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APPLICAT%0N TO DEPARTmeNT OF ENV%RON~NTAL QUALITY sar. no. 3-76-97 FOR STATEMENT OF FEASIBILITY FOR PROPOSED SUBSURFAC~ S~WAGE DISPOSAL rec. #1756 RETURN TO= Marion County Health Department Salem~ Oregon 97301 Phone: 588-5346 FEE SCHEDULg: Non-refundable $25.00 per lot to be,. submitted with application. DF~__SCRIPTION ~.F_ PARCEL (Attach Plot Plan as Exhibit A) which is attached as Exhibit A. NOTS: ~e M~ion County Health ~p~ent~ as con~act agent for the D.E.Q. ~ must complete a site investigation ~fore a statement can ~ given. In order ~ verify sell types ~d determine this suitability~ it is often necess~y to require two (2) soil test ho~es 2 ft. by 3 f%. wide and 4 ft. deep ~d 75 ft. ap~t in the area proposed for the sewage system. You will be contacted tf field tnves~gatton indica~s a need for such ~les. Test holes ~e re,ired tar more tha~ one p~cel. T~$ report~ when completed~ will Dot e~imina~ ~e need for req~red pla~tng co~ission agprovai, building or location permits. Test ~les ( ) ~ve been graphed ( ) will be prepped by ~__ (date) I HEREBY RFA~U~ST FROM TH~ DEPARTMENT OF ENVIKON~NTAL QUALITY A STATEMENT OF OF THS ~VE ~THOD OF SEWAGS DISPOS~ ~R T~ ~VE D~SCRIB~D (for ~ or Agent use only) Co~ents an~ reco~endations based on subs~face Site Investigation by ~EQ or Con~ac% Agent: The soils on the property are similar to Amity silt loam ~nd ~oodburn silt loam. Silty clay lo~m at 24". Approved for one homesite on 4.75 acres pending acceptable plot plans prior ~o any construction. The sewage system must be located approximately 350' back from the road in the better drained ~odburn soil. The Amity ~oils in t~e front have a shallow water table and are not acceptable. Agent Marion County Signature ~ Date Statement of D~JQ Relative to Above Application ~/The above described method of sewage di~Dosal is a~roved subject to the following conditions $ , The above deacribed method of sewage disposal is not approved for the following