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073- x//9 /A/&/ <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: WILSON PROPERTY INVESTMENTS, LLC Phone: 503-859-2134 <br /> Site Address: 22626 JENNIE RD Parcel#: 092E18DB100100 <br /> city: LYONS county: Marion <br /> Permit#: Start Start up date if 1st year in use: NA <br /> PRESSURE DISTRIBUTION NA <br /> System Model#. System Serial#. <br /> Report Year: 2025 Date of Service Performed: 3/4/2025 <br /> Email Address: WILSONOPS@WVI.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 /> x❑ ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> ❑ 0 Is the system currently under a service contract with a certified maintenance provider? <br /> El ❑1 Is the system failing? <br /> ❑ I Discharge of sewage to the ground surface? <br /> ❑ MI 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 dIfy-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 •- lled'q it and photocopied.) <br /> Original Signatu -: Date: <br /> 12/31/2025 <br /> Note: Maintenance provid-rs m t main =in accurat= records of their maintenance contracts,customers, <br /> performance data,and tim='nes rem= ing the con racts. These records must be available for inspection upon <br /> request by the agency per OA- 40-071-1 r 24). <br />