Laserfiche WebLink
MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)588-5147 FAX(503)588-7948 <br /> http://publicworks.co.marion.or.us/building/ <br /> SEPTIC TANK ABANDONMENT FORM <br /> THE SEPTIC TANK AT: 0,. tr- <br /> c lew► , Q i2 1-1 3Gc- <br /> ACTIVITY NUMBER: 5 S - 3 -- Cat S 6 1 -1 <br /> WAS PUMPED BY: ZL-t" <br /> DEQ License# gl.4 <br /> DATE TANK PUMPED: -02,44-- a3 <br /> ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> THE TANK WAS: <br /> [] REMOVED <br /> 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 /> 13 REJECT ND D ri— <br /> [] BAR RUN GRAVEL <br /> [] CRUSHED ROCK <br /> COMPANY NAME: vvi uC. <br /> SIGNED: • <br /> DATE: <br /> MC S-02 <br /> rev:6/03,12/10 <br />