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f'+ State of Oregon Department of Environmental Quality 02(2 " 0/fc 1AI 0" <br /> 3t Annual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL Information) <br /> Property owner: JAMES EASTER Phone: 503-509-9284 <br /> S Address: 14281 MARION RD. Parcel#: 092W33BD01900 <br /> City: TURNER County: Marion <br /> Permit#: 555-20-008185 Startup date if 1st year in use: 2/8/21 <br /> SINGULAIR System serial#: N/A <br /> System Model#: <br /> Report Year: 2025 Date of Service Performed: 10/8/2025 <br /> Email Address: jamie53071@gmail.com <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> Q ❑ 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 /> x❑ ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ I] Is the system failing? <br /> ❑ I] Discharge of sewage to the ground surface? <br /> ❑ • 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 /> - t certify that thisreport 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 fil and photoco i .) <br /> Ornal nature: <br /> Date: 12/31/2025 <br /> Sig <br /> Note: Maintenance providers sl aint n accurate rec rds of their maintenance contracts, customers. <br /> performance data,and timelines or rens a contr s. These records must be available for inspection upon <br /> request by the agency per OAR 340-071-0130(24). <br /> DEQ Annual Operation andMaintenance Nepal Form Rev c2022 <br />