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40 MARION COUNTY PUBLIC WORKS <br /> ,il"t BUILDING INSPECTION DIVISION <br /> �%/�►,l <br /> ����- 5155 Silverton RI)NE <br /> 11.11 Salem.OR.97305. <br /> (503)588-5147 Fax.(503)588-7948 <br /> http:!/www.co.marion.or.us <br /> SEPTIC SYSTEM CERTIFICATION for RECORD REVIEW <br /> PROPERTY OWNER: <br /> Brett Mikesk <br /> a <br /> s1, h;ADDRESS: 8390 Orlando Lane NE, Sa.lem., OR., 97303 <br /> DATE 7/9/24 <br /> ,I <br /> FILE NUMBER: ` 15 —�' 005 Lft t "° k1 <br /> I certify that I have personally investigated the existing septic system on the above property and have <br /> identified the exact location of all parts of the septic system,including the septic.tank, distribution box <br /> or drop boxes, drainfield lines and future septic system replacement area. The attached site plan is an <br /> accurate representation of the location of the septic system and proposed structure(s) on the property, <br /> and the proposed development meets all minimum setback requirements from the existing septic <br /> system,and the future septic system replacement area. In addition if there isn't a septic system serving <br /> the property, .this`document:is :to certify that a full investigation has been made to determine that the <br /> parcel is not being served by a septic system. <br /> I further certify:that I have,to the best of my abilities,thoroughly inspected the septic system and;found <br /> no evidence of any failure. The system appears to'be functioning in a,satisfactory°manner at this time, <br /> SIGNATURE; <br /> (Pro! Irty Owner or the Owner's.Authorized Agent) <br /> Name(please prin <br /> ett Mikeska <br /> Company Name: <br /> Mailing Address: 83.90. Orlando Lane NE, Salem, OR 97303 <br /> Phone Number: 971-21:8-247'6 <br /> G tFORMS\SEPTIC\S 38 RR.Ce t ficationFinai doc S-38,Rev: 9/10„1/11 <br />