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State of Oregon Department of Environmental Quality e 06220,6--- /N62y <br /> 31 Annual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> Property Owner: WENDY & GRANT WIEGE Phone: 503-689-6077 <br /> Site Address: 7782 HOWELL PRAIRIE RD. NE Parcel#: 062W24D000500 <br /> City: SILVERTON county: Marion <br /> 555-19-006596-PRMT Startup date if 1st year in use: UNKNOWN <br /> Permit#: <br /> System Model#: AX2ORT system Serial#: 141708 <br /> Report Year: 2025 Date of Service Performed: 5/16/2025 <br /> Email Address: WENDYJO010@GMAIL.COM <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> ❑ Was maintenance performed as required by septic system rules and the manufacturer? <br /> a ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> 0 ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ 0 Is the system failing? <br /> ❑ ® Discharge of sewage to the ground surface? <br /> ❑ In Discharge of sewage to drain tiles or surface waters? <br /> ❑ ® Sewage backup into plumbing fixtures? <br /> If you answered"Yes"on the last four questions,was a repair permit obtained? If not,explain: <br /> --I-certify that this report is complete and accurate to the best of my knowledge. I understand that falsification of this <br /> report is grounds for revocation of my certification and/or civil penalties. <br /> "Maintenance Provider Name(please print): Cory Morgan - A & B Septic Service <br /> "Certification#: M 587 *Certification Expiration: 3/28/2026 <br /> (*This line only can be ed oi)t and photocopied.) <br /> A 12/31/2025 <br /> Original Signature. :�h' --- Date: <br /> Note: Maintenance provid=rs mu- m tain accur- e records of their maintenance contracts, customers, <br /> performance data,and tim- es :sr r- ewing the * tracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-0 -0130(24). <br /> DEO Annual Operation and Maintenance Report For'n Rev.6;2022 <br />