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.'~' APPLICATION TO ' DEPARTMENT OF ENVIRONMENTAL QUALITY sar. no. 7-76-8 rec. f/3745 FOR STATF2~ENT OF FEASIBILITY FOR PROPOSED SUBSURFACE SEWAGE DISPOSAL RETURN ~D; F~.E ~CH~DULE: Marion County Health Department ~0%_.~) ~ % Non-refundable $25.00 per lot ~180 Center St. NE~ Room 220 to be submitted with DESCRIPTION OF PARCEL {Attach Plot plan as Eahibit A) S reposed subsurface sewage system Or systems on the plot plan wb~%ch is attached as Exhibit A. NOTE: The Marion County Health Department, as contract agent for the D.E.Q.~ must complete a site investigation before a statement can be given, In order to-verify soil types and determine this suitability, it is often necessary to require %we (2) soil test holes 2 ft. by 3 ft. wide and 4 fro deep and 75 ft. apart in the area proposed, for the sewage system. You will be contacted if field investigation indicates a need for such'holes. Test holes ara required for more than one parcel. This report, when completed~ will not eliminate the need for required planning commission approval~ building or location permits. Test holes ( ) have been prepared ( } will be prepared by (date) I HEREBY REQUEST FROM TH~ DEPARTMENT OF ENVIRONMENTAL QUALITY A STATEMENT OF F~ASIBILITY OF THE ABOVE METHOD OF SEWAGE DISPOSAL ~OR THE ABOVE DESCRIBED PARCEL. City~ State~ Zip Code ~J~~ . L~/ -~'.~B Date ~-. (for DEQ or Agent use only) ' Comments and recommendations based on Subsurface Site Inves~igation by DEQ or Contr8ct Agen~ Soil is similar to Sifton gravelly loam. Gravelly loam at'24". Approved pending plot plan showing sewage on very highest part of this lot. This plot plan is to be submitted with the permit application. Statement Of DEQ Relative to Above Application (~he above described method of sewage disposal is approved subject to the following condftions: ( ) The above described method of sewage disposal is not approved for the following reasons For the Department of ~v~ronment~Quality: