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Existing System Evaluation Report for Onsite <br /> 7 Wastewater Systems <br /> DEQ State of Oregon Department of Environmental Quality <br /> StaisalOragm <br /> ocrwmoat Onsite Program <br /> oniihmmild 165 East Seventh Ave, Suite 100 <br /> away <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:/Iwww.oregon.gov/deq/Residential/PageslSeptic-Smart.aspx <br /> Septic System Owner-Provided Information: <br /> Property Owner(s)(Sellers): Joesph& Karen Brady Telephone: <br /> Site Address:20521 Bridge Creek Rd SE City: Silverton Zip Code:97381 <br /> County: Marion. Lot size: 46.93 Acres/Square Feet(circle units) <br /> Legal Description: 081 E01 B000100 <br /> Age of wastewater treatment system unk (years) Is there a service contract for system components? n0 <br /> Date the septic tank was last pumped 7-10-23 (please attach receipt if available) <br /> Number of people occupying dwelling unk If unoccupied,for how long has it been vacant? unk <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 /> Date(MM/DD/YYYY) Signature of Owner,or agent if present <br /> Name of person performing evaluation(please print): Josh Hansen <br /> Certification: <br /> ❑Q Installer ❑ Professional Engineer <br /> 2 Maintenance Provider ❑ Environmental Health Specialist <br /> 0 National Association of Wastewater Technicians ❑ Waste Water Specialist <br /> El Other:DEQ approved in writing(please describe) <br /> Certification Number. RI 761, RM 150 <br /> Business name Oregon Sewer&Drain LLC Email josh@oregonsewer.com <br /> Business address PO Box 1282, Silverton, OR 97381 Phone 503-874-9414 <br /> Date of Evaluation:7-10-23 (MM/DD/YYYY) <br /> hereby certify,by my signature,that!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 /> 7-11-23 <br /> Date(MM/DD/YYYY) Si of Qualified Septic System Evaluator <br /> Page 1 of Updated 12/29/2016 <br />