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ea5-- 00,2-in "- <br /> -erg, State of Oregon Department of Environmental Quality <br /> Annual Operation and Maintenance <br /> rill <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> Propertyowner: AMME STANDRING Phone: 971-998-3857 <br /> Site Address: 101 1ST ST Parcel#: 105E02AD00600 <br /> City. DETROIT County: Marion <br /> Permit#: 555-22-005744-PRMT-01 Startup date if 1st year in use: 05/01/2024 <br /> AX2ORT LOGO <br /> System Model#: System Serial#: <br /> Report Year: 2025 Date of Service Performed: 12/18/2025 <br /> Email Address: AMME.STANDRING@CHARTERMECHANICAL.COM <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> i] ❑ Was maintenance performed as required by septic system rules and the manufacturer? <br /> x❑ ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> x❑ ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ In Is the system failing? <br /> ❑ ID Discharge of sewage to the ground surface? <br /> ❑ ❑� 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: 3/28/26 <br /> (*This lin- • • t and p • opied.) <br /> Original Signature: <br /> r- ��/'�_ Date: 12/31/2025 <br /> Note:Maintenance providers/n ,t aintain a urate records of their maintenance contracts, customers, <br /> performance data, and timelin--, for 1-newing t - contracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-r-1-0130( 4). <br /> DEG Annual Operation and Maintenance Report Foci Rev ni2022 <br />