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�''� MARION COUNTY PUBLIC W• ORKS LC nyxIE <br /> 011 1j�������"� BUILDING INSPECTION DIVISION <br /> • %` 1 5155 Silverton RD NE j ALIG 2'/ 2024 L <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 MARION COUNTY <br /> http://www.co.marion.or.us BUILDING INSPECTIOi <br /> SEPTIC SYSTEM CERTIFICATION for RECORD REVIEW <br /> PROPERTY OWNER: <br /> Russ Matlock <br /> SITE ADDRESS: <br /> 10194 Mt. Angel Gervais Rd NE, Gervais,OR 97026 <br /> DATE: 8-22-2024 <br /> FILE NUMBER: 24 - 00 Col 7 j— <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 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,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: <br /> ( operty Owner or tie wner's Authorized Agent) <br /> Name(please print): Russ Matlock <br /> Company Name: <br /> Mailing Address: 10194 Mt. Angel Gervais Rd NE <br /> Gervais, OR 97026 <br /> Phone Number: 503-792-4207/503-310-5423 <br /> G:\FORMS\SEPTIC\S-38 RR Certi£cationFinal.doc S-38 Rev: 9/10,1/11 <br />