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, <br /> • ,linilkorot.-4„.. MARION COUNTY PUBLICWORICS <br /> BUILDING INSPECTION DIVISION <br /> ,,--- -es_2t,....in 5155 Silverton RD NE <br /> , <br /> • <br /> amm Salem OR 97305 <br /> • (503)538-5147 Fax(503)588-7948 <br /> htfp://www4o.marion.or.us <br /> SEPTIC SYSTEM CERTIFICATION for RECORD REVIEW <br /> PROPERTY OWNER.. Bernard DeLay <br /> 10378, Champoeg RD NE. Aurora OR 97002 <br /> srrE ADDRESS: ' ' <br /> DATE: <br /> 5/26/23 <br /> '' —rtN,t) <br /> FILE NUMBER ---)15 N.-7 CrODCI-1616 E__ <br /> I certify that I have personally investigated the existing septic system on the above property and have <br /> identified the exact location of all parts of the septic system,including the septic tank,distribution box <br /> or drop boxes, drainfteld lines and future septic system replacement area.The attached site plan is an <br /> accurate representation of the location of the septic system and proposed structure(s)on the property, <br /> and the proposed development meets all minimum setback requirements from the existing septic <br /> system,and the future septic system replacement area. 14 addition if there isn't a septic system serving <br /> the property, this document is to certify that a full investigation has been made to determine that the <br /> parcel is not being served by a septic system. <br /> I further certify that I have,to the best°Inv abilities,thoroughly inspected the septic system and found <br /> no evidence of any failure, The system appears to be functioning in a satisfactory manner at this time. <br /> • <br /> , k <br /> SIGNATURE: , , <br /> (Property Owner o th Owner's Authorized Agent) <br /> eLa <br /> Name(please print): Bernard 13 <br /> • Company Name: <br /> 10378 Champoeg RD NE <br /> Mailing Address: <br /> Aurora, OR 97002 <br /> ' <br /> Phone Number: 503-784-7996 <br /> '0,801tMliSSEPTIC§S-38 flaCestificationFinaLdtv S-38 Rcv:9110,Ini <br />