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Community Development <br />Buildin§ inspection Division <br /> <br />Marion CoUnty <br /> <br />OREGON <br /> <br />SEPTIC TANK ABANDONMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />~,r-o''r'~'- orz. ~t-/ <br /> <br />~icenSed D.E.Q. pumper) <br /> <br /> ~--7 -9~ <br /> <br />THE TANK WAS: <br /> ~ REMOVED <br /> <br />[ ] <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 <br /> <br />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 />PERMIT #: 9~- O~7~S <br /> <br />SITE #: <br /> <br />DATE://-7--~(~ <br /> <br />(503) 588-5147 Senator Building 2nd Floor <br /> 220 High St. NE. Salem, OR 97301-3670 <br /> <br />MC15-S2 <br />REV 10-92 <br /> <br /> <br />