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EXISTING SYSTEM EVALUATION REPORT X FXISTING SEPTIC TANK EVALUATION REPORT <br /> Existing System Evaluation Report for Onsite <br /> Wastewater Systems <br /> DEQ <br /> State of Oregon Department of Environmental Quality <br /> 1 Onsite Program <br /> 165 East 7th Avenue,Suite 100 <br /> Eugene,Oregon 97401 <br /> Please answer the following questions completely.Do not leave arty blank responses.Write unknown it <br /> unknown.Refer to Oregon Administrative Rule 340-071-0155 for more information,and please visit <br /> Septic System Owner-Provided Information: <br /> Noae ry ovmettOiseilersl FRANK.MASSER Telephone <br /> Sate Address 50617 LINNWOOD DR <br /> Qtr. GATES Zip Code: 97346 <br /> County: GATES Lot Size: 17,711 SQ FT Acres/Square Feet(circle units) <br /> Legal Description. <br /> T 9S R 3E SEC 26CD Ti. 203 <br /> Age or wastewater treatment system N/A <br /> ---��.(years) k there'venial Contract for system components? NO <br /> ()ate the srptK tank was last pumped UNKNOWN <br /> (piers rttbdl receipt N available) <br /> Nurnbrr of people oft upying the dwefling N/A M <br /> unmoved,how long has k been vacant N/A <br /> was Ns section completed by the evaluator beriux own Of <br /> agent was unasra+lat,k 7 YES <br /> The above information is true and to the best of my knowledge, <br /> 11/13/2020 <br /> U,re tMMilxt/rrryl SPOKE WITH FRANK MASSER BY PHONE <br /> Name of Signaturerrl Ownerf forming Inspection Ipiease per"l CNRIS RHODABACK <br /> c—tua at,,v, <br /> installer <br /> X MarHerwKe Providerrholesuunal tnrorwrr <br /> attorul AcsncNtton of Wastewater Ter hokum tnvirtrrnentil Ilragh Spnr:ialist <br /> N <br /> Other Ik.o awruved n ei^aMMt 1piease(*lent* <br /> Wastewater)r+rt'dakst <br /> GYrirK.nnrd Number. RM 8 <br /> FluslrMYs turn.. A;B Septa Srrvr r/Y <br /> +tk-,Sept(xrv`e email <br /> Business address P tt Boa 411 ANanY.Ur.47l,1,J, <br /> P <br /> Date of'valuation 12/2/2020 <br /> (Mt-voo Yyyi <br /> I hereby certify,by my s{4stature,that I meet an of the qualifications required to perform ortshe wastewater <br /> system evaluations In the state of Oregon pursuant to OAR 3400/1-015S. <br /> 12/2/2020 <br /> wt.iMM/oo/yyyyl CHRIS RHOOABACK <br /> *Nam."of rluakMarl SrYrtlt System'motor* <br /> Page 1 of 8 <br /> Update 12/19/1016 <br />