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Building Inspection Division · Communi~ Development Center <br />285 Church Street NE * Room 132 · Salem, OR 97301-3670 <br /> <br />P.02 <br /> <br />THE SEPTIC TANK AT: <br /> <br />9463 Golf Club Road <br />Aumsville~ Oregon <br /> <br />WAS PUMPED BY: <br /> <br />Stay, on/Mill City & Sllverton Septic Services <br /> (licensed D.E.Q. pumper) DEQ #34916 <br /> <br />DATE TANK PUMPED: <br /> <br />4/18/96 <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <br /> <br />[x] <br /> <br />FILLED <br />(note: the bottom of the tank should, be per- <br />forated or cracked to prohibit the accumula- <br />tion of surface water in the tank) <br /> <br />FILL MATERIAL: <br /> .[. ] REJECT SAND <br /> [ ] BAR RUN ORAVEL <br /> [~ CRUSHED ROCK <br /> [ ] OTHER: <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />PERMIT #: 96-01045 or 96-1044 <br /> <br />SITE <br /> <br />abandon.cnk 4/95 <br />MC-15-S2 <br /> <br /> <br />