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11-h,tmb(a5lo-S <br /> State of Oregon <br /> Department of Environmental Quality <br /> Water Quality Division <br /> DEQ Onsite Program <br /> Annual Operation and Maintenance Report Form <br /> Envhandel <br /> Quay <br /> General Information <br /> Property Owner: Wylee Condo Association Phone#: 503-318-3351 <br /> Site Address: 23055 NE Airport Road City: Aurora <br /> County: Marion Permit#: 04-10056 Startup Date: 08/01/2005 <br /> System Model#: AX 20 B1 System Serial#: RTU 108036 <br /> Service Report Year: 2025 <br /> Onsite wastewater treatment system status: <br /> Yes No <br /> 74 El Was maintenance performed as required by septic system rules(OAR 340-071)and <br /> the manufacturer? <br /> (g] 0 Is the system operating in accordance with the agent-approved design specifications? <br /> '(jprr 0 Is the system currently under a service contract with a certified maintenance provider? <br /> Is the system failing? <br /> Yes No <br /> O Discharge of sewage to the ground surface <br /> n Discharge of sewage to drain tiles or surface waters <br /> O DO Sewage backup into plumbing fixtures <br /> O 0 If yes,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 <br /> this report is grounds for revocation of my certification and/or civil penalties. <br /> Maintenance Provider Name(please print): Dustin Kenton <br /> Certification#: RM 54 Certification Expiration Date: 07/21. 2027 <br /> Signature G 7 Date: 01/14/2026 <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 agent per OAR 340-071-0130(24). <br />