Laserfiche WebLink
MARION COUNTY PUBLIC WORKS <br /> •,,,g1Cf,1/4,1; BUILDING INSPECTION DIVISION <br /> 555 Court St NE/PO Box 14500 <br /> 11Mg Salem OR 97309-5036 <br /> (503)58 8-5147 FAX(503)588-7948 <br /> lattp://publieworks.o.mariamor.us/liuildin.g/ <br /> .• <br /> SEPTIC TANK ABANDONMENT FORM <br /> THE SEPTIC TANK AT: 9'179 ilur <br /> 6 tkoic Lit 'ts,s‹,, <br /> ACTIVITY NUMBER: <br /> : •WAS PUMPED BY: xleg, <br /> DEQ License# 3 0/. <br /> . DATE TANK PUMPED: 7-c79-4- • <br /> • <br /> ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> • <br /> .A <br /> THE TANK.WAS: <br /> • <br /> [) REMOVED • <br /> • <br /> W" FILLED <br /> (NOTE:The bottom of the tank should be perforated or cracked to prohibit the <br /> •I• • • accumulation of surface w•ater in the tank) <br /> FILL MATERIAL: <br /> • <br /> 4. REJECT SAND <br /> (3 BAR RUN GRAVEL <br /> r.‘ <br /> CRUSHED ROCK' <br /> COMPANY NAM:E: <br /> • . <br /> ' " - SIONED: 4„,16:at/c DATE: 9.—•(4P--,,&? <br /> , MC SO2. <br /> try 6103 <br /> •:' ' <br />