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-erg. State of Oregon Department of Environmental Quality <br /> Annual Operation and Maintenance <br /> ra <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> MICHAEL MURPHY 503-559-4608 <br /> Property Owner: Phone: <br /> Site Address: 19141 RIVER RD. NE Parcel#: 042W300000700 <br /> ST. PAUL Marion <br /> City: County: <br /> 11-05808 NA <br /> Permit#: Start up date if 1st year in use: <br /> System Model#: AX2ON 1 B System Serial#: 123848 <br /> Report Year: 2025 Date of Service Performed: 2/26/2025 <br /> Email Address: michael_murphy58@msn.com <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> Lj- ❑- 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 /> ❑ ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ ® Is the system failing? <br /> ❑ it Discharge of sewage to the ground surface? <br /> ❑ It Discharge of sewage to drain tiles or surface waters? <br /> ❑ IN 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 only can be ed 3. t\and photon• — „_ <br /> c-'/ — —. 12/31/2025 <br /> Original Signature: ALA��/S Era Date: <br /> MP" vir <br /> Note: Maintenance provider aintain a : rate records of th-'r maintenance contracts,customers, <br /> performance data, and timelin- ill- renewing the c• nets. These records must be available for inspection upon <br /> request by the agency per OAR 340-071-0130(24). <br /> DEG Annual Oneraiiur and M h.ntena lice k epor: r orm Rev.6'2o22 <br />