Laserfiche WebLink
State of Oregon Department of Environmental Quality <br /> Annual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> Property owner: DON & BRANDI TAYLOR Phone: 503-917-1755 <br /> Site Address: 350 JANICE CT. Parcel#: 105E02DA06600 <br /> City: <br /> DETROIT county: Marion <br /> Permit#: <br /> 555-16-006684-SEP Startup date if 1st year in use: N/A <br /> System Model#: . 20RT System Serial#: 145050 <br /> Report Year: 2025 Date of Service Performed: 10/16/2025 <br /> Email Address: BKTONAGEL@HOTMAIL.COM <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> El ❑ Was maintenance performed as required by septic system rules and the manufacturer? <br /> • ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> J ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ ❑t Is the system failing? <br /> ❑ i.1 Discharge of sewage to the ground surface? <br /> ❑ 0 Discharge of sewage to drain tiles or surface waters? <br /> ❑ It 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 fill ut and photocopied.) <br /> Original Signature: Date: <br /> 12/31/2025 <br /> Note: Maintenance providers m t maintain urate records of their maintenance contracts,customers, <br /> performance data,and timeline r renewing t e contracts. These records must be available for inspection upon <br /> request by the agency per OAR -071-0130( ). <br /> DEG Annual Operation ane Maintenance Repro urn Rev 612022 <br />