Laserfiche WebLink
I1—00093g- INQ <br /> -erg_ 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: BRETT ROBERSON Phone: 503-932-8233 <br /> Site Address: 8088 VALLEY WAY SE Parcel#: 083W36A 00100 <br /> City: TURNER County: Marion <br /> Permit#: 55-14-005719-SEP Start up date if 1st year in use: 5/9/16 <br /> System Model#: AX2ORT System Serial#: 131990 <br /> Report Year: 2025 Date of Service Performed: 10/13/2025 <br /> Email Address: brett@robersonmotors.com <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> O ❑ 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 /> E ❑ 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 /> ❑ 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 only can ba'i fled out an. - otocopied. <br /> �� Agil V V Ins— 12/31/2025 <br /> Original Signaturq' Date: <br /> Note: Maintenance provide t m. ntain acc -te records of their maintenance contracts, customers, <br /> performance data, and timelines r re -wing t - contracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-071-r- 0(24). <br /> DEQ Annual Operation and Inal nellance Report Form Rev.6:2022 <br />