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V7---- '''' <br /> -L. t:D15i <br /> 5 !C =WEB <br /> " -_ Existing System Evaluation Report for O it <br /> = �` J�L 08 2024 <br /> = _ " Wastewater Systems - <br /> DEQ MARION COUNTY <br /> State of Oregon Department of Environmental Quality BUILDING INSPECTION <br /> State on <br /> D 1ITIOntof Onsite Program <br /> Ernimnmental 165 East Seventh Ave, Suite 100 <br /> Quality <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): Holy Family Academy Telephone: 503-792-3630 <br /> Site Address: 10697 Howell Prairie Road NE City: Salem Zip Code: 97305 <br /> County: Marion Lot Size: 7.75 acres Acres/Square Feet(circle units) <br /> Legal Description: 062W010001400 <br /> Age of wastewater treatment system 6 (years) Is there a service contract for system components? yes <br /> Date the septic tank was last pumped unknown (please attach receipt if available) <br /> Number of people occupying dwelling unknown If unoccupied,for how long has it been vacant? n/a <br /> Was this section completed by the evaluator because owner or agent was unav ' ble? Yes <br /> The above' fo ation is true and to the best of my knowledge. <br /> gA-1 Of <br /> Date(MM/DD/YYYY) Signature of Owner,dr agent if present <br /> Name of person performing evaluation(please print): Daniel N. Shafer <br /> Certification: <br /> ❑ Installer ❑ Professional Engineer <br /> ❑✓ Maintenance Provider ❑ Environmental Health Specialist <br /> ❑ National Association of Wastewater Technicians ❑ Waste Water Specialist <br /> ❑ Other:DEQ approved in writing(please describe) <br /> Certification Number: M466 <br /> Business name Santiam Septic & Drain Email office@santiamseptic.com <br /> Business address 2829 Ridgeway Drive SE Phone 971-354-1280 <br /> Date of Evaluation: 06/28/2024 (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 /> 07/03/2024 A. r <br /> Date(MM/DD/YYYY) Signature of Qualified Septic S tern Evaluator <br /> Page 1 of 8 Updated 12/29/2016 <br />