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555 - Z3-005155 • Aci <br /> 4,11 444: MARION COUNTY PUBLIC WORKS n ECEn <br /> BUILDING INSPECTION DIVISION IJ Y <br /> w 5155 Silverton RD NE <br /> Salem OR 97305 MAY 05 2023 <br /> (503) 588-5147 Fax (503) 588-7948 MARION COUNTY BUILDING INSPECTION <br /> SEPTIC SYSTEM CERTIFICATION for RECORD REVIEW <br /> PROPERTY OWNER: Austin Goodman Basl <br /> SITE ADDRESS: 6548 Carter Rd Sublimity, OR 97385 <br /> DATE: 2-4-2023 <br /> FILE NUMBER: 555-2.3— U 1 &€ <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, drainfield 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. In 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 of my abilities, thoroughly inspected the septic system and found <br /> no evidence of anyfailure. The system appears to be functioningin a satisfactorymanner at this time. <br /> Y Pp <br /> SIGNATURE: <br /> - <br /> (Property Owner or the Owner's Authorized Agent) <br /> Name (please print): Austin Goodman Basl <br /> Company Name: NA <br /> Mailing Address: 615 SW 7th St <br /> Sublimity, OR 97385 <br /> Phone Number: <br /> 503-871 -9736 <br /> G:\FORMS\SEPTIC\S-38 RR CertificationFinal.doc S-38 Rev: 9/10,1/11 <br />