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ig °°14°Cifce tir14 <br /> • <br /> EXISTING SYSTEM EVALUATION REPORT EXISTING SEPTIC TANK EVALUATION REPORT " x <br /> • I <br /> Existing System Evaluation Report for Onsit <br /> Wastewater Systems- - MAY 31 2018-- ) <br /> DEQ I <br /> Sete of Oregon Department of Environmental Quality MARION <br /> BUILDING INSPCOUNTYECTION <br /> Onsite Program <br /> 165 East 7th Avenue,Suite 100 <br /> Eugene,Oregon 97401 <br /> Please answer the following questions completely.-po 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 /> httpfilV/WW:Ofedrigov/DEQ/VVQ/pagesionsite/septicsmart.aspx. <br /> SeptIc SysternOwner-Prosiided Information; <br /> Property Owner(s)(Sellers) SAMUEL BEYER TelephOne <br /> Site Address 3853•RIDGEWAY DR SE City: TURNER Zip Code: 97892 <br /> County:: MARION Lot Size. <br /> • 5 ACRES AcreS/Scivare'Feet(circle units) <br /> Legal Description: T09. R 2W SEC 6C TL 1700 <br /> Age of wastewater treatment system N/A (years) Is tttere a service contratt fcir'sYstern components? NO <br /> Date the septic tank was last pumped UNKNOWN (please attach receipt if available) <br /> Number cif'people occupying the dwelling 2 If unoccupied,how long has it been vacant <br /> - Was this section completed by the evaluator because own or agent was unavailable.? <br /> YES <br /> The above information is true and to the best of my knowledge. <br /> 5/16/2018 SPOKE WITH-SAMUEL BEYER BY PHONE <br /> Date(sAwootityiro Signature of-Owner <br /> Name of person performing inspection(please print) SETH ANDERSON <br /> Cerfification: <br /> Installer Professional Engineer <br /> X Maintenance Provider Environmental Health Specialist <br /> National AsSociation of Wastewater Technicians r Wastewater Specialist <br /> Other DEQ approved in writing(please destribe) <br /> Certification Number'. RM 110 <br /> Business name: A.&B Septic Service/Valley Septic Service Email , a_b_septic@hotrnail.com <br /> Business'address:P.O.Box 444,Albany,Or,97321 Phone: .1-866-9274156 <br /> Date of Evaluation: 5/18/2018 (rvIM/DD/YYYY) <br /> I hereby certify,by my signature that lyneet all of the qualifications required to perform onsite wastewater <br /> system evaluations in the State of Oregon pursuant to OAR 340-071-6155. <br /> 5/18/2018 SETH ANDERSON <br /> Date(MM/DD/YYYY) Signature of Qualified Septic System Inspector <br /> Page 1 of 8 Updated 12/29/2016 <br /> _ , , <br />