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MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> - Salem OR 97305 <br /> (503) 588-5147 FAX(503) 588-7948 <br /> http://publicworks.co.marion.or.us/building/ <br /> SEPTIC TANK ABANDONMENT FORM <br /> THE SEPTIC TANK AT: 5791 Sunnyview Rd SE <br /> Salem, Oregon, 97305 <br /> ACTIVITY NUMBER: 555-24-002398-PRMT <br /> WAS PUMPED BY: Not pumped, not necesarry(metal tank with rusted holes,well drained) <br /> DEQ License# 38988 <br /> DATE TANK PUMPED: N/A <br /> ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> THE TANK WAS: <br /> [)4] REMOVED -Tank hauled to Burcham's Metals Inc, <br /> 3407 Pacific Blvd. SW,Albany, Oregon, 97321 <br /> [] FILLED <br /> (NOTE: The bottom of the tank should be perforated or cracked to prohibit the <br /> accumulation of surface water in the tank) <br /> FILL MATERIAL: <br /> [ ] REJECT SAND <br /> [] BAR RUN GRAVEL <br /> [>] CRUSHED ROCK <br /> COMPANY NAME: New Creation Contracting <br /> SIGNED: DATE: 8/2/24 <br /> MC S-02 <br /> rev:6/03,12/10 <br />