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025-O00%\t-‘ sh11�� <br /> 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: EVERFAB Phone: (503) 303-3300 <br /> Site Address: 9049 PORTER WAY SE Parcel#: T9 R1W S6 TL601 <br /> City: AUMSVILLE County: MARION <br /> Permit#: 555-23-002331-PRMT-01 Start up date if 1st year in use: 01/18/2024 <br /> System Model#: SANDFILTER System Serial#: <br /> Report Year: 2025 Date of Service Performed: 07/07/2025 <br /> Email Address: office.septech@gmail.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 /> E ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> Q ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ an Is the system failing? <br /> ❑ ® Discharge of sewage to the ground surface? <br /> ❑ IN Discharge of sewage to drain tiles or surface waters? <br /> ❑ in 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): Tim York- Septic Technologies <br /> *Certification#: M592 'Certification Expiration: 03/26/26 <br /> ('This line only can be filled out and photocopied.) <br /> Original Signature: Da e: 12/31/2025 <br /> Note: Maintenance pro - ers must maintain accurate records of their maintenance contracts,customers, <br /> performance data, and timelines for renewing the contracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-071-0130(24). <br />