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State of Oregon Department of Environmental Quality / /v r /ild,/ <br /> Annual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> Property Owner JANET & TED HIGHBERGER Phone: 503-930-8105 <br /> Site Address 530 N SANTIAM HWY Parcel#: 105E01DC07800 <br /> a DETROIT coup Marion <br /> v ty <br /> Permit#: 555-22-001509-PRMT Start up date if 1st year in use: 07/24/2023 <br /> System Model#: AX25RTN-1 B/30 System Serial#: LOGO BOARD <br /> Report Year: 2025 Date of Service Performed: 6/30/2025 <br /> Email Address: TLHIGHBERGER@HOTMAIL.COM <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> El ❑ 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 /> El ❑ 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 /> LI I] Discharge of sewage to drain tiles or surface waters? <br /> ❑ I] 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 on ••ted.) <br /> 'el lan, 1 2/31/2025 <br /> Original Signature: Date: <br /> Note: Maintenance providers m in -•• accurate re ords of their maintenance contracts,customers, <br /> performance data, and timelines for newing • - •ntr. . These records must be available for inspection upon <br /> request by the agency per OAR 340-071-0130(24). <br /> DEQ Annual Operation and Maintenance Report Form Rev.612022 <br />