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State of Oregon Department of Environmental Quality 2L bba-134_-.11w. ` <br /> Annual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> Property owner: MARK & MELISSA FERRON Phone: 503-510-3204 <br /> Site Address 8325 KAY LN. SE parcel#: 081W32B001402 <br /> city: AUMSVILLE County: MARION <br /> Permit#: 04-06079 Start up date if 1st year in use: 9/23/25 <br /> System Model#: AX2ORT System Serial#: LOGO <br /> Report Year: 2025 Date of Service Performed: <br /> Email Address: MTFERRON@GMAIL.COM <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> x❑ ❑ Was maintenance performed as required by septic system rules and the manufacturer? <br /> ❑ ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> El El Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ ® Is the system failing? <br /> ❑ IN Discharge of sewage to the ground surface? <br /> ❑ 0 Discharge of sewage to drain tiles or surface waters? <br /> El III Sewage backup into plumbing fixtures? <br /> If you answered"Yes"on the last four questions,was a repair permit obtained? If not, explain: <br /> '""""" START-UP DONE AFTER 7/1/2025"""""""' <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 587 3/28/2026 <br /> "Certification#: 'Certification Expiration: <br /> ('This line only ca e filled ou tocopied.) <br /> Original Signatu • Date: 12/31/2025 <br /> Note: Maintenanc rovider must maintain accur e records of their maintenance contracts, customers, <br /> performance data, an " n r renewing the c ntracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-0/i- ). <br /> DEQ Annual operation and Maintenance Repent Fain Rea.G2022 <br />