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APPLICATION TO 1 z-1 -- LI.,_ / ('( <br /> DEPARTMENT OF~ENVIRONMXNTZ~L QUALII'¥ <br /> FA ser, no. 4-77-7 <br /> <br /> STATEMENT OF F~SIBILt~ FOR PROPOSED SUBSUrfACE SEWAGE DISFOS~ <br /> <br />R~TU~ TO: FEE SCHEDULE~ <br />Marion County Health Department <br />3180 Center St, N~ Room 220 <br />Salem, Oregon 97301 <br /> <br />rec. #$048 <br /> <br />Non-refundable $37.50 per lot <br />to be submitted with <br />application. <br /> <br />.![.~_~C~RIPT,~Ip~N_.(2~,,~,.,A,,R.~E~L (Attach Plot Plan as Exhibit A) <br /> <br /> Section _; Township ; Range County <br /> Narrative Description: <br /> <br />, Oregon; Tax lot <br /> <br />:'ROPOSED USE OF PARCEL (NUMBER OF HOMESITES) AND LOT SIZ~_,S~_ <br /> <br /> tf for a commercial business or re~ta~a~t, we ~ee~ to know th~ ~u~er ~oy~S and/ <br /> or tb.e seating capacity: <br />PRES~TLY DESIGNATED LAND USE~ ZOMI~ ~D N~ OF DESI~ATING AGENCY: <br /> <br />TEST t]OLE REQUIREi~ENTS: <br />One Homesite: You wt3,1 not need to dig test holes unless notified. <br />Two or More Homesites: Two test boles must be prepared on each parcel, 2 ft. by 3 ft, wide <br /> and 4 ft. deep, ned 75 ft. apart in the proposed areas. <br /> Test holes ( ) have been prepared ( ) will be prepared by <br /> (date) <br />THIS REPORT IS NOT A PERMIT. It does not eliminate the need for required planning commis- <br />sion approval, building, or 1, ocation permits, <br /> <br />I HEREBY r~EQUEST FROM THE DEPARTMENT OF ENVIRONMENTAL QUALITY A STATEMENT OF FEASIBILITY OF <br />THE ABOVE METHOD OF SEWAGE DISPOSAL FOR THE ABOVE DESCRIBED PARCEL. <br /> <br />Name of Applicant ~J~ A/ /~--~,g[ ~1~_ Signature of Applicant -- <br /> <br /> (for DEQ o~ Agent use only) ~-- ~ <br /> <br />Co~ents and r~commendat:[on$ based on Subsurface Site Investigation by DEQ or Contract Age~ <br /> <br /> · he soils on Che proper~y are similar ~o a Woodburn sil~ loam wiCh a <br /> cla~ loam a~ 2z~,'. The soil profile lacks a resCric2ive layer usually <br /> fo~d in a Woodbumm soil. The prope~ is approved for one homesite on <br /> appz'oxi~Cely ~-acres pending accep~a'ble plOC plans p~ior ~o any con,- <br /> s2~c~ion. The sewage system is ~o be locaCed along Che north, propez.ty <br /> 1, ine on the higher g~d. This may acquire a p~p system due to <br /> ciera%ion of ~he approved sewage area ~d surro~di~ arced. <br /> <br /> Statement of DEQ/Contract Agent Relative to Above Application <br /> <br />above described method of aewage disposal is approved subject to the following <br /> <br />The above described m~thod of sewage disposal is not approved for the fol]owlng rees~, · <br /> <br />EIt-50 Rev..!1/76 <br /> <br /> <br />