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: J71 1Ordc.,1 fj <br /> cc, cr731.7 <br /> ACTIVITY NUMBER: -. 7 Oo 7 q1 77 <br /> WAS PUMPED BY: -c\r,,.,i r S re0.1,-r. <br /> DEQ License# 0/ <br /> DATE TANK PUMPED: 1 p 41 <br /> ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> THE TANK WAS: <br /> [] REMOVED <br /> ,c], 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 /> V] CRUSHED ROCK <br /> COMPANY NAME: c W A ( (/tc.c.r71•! ) <br /> SIGNED: Cr (1•t`'<),(! DATE: <br /> MC S-02 <br /> rev:6/03, 12/10 <br />