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09:55~ NEILS 3EHSE~ FI~RMS IHC (5~1] 327-2~$0 <br /> <br />3150 Lancaster Dr NE - Suite C <br />Salem, Oregon 97~05-139g <br /> <br />FAX~ 558-794~ <br /> <br />PROPERTY OWNER: <br /> <br />sITE ADD!~S: <br /> <br />ACTIVITY NUMBER: <br /> <br />,f~P'r_IC SYSTEM CERTIFICATION <br /> <br />I cerQ~ t~i! ! have pcr~or~ly investigated th~ ~g septic systcm on ~c above pmpc~ ~d <br />have identi~ ~e ~act Io~fion of ~ p~ o~ ~ seg6c zys~, ~clud~g ~c szp~c ~. <br />dis~budon box or ~op boxy, d~ctd ti~ ~ ~e ~c syst~ ~pl~ment ~ea. The <br />at~ si~ pl~ ~ ~ a~te mp~on of~e localion of~ ~ptic system ~ p~oposea <br />s~c~e(~) on ~e p~pe~, ~d ~c pro~s~ development ~ ~1 ~;n;m,~ set~k <br />mc~[s ~m ~c e~s~g septic ~s~, ~d ~e fu~ ~ptic ~smm r~l~n~ ~ <br /> <br />I hirthcr c~1i~ that I h~ve, lO llle b~t of my abilities, thoroughly ir~p~t~ the septic system and <br />found no evidence of any failure. 'l'ne system appears to be ~mctio~i,~! in a satisfactory manner <br />at chis time. <br /> <br />SIONATUP,~: <br /> <br />N'ame(pleasal~im): <br /> <br />(]i~.ns~d septic ins~llcr, septic con.~lclnr or o~er) <br /> <br />M~iling Ad~ke~s; <br /> <br />Date: <br /> <br /> <br />