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SEP'~IC TANK ABA_NDONI4ENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />county <br /> <br />wAS PUMPED BY: <br /> <br />(licensed D.E.Q. pumper) <br /> <br />DATE TANK PUMPED: <br /> <br />THE TANK WAS: <br /> [ ] R~OV~D <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 GRAVEL <br /> [ ] CRUSHED ROCK <br /> [ ] OTHER: <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />SIGNED: ~ ~~ <br /> <br />SITE #: <br /> <br /> <br />