Laserfiche WebLink
="- ' = BUILDING INSPECTION DIVISION <br /> 5155 Silverton IU)NE • • <br /> Salem OR 97305 <br /> (503) 588-5147 Fax(503) 588-7948 <br /> _ - http://www.co.marion.or.u-s <br /> • <br /> SEPTIC SYSTEM CERTWICATION for RECORD REVIEW <br /> • <br /> PROPERTY OWNER: Lo <br /> SITE ADDRESS: t° \0. -If `e-AN 04.1S-e— 1'fG( <br /> FILE NUMBERi I _ 37 CPS <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 strn.ctare(s) on the property, <br /> and the proposed development meets all minimum- setback requirements fromtheexisting septic <br /> system, and the future septic system repla-cement area. In addition if there isn't a septic system serving <br /> the property, this document is to certify that a fall 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 atibis time. <br /> • <br /> SIGNATURE: • <br /> • <br /> • - (Property Owner or the Owner's5 srripedAgent) <br /> Names(please print): DAfr.; .- 1. i 4c/C1--e-. • <br /> Company Nam e: GCLir— 6)� ,j- - l„�� <br /> Mailing Address: P(/ 1317• • <br /> - %® OP- co X37 <br /> - ' Phone Number: q I- O3 r . _ • <br /> • <br /> G:\FORMS\SEPTICIS-38RRCert cationFinaLdoc S-38 Rev. 9/10,1/11 <br />