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,, sar. a . ~18~ <br /> APPLICATION TO <br /> ,~DEPARTMENT OP ENVIRONMENTAL QUALX~ <br /> <br />STAT~NT OF FEASIBILITY ,FOR gROPOSED SU~S%~FACE S~AGE DISPOSAL <br /> <br />RETURN TO: <br />Marion County Health Department <br />Sa!em~ Oregon 97301 <br />Phone: 588-5346 <br /> <br />FEE SCHEDULE= <br />Non-refundable $25.00 <br />per 1ct to be sU~itted <br />with application. <br /> <br />DESCRIPTION Ow PARCEL (Attach Plot gl_an as Exhibit A) , <br /> <br /> saction ownsh p County of ion, O egon, <br /> Narrative ~scription: · <br /> <br /> ............................. <br />Show loca~on o~ proposed s~surface sewage system or s~ <br />which is attac~d as Ex~Dlt A. <br />NOTE: The M~ion Co~ty ~alth ~p~en%, as con~act agent for the D.E.Q., must <br />complete a ~ite.,inve~%iga~ion ~fore ~ statement can ~given. Xn order ~ verify <br />soil t~es and determine ~s suitability, i~ is of%eh necess~y to require two (2) <br />soil %~s% ~le~ 2 ft. by 3'ft. wide and 4 ft. deep and 7~ fi. ap~t in ~e <br />proposed for the sewage system. You will be contacted if field inves~a~on <br />indicates a need for much ~les. Test holes ~e re.ired for more than one <br />T~S reports w~n c~pleted$ will not eliminate ~e need for req~red <br />co~ission approvals building or l*ca~on <br /> Test holes ( ) have ~en prepped ( ) will be ~ep~ed by <br /> (date) <br /> <br />I HEREBY REQUEST FROM THE DEPARTMENT OF ENVIRONMENT~J~ QUALITY A STATgMENT OF APPROVAL <br />OF THE ABOVE METHOD OF SEWAGE DISPOSAL ~OR THE ABOVE DESCRIBED ~ARCEL. <br /> please print <br /> <br /> Applicant ~ ~, ,~./-~-~r/. SignatUre of Applicant ~ <br />Name <br /> of <br />Address of Applicant /~ ~{~'9%A/~, Title ~.~ <br />City~ State~ Z~p Code ~-~/~;3, ~D~ g?-¢~oi Date <br /> <br /> (for DEQor Agent use only) <br /> <br />Comments and reccm%~endaticns based on Subsurface 'Site Investigation by DF~ or Contract <br />Agent: <br /> <br />S~il is similar to Nekia silty clay loam. Silty clay at 24". <br />Approved pending acceptable plot plan prior to construction. <br /> <br />Age9 _t_ Mari°n CoUnty ~lgnatUre Date <br /> <br /> '"a~ove Sta~en% of D~::~ela~ve ~ ~e ~plicati~ <br /> descried meted o~ Sewage dish,al ts app~Ved subject ~ <br /> following condl~o~s ~., <br /> <br /> ~e a~ve descried ~d of sewage dis~sal is not approved for ~ ~llow~g <br /> <br />ENVIRONMENTAL HEALTH SERI/'fCE~ <br />Marion Count?' lJeparlra~n[ of <br />Room 220, 3180 Center St~et, <br /> <br /> <br />