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Salem, Oregon 97305-1398 <br /> <br />PH# 588-5147 <br />FAX0 588-7948 <br /> <br />PROPERTY OWNER:,'-'-' <br /> <br />SITE ADDRESS: <br /> <br />ACTIVITY NUMBER: <br /> <br />I certify that I have personally investigated the existing septic~system on the above property and <br />have identified the exact location of all parts of the septic system, including the septic tank, <br />distribution box or drop boxes, dralnfield lines and future septic system replacement area. The <br />attached site plan is an accurate representation of the location of the septic system and proposed <br />structure(s) on the property, and the proposed development meets all minimum setback require- <br />ments from the existing septic system, and the future septic system replacement area. <br /> <br />I further certify that I have, to the best of my abilities, thoroughly inspected the septic system and <br />found no evidence of any failure. The system appears to be functioning in a satisfactory manner <br />at this time. <br /> <br />SIGNATURE: ~ _' <br /> 'installer, .pti consultant or owner) <br />Name (please print): ~:L~ &--~~22~~~ <br />Company Name: <br /> <br />Mailing Address: ..~ ~~. ~IX <br /> <br />Date: <br /> <br />MC 15-S38 <br />REV 6/98 <br /> <br /> <br />