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MARION COUNTY PUBLIC WORKS V i <br /> BUILDING INSPECTION DIVISION 7-P <br /> 5155 Silverton RD NE I J i <br /> Salem OR 97305 JUL 10 2023 <br /> (503) 588-5147 Fax(503) 588-7948 <br /> http://www.co.marion.or.us 3UILDINGNuARIO COUNTY <br /> INSPECT ON <br /> SEPTIC SYSTEM CERTIFICATION for RECORD REVIEW .Iv D <br /> \AASt <br /> 1�1 <br /> PROPERTY OWNER: a...rovt d trA// t r <br /> r? <br /> SITE ADDRESS: r J 7, 7 Tr L1 V <br /> U we Ref SE . 0 <br /> DATE: 7 /07Z O Z, <br /> FILE NUMBER: 3 ^ oSi21 -ooS S 1 I— X <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 any failure. The system appears to be functioning in a satisfactory manner at this time. <br /> SIGNATURE: <br /> r perty Owner or the ner's Authorized Agent) <br /> Name (please print): T/ 1`f a <br /> Company Name: 11 roc$ 4/0-rnti,t)t)2/1— <br /> t <br /> 617203 <br /> Mailing Address: � l� . F 6-K 2 ld ( / c (I f <br /> Phone Number: �d 3 — l®19/zf T <br /> G:\FORMS\SEPTIC\S-38 RR CertificationFinal.doc S-38 Rev: 9/10,1/11 <br />