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2-7&M6P6-// / <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 CAROLINE HOWE Phone: 503-810-5877 <br /> 23257 SANTIAM WAY SE 092E17BA01800 <br /> Site Address: Parcel#: <br /> LYONS Marion <br /> City: County: <br /> 555-22-000107 p y 9/6/22 <br /> Permit#: Start u date if 1st ear in use: <br /> System Model#: AX2ORT System Serial#: 147849 <br /> Report Year: 2025 Date of Service Performed: 10/20/2025 <br /> Email Address: CJHOWE@YAHOO.COM <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> ❑ -Was maintenance performed as required by septic system rules and the manufacturer? <br /> i] ❑ 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 /> ❑ ❑� Is the system failing? <br /> ❑ Q Discharge of sewage to the ground surface? <br /> ❑ 0 Discharge of sewage to drain tiles or surface waters? <br /> ❑ UI 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 line only can be fill.• out and•h.—. <br /> Original Signature: Date: <br /> 12/31/2025 <br /> Note: Maintenance provider <br /> !'•tain accurate r-.ords of their maintenance contracts, customers, <br /> performance data,and timeline -ne • he contracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-071-0130(2. . <br /> 0E0 Annual Operation and Maintenance Report your Rev 4.2022 <br />