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• <br /> • <br /> . . . - 555_ l`j—•eODCs85---IIQQ <br /> �„... .. .. - . . -.Slate.of Oregon,- <br /> { • <br /> i :..•' 7 • .• :.-.Departtnent.of Environmental:Quality <br /> - • . <br /> Water:Quality D vision- <br /> • 3 ";�. ; - . • :Onsite•:P•ro ram - - <br /> •fid.. • • -• •-'Annual�-:Operation:and Ma ntenance' :Rep:ort Forth <br /> G`enei�al Inforrra :o .. . . . : 56 3 O -t�"F' <br /> :.Property.Owner:.::.11e : . ) i 1 .a... . Phone •#.:. r ■ . <br /> :. <br /> Site:Add r Ir =Y.:. nn•11 1 i . - Tile,•� ' - <br /> .-•County: 1 - :Permit-#. : • . -.: . -Startup::Date: Y . 41 <br /> .System-Model - System Serial#,-.- _(,, 33 • -. <br /> • <br /> • .Service IReport:Y'ear:.. • .Z..;.01... : .. - • _ • . . <br /> O.nsite'wastewatertreatiTient s• ystem.status - • - : • .• - - • <br /> •- >: D Vas`maintenance performed.as required by`septic-system•rules.(OAR 34007'1)and - <br /> . <br /> • <br /> • the•manufacturerl. " • . • . 1 • . <br /> -.• ...t:: Is the system operating:in`,accordance`with the agent=approved design specifica ions? <br /> • [] .-Is''tbesystemcurrentlyunder.•a-service:contr�act.with a'•certifed inaintenance,provider? • <br /> ;Is t e.:syste n:fail ng? . <br /> Yes:` No <br /> -O ...,..-of sevageto the::gtound'sucface . • <br /> :...: :_ :,:.Q :: I.:-.Discharge°of sewage to•drain-tiles_or surface waters.•:.. . -: -• : •,C .-- ••:Sewage backup.intOpiunibing fixtures: .. • • • - • <br /> Q =If• es,was al- • 1• = ' 't•obtained')If not, :explain: • . . <br /> .`-.. I::certify that.thi 'report:is.complete and:accurate:to the.best..of'my.knowledge:'I: <br />