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Dvt3c\\5-zN1a? <br /> State of Oregon Department of Environmental Quality <br /> iA Annual Operation and Maintenance <br /> DEQ <br /> Report Form <br /> General Information (Complete ALL information) <br /> Property Owner: MICHAEL MURPHY Phone: 503-559-4608 <br /> 19131 RIVER RD. NE 042W3000700 <br /> Site Address: Parcel#: <br /> City: ST. PAUL county: Marion <br /> Permit#: 11-05808 Start up date if 1st year in use: NA <br /> System Model#: AX2ORT 1 B System Serial#: 125086 <br /> Report Year: 2025 Date of Service Performed: 9/22/2025 <br /> Email Address: michael_murphy58@msn.com <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> x❑ ❑ Was maintenance performed as required by septic system rules and the manufacturer? <br /> ❑ ❑ 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 /> ❑ ® 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 echify-that-*is-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 it: M 587 *Certification Expiration: 3/28/2026 <br /> (*This line only .n be fille• , t and photoc.'ed.) <br /> Original Sign-ture: —••#116L.AikIilk _ — Date: 12/31/2025 <br /> I.- <br /> Note: Maintenance providers m.' tam accurate records • their maintenance contracts,customers, <br /> performance data,and timeline • enewing the contracts. Th;-e records must be available for inspection upon <br /> request by the agency per OAR 340-0 I 0 24). <br /> JFu Rnnua operation and Maintenance Report Fonn Rev !$.. <br />