Laserfiche WebLink
RPCIEHE ":7') <br /> SEP 07 2021 <br /> MARION COUNTY <br /> l--� http://publicworks.co.marion.or.us/build 'B-DING INSPECTION <br /> SEPTIC TANK ABANDONMENT FORM <br /> THE SEPTIC TANK AT: I i 3 8 e Uri./I&„ RI <br /> ACTIVITY NUMBER: ri-5- Z I - 00-),61 - P P/i T <br /> WAS PUMPED BY: (r,P C.f S4Q +`C_ <br /> DEQ License# ii407/ <br /> DATE TANK PUMPED: 5 l Z/7-/ <br /> ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> THE TANK WAS: <br /> [] REMOVED <br /> [A, FILLED <br /> (NOTE: The bottom of the tank should be perforated or cracked to prohibit the <br /> accumulation of surface water in the tank) <br /> FILL MATERIAL: <br /> [] REJECT SAND <br /> [] BAR RUN GRAVEL <br /> 14 CRUSHED ROCK <br /> COMPANY NAME: ea I a UG <br /> SIGNED: 1? .ed DATE: 9 l-) /z <br />