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MARION COUNTY <br />BUILDING INSPECTION <br /> <br />SEPTIC TANK ABANDONMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTIVITY NUMBER: <br /> <br />WAS PUMPED BY: <br /> <br /> $4-4 ,q4o~J <br />(licensed D.E.Q. pumper) <br /> <br />DATE TANK PUMPED: <br /> <br />THE TANK WAS: <br /> [pL REMOVED <br /> <br />[] <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 /> <br />[] <br />[] <br />[] <br /> <br />REJECT SAND <br />BAR RUN GRAVEL <br />CRUSHED ROCK <br />OTHER: ~a~*,'~ ~ac0( <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />Marion County Building Inspection <br />3150 Lancaster Dr. NE, Suite C <br />Salem, Oregon 97305-1398 <br /> Phone: 588-5147 <br /> <br />abandon.tnk 4/97 r <br />MC-15-S2 <br /> <br /> <br />