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APFLICAT!ON TO <br /> DEPARTMENT OF F~NV~RONM~NTAL QUALIZY <br /> -' FOR ser. no. 11-77-4 <br />STATEMENT OF FEASIBILITY FOR PROPOSED SUBSURFACE SEWAGE DiSPoSAL <br /> <br />rec. f/6875 <br /> <br />RETURN TO: <br />Marion County Health Department <br />3180 Center St. NE, Room 220 <br />Salem. Oregon 97301 <br /> <br />FEE SCHEDULe: <br />Non-refundable $37.50 per lot <br />to be mubmitted with <br />application. <br /> <br />DESCRIPTION OF PARCEL (Attach Plot Plan as Exhibit A) <br /> <br /> Scctioa 1\ ; Township [ ; Range /p~ ; County of '>~% ~ [%~ 0% Oregon; Tax lot ~, ~ ~,~ [ <br /> Narrative Description: ~ ~x~,m %.~-~ O ..,,~ tg'0 g-/x'~ '~ ',5 90 ~ ~,B,._~ 2,.o~ ~,~ , ~,,(,..,.,~ ~ 2 9 <br /> <br />PROPOSED USE OF PARCEL (NUMBER OF }IOMESIT~S~ "~N~~,', <br />' "T .... <br /> If for a commercial business or restaurant, we need to kaow the number of employee~ and/ <br /> or the seating capacity: <br />PRESENTLY DESIG~AT~ L~D USE~ONING, ~D <br /> <br />TEST HOLE REQUIREMENTS: <br />One Homesite: You will not need to dig test holes unless notified, <br />Two or More Homesites: Two test holes must be prepared on each parcel~ 2 ft. by 3 ft. wide <br /> and 4 ft. deep, asd 75 ft. apart, in the proposed areas. <br /> Tes~ holes ( ) have been prepared ( ) will be prepared By __ <br /> (date) <br />THIS REPORT IS NOT A PERMIT. It does not eliminate the need for required planning corm~is- <br />sion approval, building, or location permits, <br /> <br />I ~ERBBY REQUEST FROM THE DEPARTMENT OF ENVIRONMENTAL QUALITY A STATEMENT OF FEASIBILITY OF <br />THE ABOYE METHOD OF SEWAGE DISPOSAL FOR T~E ABOVE DESCRIBED PARCEL. <br /> <br />Name of Applicant <br /> <br />Address of Applicant ~G. <br /> <br />City, State, Zip Code <br /> <br />Title Owne~ ~ <br />Date ~)$~, ~, ~-I'7 <br /> <br /> (for DEQ or Agent use only) ~-- L~-7~'{~'~ <br /> <br />Comments and r~commendations based on Subsurface Site Investigation by DEQ or Contract Agen <br /> <br />The soil on the property is similar to a Woodburn silt leam. Silty clay loam at 24". <br />The property is approved for one homesite on 9 acres pending acceptable plot plans prior <br />to any construction. <br /> <br /> Statement of DEQ/Contract Agent Relative to Above Application <br /> <br />(g~/The above described method of sewage disposal is approved subject to the following <br /> conditions: <br /> <br />( ) The above described method of sewage disposal ia not approved for ~he following reasons <br /> <br />EH-50 Rev. 11/76 <br /> <br /> <br />