Laserfiche WebLink
• <br /> • <br /> 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: 16177 Si-al-tom <br /> v E <br /> ACTIVITY NUMBER: 2 3, oO 1/7 6 I <br /> WAS PUMPED BY: FireA4 S 5 EP P C <br /> DEQ License# 317 ° 7 <br /> DATE TANK PUMPED: <br /> ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> THE TANK WAS: <br /> [] REMOVED <br /> V 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 /> [c]' CRUSHED ROCK <br /> COMPANY NAME- C /d 1Drg <br /> SIGNED: DATE: Q g 2'7/4 3 <br /> MC S-02 <br /> rev:6/03,12/10 <br />