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• <br /> Existing System Evaluation Report for Onsite <br /> Wastewater System s <br /> —- State of Oregon Department of Environmental Quality <br /> Onsite Program <br /> E ry"mentai 165 East Seventh Ave, Suite 100 <br /> euaEugene, OR 97401 <br /> Please answer the following questions completely. Do not leave any blank responses.Write unknown if <br /> unknown. Refer to Oregon Administrative Rule 340-071-0155 for more information, and please visit <br /> http;//www.oregon.gov/deq/Residential/Paq_es/Septic-Smart.aspx. <br /> Septic System Owner-Provided Information: <br /> Property Owner(s)(Sellers): Peter& Donna Paradis Telephone: <br /> 174,12 <br /> Site Address: =1 27-Abiqua Rd NECity: Silverton Zip Code:97381 <br /> p� <br /> County: Marion Lot Size: -f 41 A� Acres/Square Feet(circle units) <br /> Legal Description: <br /> Age of wastewater treatment system ? (years) is there a service contract for system components? no <br /> Date the septic tank was last pumped ? (please attach receipt if available) <br /> Number of people occupying dwelling If unoccupied. for how long has it been vacant? <br /> Was this section completed by the evaluator because owner or agent was unavailable? Yes <br /> The above information is true and to the best of my knowledge. <br /> tORz-s— <br /> Date(MM/DD/YYYY) Signature of Owner.or agent if present <br /> Name of person performing evaluation(please print): Josh Hansen <br /> Certification: <br /> ❑✓ Installer ❑ Professional Engineer <br /> ❑✓ Maintenance Provider ❑ Environmental Health Specialist <br /> ❑ National Association of Wastewater Technicians ❑ Waste\Vater Specialist <br /> ❑ Other: DEQ approved in writing(please describe) <br /> Certification Number: 38968 , M271 <br /> Business name Oregon Sewer& Drain LLC Email josh@oregonsewer.com <br /> Business address PO Box 1282 Silverton, OR 97381 now.503-874-9414 <br /> Date of Evaluation:4-4-19 (i\•th IDD/YYYY) <br /> 1 hereby certify,by my signature,that I meet all of the qualifications required to perform onsite wastewater <br /> system evaluations in the state of Oregon pursuant to OAR 340-071-0155. <br /> 4-8-19 <br /> Date(MNt/DD/YYYY) Signal -e Qualified 'tem Evaluator <br /> Page 1 of 8 Updated 12/29/2016 <br />