Laserfiche WebLink
ao-DoolQ11-"IXR? <br /> State of Oregon Department of Environmental Duality <br /> Annual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> Property Owner: OREGON CORRECTIONS ENTERPRISES Phone: (503) 428-5500 <br /> Site Address: 8045 STATE ST Parcel#: T7 R2W S26C TL1500 <br /> City: SALEM county: MARION <br /> 555-20-009317-PRMT <br /> Permit#: Start up date if 1st year in use: <br /> System Model#: SANDFILTER System Serial#: <br /> Report Year: 2025 Date of Service Performed: 10/28/2025 <br /> Email Address: office.septech@gmail.com <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> a ❑ 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 /> Q 0 Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ • Is the system failing? <br /> O la 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): 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: Date: 1 Z/31/2025 <br /> Note: Maintenance pr iders 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 /> .s ,.:1 <br />