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Marion County <br /> OR~GON <br />COMMUNITY OEVELOPMENT <br />DEPARTMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />SEPTIC TANK ABANDONMENT <br /> <br /> ~e~-~o,q-. 0/~. <br /> <br /> RECEIVED <br /> APR 1 Y 2gO0 ~ <br /> MAfllO~ COUNTy <br />BUILDING INSPECTION <br /> <br />ACTIVITY NUMBER: <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <br /> <br />(licensed D.E,Q. pumper) <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 /> [0/ BAR RUN GRAVEL <br /> [ ] CRUSHED ROCK <br /> [ ] OTHER: <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIFr WITH THIS FORM. <br /> <br />\ <br /> <br />DATE: <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.mk 4/97 <br />MC-15-S2 <br /> <br /> <br />