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· ~u~ ~OV~_r~!! DEFARTFfE~IT OF ENV%~0NMENYAL QUALITY or Hott~'l, 2nd Floor 220 ~gh Street N,~. ~e~Oreqo~ ~730~$TATEM~NT OF 7~SIBIL%~ FOR PROPOS~D SUBSURFACE SEWAG~ DISPOSe, KETU~ TO: Marion County ~ealth Department 3180 Center St, NE, Room 220 Salem~ Oregon 97301 FEE SCHEDULE: Non-refundable $37.50 per let to be submit~ed with application. DESCRIPTION OF PARCEL (Attach Plot Plan as Exhibit A) PROPOSED USE OF PARCEL (NIUMBER OF HOMESITES) AND LOT SIZE(S): i r,~?,) .,g'. '"' If for a commercial businese or restaurant, we need to know the nu~Sb~ of employees and/ or the seating 't capecl.y. - PRESF~NTLY DESIGNATED LAND USB~ ZON,!NG~ AND NAME OF DESIGNATING AGENCY: TEST HOLE REQUIREMENTS: One Homes%te; You will not need to dig test holes unless notified. 'I~e or More Homesites: ~o test holes ~u~t be prepared on each parcel, 2 ft. by 3 ft. wide ~//fl- and'~ft, deep, end 75 ft. apart in t~e~_proposed areas. Test h'oles < ) have been prepared (~7 will be prepared by (date) THIS REPORT IS NOT A PE~IT. It does not eliminate the need for required planning co~is- sion approval, building, or location permits. I HEREBY REQUEST FROM THE DEPARTS. lENT OF ENV%RONMENTAL QUALITY A STATEMENT OF FEASIBILITY Oi AB0W: METHO 0P SI;W*S ISP0Sg PeR a 0= Neme of Applicant ;;q.~l% C¢?~k ~ .~.¢~. Signature of Applicant ~. ~..... ~ .,''. .,_~ : ~ ~, . . ...;>-4':~.Z.x..l ~,¢<~,' ~ Title O~e~,.B~er,. Agent Address Applicant . ~,,. / ~ .-- ~ ~ ' f *********************************************************************************************- (for DEQ or Agent use only) Cements and recommenda~ion~ based on Subsurface Site Investigation by DEQ or Contract Age~ Soil is similar to ~ifton gravelly loam. Gravelly loam at 24". Coarse grain material below 36". Approved pending consflruction permit application.