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ie <br /> MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silverton RD NE <br /> 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: Wel erh°Le, ( <br /> SUE ADDRESS: I((Ol�'� Piehc.r Rd ,S6 u- OK `) )39 <br /> DATE: 5-1 0-I9/ 1 %• FILENUBER: // <br /> ® —646 <br /> • <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 structures) 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,thoron.hly 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: #4446., <br /> (Property Owner or the Owner's Authorized Agent) <br /> Name (please print): Je�� 1('neln�c,�1„c�ur <br /> Company Name: Lialer=r.c akar- <br /> Mailing Address: I(9O 19 R0 t SL <br /> -arner OR °I )35), <br /> Phone Number: ,-VJ-3d-) -3 <br /> • <br /> G:\FORMS\SEPTIC1S-38 RR CertcationFinaLdoc • S-38 Rev: 9/10,1/11 <br />