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25 - oo21-7Z- INQ'1 <br /> ..r/ -r-L State of Oregon Department of Environmental Quality <br /> SAAnnual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> FEDERICO ROCHA 503-509-7636 <br /> Property Owner: Phone: <br /> 7930 MARION RD. 082W28CD00500 <br /> Site Address: Parcel#: <br /> City: TURNER county: Marion <br /> Permit#: 555-20-002932-PRMT Start up date if 1 st year in use: 1/15/2021 <br /> System Model itAX2ORT System Serial it. 143243 <br /> Report Year: 2025 Date of Service Performed: 10/15/2025 <br /> Email Address: RTFORESTRY@GMAIL.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 /> I] El Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ II Is the system failing? <br /> ❑ Q Discharge of sewage to the ground surface? <br /> ❑ III 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 ft: M 587 'Certification Expiration: 3/28/2026 <br /> ('This line only can filleaout and photoc <br /> 12/31/2025 <br /> Original Signatur : Date: <br /> Note: Maintenance providers%aintain ac• rate recap We contracts,customers, <br /> performance data, and timelines • renewing t - contracts. hese records must be available for inspection upon <br /> request by the agency per OAR 340-071-0130(2, . <br />