Laserfiche WebLink
-erg State of Oregon Department of Environmental Quality /" /O ? 7 <br /> Annual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> Property Owner: GERMAN KRASKOV Phone: 503-932-1182 <br /> Site Address: 13495 WOODBURN-MONITOR RD Parcel#: 051 W27A00600 <br /> city: WOODBURN county: Marion <br /> Permit#: 11-03132 UNKNOWN <br /> Start up date if 1st year in use: <br /> System Model#. AX2ON System serial#: 123430 <br /> Report Year: 2025 Date of Service Performed: 6/5/2025 <br /> Email Address: garykraskov@gmail.com <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> 0 Was maintenance performed as required by septic system rules and the manufacturer? <br /> Q ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> El ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ ❑� Is the system failing? <br /> ❑ Q Discharge of sewage to the ground surface? <br /> ❑ lj 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 riot,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 /> M 87 3/28/2026 <br /> "Certification#: i4catio n Expiration: <br /> ('This line only w filled ut apd-plJgtocopietl.) <br /> _Qdginal-Signafu : Date: 12/31/2025 <br /> Note: Maintenance providers m t aintain accurate ecords of their maintenance contracts,customers, <br /> performance data,and time a for r ewing the cont s. These records must be available for inspection upon <br /> request by the agency per OAR 340-07 - 0 24). <br /> DEGAncLaOpenTioramPianterianceRepormirn Rev 62022 <br />