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• <br /> MARION COUNTY PUBLIC WORKS <br /> .10. 440,1IN BUILDING INSPECTION DIVISION <br /> w%�� �� 5155 Silverton RD NE . <br /> Imo' Salem OR 97305 <br /> (503)588-5147 Fax(503) 588-7948 <br /> http://www.co.marion.or.us <br /> • <br /> SEPTIC SYSTEM CERTIFICATION for RECORD REVIEW <br /> PROPERTY OWNER: A %a- cD l-in 63sma n <br /> SITE ADDRESS: 12,1 c1S Sbpl.te,., / pi-,,A,vsv,llE c1-7'3ZS <br /> DATE: 1-22,-19 <br /> riLE NUMBER: \.81-00 t 3 402-A czC— . <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 ailrlition 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: OP A J <br /> • 1.erty Owner or the Owner's Authorized Agent) . <br /> Name (please print): Pr rYst As rni,r\ <br /> . Company Name: <br /> Mailing Address: )2F1S ije,,,_ ter. ,,,,,,,sjot t °1-73zS <br /> Phone Number: .5 o s— S$o- 611.9 Zip <br /> G:IFORMSISEPTJC1S-38 RR CertificationFinal.doc S-38 Rev: 9/10,1/11 <br />