Laserfiche WebLink
EXISTING SYSTEM EVALUATION REPORT x EXISTING SEPTIC TANK EVALUATION REPORT <br /> Existing System Evaluation Report for Onsite Wastewater Systems p P, _C L -WE 11 <br /> DEQ �! <br /> State of Oregon Department of Environmental Quality LI Li DEC 26 2023 "-� <br /> Onsite Program 165MARION COUNTY <br /> 165 East 7th Avenue, Suite 100 BUILDING INSPECTION'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/ded/Residential/Pages/Septic-Smart.aspx <br /> Septic System Owner-Provided Information: <br /> Property Owner(s)(Sellers) RANDY MILLER Telephone: <br /> Site Address 7836 BURTON PL City: SALEM Zip Code: 97317 <br /> County: MARION Lot Size: 2.46 Acres,* •uare Feet (circle units) <br /> Legal Description: T 8 R 2W SEC 2C TL 200 <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 6/29/2021 (please attach receipt if available) <br /> Number of people occupying the dwelling 2 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 /> 12/14/2023 SPOKE TO RANDY MILLER BY PHONE <br /> Date(MM/DD/YYYY) Signature of Owner <br /> Name of person performing inspection(please print) BRANDON BOGART <br /> Certification: <br /> x I Installer Professional Engineer <br /> I j Maintenance Provider ! 1 Environmental Health Specialist <br /> National Association of Wastewater Technicians Wastewater Specialist <br /> Other DEQ approved in writing(please describe) <br /> Certification Number: 13516 <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: 12/18/2023 (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 /> 12/18/2023 BRANDON BOGART <br /> Date(MM/DD/YYYY) Signature of Qualified Septic System Evaluator <br /> Page 1 of 8 Updated 12/29/2016 <br />