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[13--oDL-tC)S-1 <br /> MAY 15 2023 <br /> MARION COUNTY <br /> Existing System Evaluation Report for OnsiteBUILDINGINSPECTION <br /> stems Wastewater Systems <br /> DEQ State of Oregon Department of Environmental Quality <br /> StatactOregol <br /> ,, Onsite Program <br /> emmunal' 165 East Seventh Ave, Suite 100 <br /> Quay <br /> Eugene,OR 97401 <br /> Please answer the following questions completely:Do not leave any blank responses.Write unknown if <br /> unknown.Refer to Oregon Administrative Rule 340-071-0155 for more information,and:please <br /> visit http:%/www.oregon.gov/deq/Residential/Pages/Septic-Smart.aspx <br /> Septic System Owner-Provided Information: <br /> Property Owner(s)(Sellers): 715 River Road LLC Telephone: 503-932-8785 <br /> Site Address: <br /> 100 E central Ave City: Gates Zip Code:97346 <br /> County: Marlon Lot Size: 0.25 AC Acres/Square Feet(circle units) <br /> Legal Description: 100 E CENTRAL AVE GATES,OR,97346 <br /> Fa 3 Age of wastewater treatment system 20 (years) Is there a service contract for system components? No <br /> Date the septic tank was last pumped Unknown (please attach receipt if available) <br /> Number of people occupying dwelling None If unoccupied,for how tong has it been vacant? <br /> 2+yes <br /> Was this section completed by the evaluator because owner or agent was unavailable? Yes <br /> The above information,is true and to the best of my knowledge. <br /> 02/15/2023 <br /> Date(MM/DD/YYYY) Signature of Owner,or agent if present <br /> Name of person performing evaluation(please print): Greg Clinton <br /> Certification: <br /> ❑,/ Installer 0 Professional Engineer <br /> ❑ Maintenance Provider 0 Environmental Health Specialist <br /> ❑ National Association of Wastewater Technicians 0 Waste Water Specialist <br /> ❑ Other:DEQ approved in writing(please describe) <br /> Certification Number: <br /> 39098 <br /> Business name Clinton Construction Inc. Email gregclinton@yahoo.com <br /> Business address P.O.Box 128 Scio, OR 97374 Phone 503-871-4764 <br /> Date of Evaluation:02/15/2023 (MM/DD/YYYY) <br /> I hereby certify,by my signature,that I meet all of the qualifications required to perform onsite wastewater <br /> system evaluations in the state of Oregon pursuant to OAR 340-071.-0155. <br /> 02/15/2023 <br /> Date(MM/DD/YYYY) ig a ualified Septic System Evaluator <br /> Page 1 of 8 Updated 12/29/2016 <br />