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Nation County <br /> OREGON <br />COMMUNITY D~VELOPMENT <br /> <br />S~PTIC TANK ABANDONM~,NT <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTIVITY NUMBER: <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />(licensed D.E.Q. pumper) <br /> <br /> /0-1,2- q~ ., <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <br /> <br />FILLED <br />(note: the bottom of the tank should be perforated or cracked to <br />prohibit the accumulation of surface water in the tank) <br /> <br />FILL MATERiAL: <br /> [ ] REJECT SAND <br /> [ ] BAR RUN GRAVEL <br /> CRUSHED ROCK <br /> OTHER: <br /> <br />ENCLOSE A COPY OF TItE PUMPING RECEIPT WiTH THIS FORM. <br /> <br />COMPANY NAME:.. <br />SIONED:~.~~ ~ <br /> <br />DATE <br /> <br />Marion County Building Inspection <br />285 Churctt Street NE <br /> Salem, Oregon 97301-3670 <br /> Phone: 588-5147 <br /> <br />abandon.mk 5~96 <br />MC-15-S2 <br /> <br /> <br />