Laserfiche WebLink
EXISTING SYSTEM EVALUATION REPORT t' ( j EXISTING SEPTIC TANK EVALUATION REPORT L_] <br /> Existing System Evaluation Report for Onsite <br /> Wastewater Systems <br /> DEQ <br /> State of Oregon Department of Environmental Quality <br /> Onsite Program <br /> 165 East 7th Avenue,Suite 100 <br /> Eugene, Oregon 97401 <br /> Please answer the tollowing questions completely. Do not leave any blank responses. Write unknown it <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) MIKE WALLIG Telephone <br /> Site Address 35443 FRANCIS ST SE City: LYONS Zip Code: 97358 <br /> County: MARION Lot Size: 0.48 Acres/Square Feet(circle units) <br /> Legal Description: T 8 R 4E SEC 32BD TL 900 <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 NEVER (please attach receipt if available) <br /> Number of people occupying the dwelling 0 If unoccupied,how long has it been vacant 3 MONTHS <br /> Was this section completed by the evaluator because own or agent was unavailable? YES <br /> The above information is true and to the best of my knowledge. <br /> 12/21/2020 SPOKE TO MIKE VIA PHONE <br /> Date(MM/DD/YYYY) Signature of Owner <br /> Name of person performing inspection(please print) CHRIS RHODABACK&JOSH SIMMONS <br /> Certification: <br /> Installer 1.7 ;Professional Engineer <br /> ! X Maintenance Provider T !Environmental Health Specialist <br /> 1-1 } <br /> X l <br /> National Association of Wastewater Technicians _ Wastewater Specialist <br /> I_ Other DEQ approved in writing(please describe) <br /> Certification Number: RM 8& 13661ITC <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: 01/04/2021 &06/03/2021 (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 /> 01/04/2021 &06/03/2021 CHRIS RHODABACK&JOSH SIMMONS <br /> Date(MM/DD/YYYY) Signature of Qualified Septic System Inspector <br /> Page 1 of 8 Updated 12/29/2016 <br />