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11- Dbb '152- I1�� <br /> State of Oregon Department of Environmental Quality <br /> Annual Operation and Maintenance <br /> DEG Report Form <br /> General Information (Complete ALL information) <br /> GARY BRAUCHT 503-949-6595 <br /> Property Owner: Phone, <br /> Site Address: 13469 MORROW LANE SE Parcel#: 092W29A 02800 <br /> City: TURNER county: Marion <br /> Permit#: 555-11-00229 Start up date if 1st year in use: NA <br /> System Model#: AX2ON System Serial# 110207 <br /> Report Year: 2025 Date of Service Performed: 12/31/2025 <br /> Email Address: GRTGARLU@OUTLOOK.COM <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> P] - 0 -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 /> ❑ i] Is the system failing? <br /> ❑ Q Discharge of sewage to the ground surface? <br /> ❑ © 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 certi)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 filled out and photocopied.) <br /> Original Signature: � ' Date: 12/31/2025 <br /> Note: Maintenance providers must maintain accurate records of their maintenance contracts, customers, <br /> performance data, and timelines for renewing the contracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-071-0130(24). <br /> DE()p.inuaL(Veral..Dri art a t canm n trot..,, Rev =R022 <br />