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MARION COUNTY PUBLIC WORKS <br /> � <br /> 41�"'� BUILDING INSPECTION DIVISION 7 C IEIVF <br /> 1= 5155 Silverton RD NE <br /> Salem OR 97305 L ' FEB 12 2019 <br /> (503) 588-5147 Fax (503) 588-7948 <br /> http://www.co.marion.or.usM` ICOUNTY <br /> BUILDING INSPECTION <br /> SEPTIC SYSTEM CERTIFICATION for RECORD REVIEW <br /> PROPERTY OWNER: Kit Al /114-n <br /> SITE ADDRESS: < 7 c S 4Y= A(A., ,,,, /4 O p 9 ? 3 2$ <br /> DATE: 2-/Z -I 9 <br /> FILE NUMBER: / - )t)/07c9 <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: WA,119ori_______ <br /> (Propertyr wner or the Owner's Authorized Agent) <br /> Name (please print): fli,q tz4 2 (e <br /> Company Name: '-fr- iC A ./� e iocn <br /> Mailing Address: 75- /Z_ I., iH(. / <br /> see°//c f' X73 25-- <br /> Phone Number: 5-d_3^ (d2 <br /> G:\FORMS\SEPTIC\S-38 RR CertificationFinal.doc S-38 Rev: 9/10,1/11 <br />