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EXISTING SYSTEM EVALUATION REPORT x EXISTING SEPTIC TANK EVALUATION REPORT <br /> Existing System Evaluation Report for Onsit <br /> Wastewater Systems <br /> DEQ SEP 18 2023 <br /> State of Oregon Department of Environmental Quality <br /> Onsite Program MARION COUNTY <br /> 165 East 7th Avenue,Suite 100 BUILDING INSPECTION <br /> Eugene, Oregon 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 visit <br /> https://www.oregon.gov/deq/Residential/Pages/Septic-Smart.aspx <br /> Septic System Owner-Provided Information: <br /> Property Owner(s)(Sellers) PAM LATIMER Telephone: <br /> Site Address 5828 SHAW HWY 228 S.E. City: AUMSVILLE Zip Code: 97325 <br /> County: MARION Lot Size: 4.84 Acres' suare Feet(circle units) <br /> Legal Description: T: 8 R: 1 W SEC: 18 C TL: 3900 <br /> Age of wastewater treatment system N/A (years) Is there a service contract for system components? NO <br /> Date the septic tank was last pumped 2016 (please attach receipt if available) <br /> Number of people occupying the dwelling 5 If unoccupied,how long has it been vacant <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 /> 07/31/2023 SPOKE WITH PAM BY PHONE. <br /> Date(MM/DD/YYYY) Signature of Owner <br /> Name of person performing inspection(please print) BRANDON PITTS <br /> Certification: <br /> i X i Installer j Professional Engineer <br /> Maintenance Provider = Environmental Health Specialist <br /> IwN^ National Association of Wastewater Technicians Wastewater Specialist <br /> LOther DEQ approved in writing(please describe) <br /> Certification Number: 13365 <br /> Business name: A&B Septic Service/Valley Septic Service Email: a_b_septic@hotmail.com <br /> Business address:P.O.Box 444,Albany,OR,97321 Phone: 1-866-927-1156 <br /> Date of Evaluation: 08/16/2023 &08/23/2023 (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 /> 08/16/2023 &08/23/2023 BRANDON PITTS <br /> Date(MM/DD/YYYY) Signature of Qualified Septic System Evaluator <br /> Page 1 of 8 Updated 12/29/2016 <br />