Laserfiche WebLink
/`Q State of Oregon Department of Environmental Quality /1 a D - is //6 <br /> SAAnnual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> Property Owner: CARL AUSTAD Phone: 503-873-3747 <br /> 887 GRANDVIEW HEIGHTS Parcel#: <br /> 061E22AC00706 <br /> Site Address: <br /> city: SCOTTS MILLS County: Marion <br /> Permit#: 06-07128 Start up date if 1st year in use: NA <br /> System Model#: ENVIRO-GUARD EF-50 System Serial#: <br /> NA <br /> Report Year: <br /> 2025 Date of Service Performed: 6/5/2025 <br /> Email Address: CRAUSTAD@YAHOO.COM <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> Q ❑ - 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 /> ❑ ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ Q Is the system failing? <br /> ❑ ❑� Discharge of sewage to the ground surface? <br /> ❑ M Discharge of sewage to drain tiles or surface waters? <br /> ❑ 8 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 fi ppo71utt and hotocopied.)hotocopied.) <br /> Original Signature: L,& J'1/' _ - 12/31/2025 <br /> tt _-=\ Date: <br /> Note: Maintenance providerSrst ma tain a:curate records of their maintenance contracts,customers, <br /> performance data,and timelines for rene • the contracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-071-0130(24). <br /> ❑EO Annual Operation and Marntena rice Hepor Porn Rev °'2022 <br />