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State of Oregon Department of Environmental Quality <br /> Annual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> Property Owner: Kathy Wymer & Steven Alley Phone: <br /> 14352 Marion Rd. SE <br /> Site Address: Parcel#: <br /> Turner Marion <br /> City: - County: <br /> Permit#: Start up date if 1st year in use: <br /> System Model#: DF50 System Serial#: 27359 <br /> Report Year: 2025 Date of Service Performed: 11/3/2025 <br /> Email Address: <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yesc� No <br /> is, ❑ Was maintenance performed as required by septic system rules and the manufacturer? <br /> ty ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> 7� ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ ® Is the system failing? <br /> ❑ ® Discharge of sewage to the ground surface? <br /> ❑ ®. Discharge of sewage to drain tiles or surface waters? <br /> ❑ Et 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 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): Austin Arts <br /> *Certification#: RM250 'Certification Expiration: 03/30/2027 <br /> (*This line only can be filled out and ph <br /> Original Signature: Date: IA/LC <br /> v <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 /> OF Annual°per:toi,and Oanlenance Repot torn.. to-,.eaoa4 <br />