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ser. no. ~-76-55 rec. NL862 APPLICATION ~O DEPARTMENT OF ENVIRONMENTAL QUALITY FOR STATEMENT OF FEASIBILITY FOR PROPOSED SUESURFACE S~WAGE DISPOSAL RETURN TO: Marion County Health Department Salem~ Oregon 97301 Phone~ 5B8-5346 FEE SCHEDULE: Non-refundable $25.00 per let to be submitted with application. DESCRIPTION OF PARCEL (Attach Plot Plan as Exhibit A) Section ~_; Township ~ ~ ~ ~ang~.~ County of Marton~ Oregon~ Tax lot_/ which is attached as Exhibit A. NOTE: The Marion County ~alth ~p~nt~ as con~act agent for the D~E.Q.~ must complete a site investigation ~fore a statement can be given. In orde~ to verify soil t~es and determine t~s suitability, it is o~n necess~y to require two (2) soil test holes 2 ft. by 3 ft. wade a~ 4 ft. deep and 75 ft. ap~t in the ~ea proposed for t~ sewage zystem. You will ~ contacted if field inv~s~gatlon indicates a need for such ~les. Test holes ~e ~equired for more th~ one T~s report~ when comple~d~ will not eli~nate the need for req~red planning co~tssion ap~rgval. building or location permits~ Test ~les ~have ~en prepped ( ) will b~ prepped by (date) I HEREBY REQUEST F~OM T'~E Dm. PARTMENT OF ENVIROEMENT~/, QUALI%~f A STATE~ OF ~P~V~ OF ~ ~VE ~THOD OF SEWAGE DISPOSAL ~R T~ ~ DESCRIBED P~CEL. please . . .... (for D~ or Agent use only) ~]ents and reco~endations based on Subs~face Site Investigation by DEQ or Contract Agent: ~e soils ~e si~l~ %o a Ne~a silt7 ol~ lo~ ~th the slope %ow~ds the south. The upper test hole h~d water standing at 36-inches. The site is approved for subsurface sewage disposal. Agent Marion County Signsture ~ ~ Date L-23-76 Statement of DEQ Relative to Above Application ( ~The above described method of sewage disposal is approved subject to the following condltions$ The above described method of sewage disposal is not approved for the following ENVIRONMENTAL HEALTH SERVICES Marion County Department of Public ~eaI~ Room 220, 3180 Center S~eet, N.E.