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RETURN TO: Marion County Health Department 3180 Center St. NE, Room 220 Salem, Oregon 97301 APPLICATION TO DEPARTMENT OF ENVIRONMENTAL QUALITY set. no. 10-76-26 FOR STATF. M~NT O~ FEASIBILITY FO~ PROPOSED SUBSURFACE $~AGE DISPOSAL FEE ~C~DULE: Non-refundable $25.00 per lot to be submitted with application. rec. #4061 D~SCRIPT~pN OF P..A~..CEL (Attach Plot Pla~ as Exhibit A) Narrative Description: L ~ ~.4f_~ ~ ~4~/.-~ ~m~/- ~ .... / ,. ~ttached as Exhi~t A. ~E: ~e M~ion Co~ty ~alth ~p~ent~ as con~act apent for the D.E.O. ~ must c~plete a site investigation ~fore a statement c~ ~ given. ~ order ~'.~erify ~il t~es dcte~ine t~s s~tability, it is of~n necess~y ~ req~re two (2) soil test holes 2 ft. ~ 3 ft. wide ~d 4 ft. deep ~d 75 ft. ap~t in t~ ~ea p~posed' for the sewage syst~. You will ~ con~cted if field investlga~on indica~s a need f~ such'~les. Test ~les ~e req~red for more ~ one p~cel. ~s ~rt, w~n c~pleted, will need for req~red planing ~ission approval, b~ld!ng or location ~st ~le~ ( ) ~ve ~en prepped ( ) will be prepped b~ . (date~ I HERSY REQ~ST ~M ~ D~NT OF E~IRO~NT~ QU~I~ A STAT~NT OF F~IBILI~ OF ~ ~VE ~OD OF S~AGE DI~S~ ~R ~ ~VE D~RIBED N~e Of ~plicant ~&~ ~ ~lq,, S~gnature of ~plic~t (for D~ ou Agent use only) ~ents ~d re~enda%~ons based on S~s~fac~ $i~ ~ves~ga~on by D~ or Con~act A~ent Soll is similar to Nekia silty clay loam. Approved previded that the sewage system is located on the highest part of the proposed lot. Statement Of DEQ R~lattv? ~o Above Application /The ~ove described method of sewage, disposal is approved subject to the following condf~iens: The ~by;e described method of sewage disposal is not approved ~or the following reasons~ Rev. 4/76