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t <br /> EXISTING SYSTEM EVALUATION REPORT I x EXISTING SEPTIC EVALUATION REPORT 71 <br /> Existing System Evaluation Report:for Onsite <br /> Wastewater Systems <br /> DEQ <br /> State of Oregon Department of Environmental Quality <br /> Onsite Program <br /> 165 East 7th Avenue,Suite 100 <br /> Eugene,Oregon 97401 <br /> Please answer the following questions completely.Do not leave any'Wank responses.Write unknown it <br /> unknown. Refer to Oregon Administrative Rule 340-071-0155 for more information;and please visit <br /> http://vvww.oregon.gov/DEWWO/pages/onsite/septicsmart.aspx. <br /> Septic System Owner-Providedlnfarmation: <br /> Property Owner(s)(Sellers) RICHARD GILMORE Telephone <br /> Site Address. 7070 LIBERTY RD S City: SALEM Zip;Code: 97306 <br /> County MARION Lot Size: 0.91 ACRES Acres/SquareFeet(circle units) <br /> Legal Description: T0.8_.._R.3W SEC 28A TL 800, <br /> Age ofwastewater treatment system. N/A (years) Is there a:service contract for system components? NO <br /> Date the septic tank was last pumped UNKNOWN (please attach receipt if available) <br /> Number of people occupying the dwelling 2 If.unoccupied,how long has it been vacant <br /> Was this section completed by the evaluator because.own or agent was unavailable? YES <br /> The above information is true andto the best Of my knowledge. <br /> 4/16/2019 :SPOKE WITH RICHARD GILMORE BY PHONE <br /> Date(MM/DD/YYYY) Signature of Owner <br /> Name.of person performing inspection(please print) EDWIN ELLIOTT&.CHRIS.RHODABACK <br /> certification: <br /> !Installer <br /> i Professional.En Engineer <br /> �Mi �'• <br /> X_i Maintenance Provider L Environmental Health Specialist. <br /> X: I National Association of Wastewater Technicians i Wastewater Specialist <br /> Other DEQ approved in writing(please describe) <br /> Certification.Number: 13271TIC'&kM 8 <br /> Business.name: A&.BSeptic Service/Valley SepticService Email a_b_septic@hotmail.co n <br /> Business address::P.O.Box 444.Albany.;Or,97321 Phone: 14166-927-1156 <br /> Date of Evaluation: 4/22/2019 (MM/DD/WYY) <br /> I hereby certify,"by my signature,that I.meetall of the qualifications required to perform onsite wastewater <br /> system evaluationsin the state of Oregon pursuant to OAR 340-071-0155. <br /> 4/22/2019 EDWIN ELLIOTT&CHRIS RHODABACK <br /> Date(MM/DD/VYVY) Signature of Qualified Septic System Inspector <br /> Page 1 of 8 Updated 12/29/2016. <br />