Laserfiche WebLink
3180 Center St. NE~ Room 220 <br />Sa]~m~ Oregon 97301 <br /> <br /> DEPAR'I~gNT OF E~IVIRONF~NTAL Ql~L~TY <br /> sar. no. 6-76-77 rec. 02098 <br /> FOR <br />STN~ELMENT OF F~AS!B!L%TY FOR DROPOSgD SkP~SURPACZ SEWAGE DISPOSAL <br /> <br /> Non-ref~dable $25.00 per lot <br /> to be su~itted wi~ <br /> application. <br /> <br />OES~}_tIBTION OF P. ARCE.~L (Attach ~lot Plan as Exhibit A) <br /> <br />Show location of p~oposed ~ubs~fa~e sewage system or/systems on the plot pl~ wbXch is <br />attache~ as F~xhfbit A. <br />~'TE: The Marion Co%~ty Health ~p~nt~ aS cOn.act agent for the D.~.Q., mu~t complete <br />a site investigation ~fore a statement c~ ~ given. ~ order ~ ,~erify soil <br />~ete~ine t~s s~tsbility, it i$ often necess~y to req~re two (2) soil test ~les 2 ~t. <br />by 3 ft. wide and 4 ~t~ deep ~d 75 ft. ap~t in th~ ~ea proposed for the sewage system. <br />You will be contacted if field investi~a~on indicates a need for such ~les. Test ~les <br />~e required for mor~ th~ one p~cel. This r~rt~ when completed, will not eliminate the <br />need for required p~ning co~ission approval, b~lding or location <br /> <br /> (~ate) <br /> <br />~ ~EREBY REQUgS'T F'RON THg D~ART~NW OF g~t%RONMgNTA~ QUA~%T~ A STAT~gNT OF FEA$%B%L%TY <br />THE A~Vg ~THOD OP SEWAGE D~SPOSAL ~R THg ~Vg DgSCRI~ED PARCgL. <br /> <br />~m of AppllC~nt . <br /> <br /> (for DEQ or &gent use only) ~- <br /> <br />Cor=aents and reco~umcnda~tions based on S~surf~ce Site Inves~a~on by DEQ or Con,act Agen <br /> <br />~.= ,~irni]er to -nfton Erav.o, 1]y loam. Gravelly losm at 94% <br /> <br /> & ~+~rlt Nation ~ oun+,.7 SignatLtre ~ Date <br /> <br /> S~ement of DE~ Relative ~ ~ve Application <br />~ The a~ de~cribed method o*' ~wage dis~sal ls approved subject to ~e following <br /> <br />( ) The a~ve described method of sewage dis~sal ls not approved for the following reasons, <br /> <br />For the ~epar~ent of ~viro~en~al Quality: - -,, ¢ , ~&*.t~,. -- gat~ ~ <br /> <br />E}4-50 Rev. 4/76 <br /> <br /> <br />