301 <br />Phc:ne: 588-5346 <br /> <br />FEE SCHUDULE: <br />Non-refundable $25°00 <br />per lot to be submitted <br />with application° <br /> <br />_DE~fRtD__~7~_ri?~._~_F P__APC_E~L (Attach Plot Plan as Exhibit A) <br /> Sec%ion~i~; Township f~ ; Range *~ County of ~1%~ ~ Oregon, Tax lot <br /> N~rative Description: ._ <br /> <br />PRESENTLY D/SI~NATED LAND U~,'~N~NG~ ~D N~ OF ~ESIGNATING AG~NC.Y / / <br /> <br />Show location o~ p/tposed subs~fa~e syst~ or systems 0n the ~lot plan which is // <br />attached as Exhibit A. <br />NOTE: The Marion County Health Dep~ent~ as con~act agent for the D~E.Q., must <br />complete a site investigation ~fore a statement c~n ~ given. In order to verify <br />soil t~es and determine %~ suitability~ it is often necess~y to require two <br />(2) soil test holes 5 ft~ deep and 75 ft. ap~t in the ~ea proposed for the sewage <br />system. You will be contacted if field investigation indicates a need for such <br />holes~ T~st holes ~e required for more th~ one p~cel. This report~ when <br />comple:ted, will not eliminate the need for required plying commission approval, <br />building or location permits. <br /> Test holes (~) have been prepped ( ) will be prepared by <br /> ( date ) <br /> <br />I HEREBY REQUEST FROM THE DEPARTMENT OF ENVIRONMENTAL QUALITY A STATEMENT OF APPROVAL <br />OF THE ABOVE METHOD OF SEWAGE DISPOSAL FOR THE ABOVE DESCRIBED PARCEL. <br /> <br />Name <br />Ad~rezs of Applicant ~.~.~o g ~' Title <br /> <br /> (for DEQ Or Agent use only) <br /> <br />Comments and recommendations based or: Subsurface Site Investigation by DEQ or Contract <br />Agent: <br /> <br />Soil is similar to Nekia silty ¢l%y loam on the higher part of the property and <br />unaccep%able Waldo silty clay lo~m on the area proposed, Th~s proper%y is approved <br />for one homesite provided that %he sewage disposal system is located on the higher <br />part o£ %he property near the north property line and at least gOO feet or more <br />from the county road. <br /> <br />Agent Marion County Signature ~/~4,/~_~J~ ~'~'~ Date Sent. 9, 1975 <br /> <br /> Statement of DEQ Relative to Above Application <br />( he above described method of sewage disposal is approved subjec~ tO the <br /> following conditions: <br /> <br />( ) The above described method of sewage disposal is not approved for the following <br />EH-50 Rev; 10/74 <br /> <br /> <br />