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SEPTIC TAI~E ABA/~DONI~ENT <br /> <br />N1ARION OOUN]¥ <br />BUILDING iNSPECTiON <br /> <br />THE SEPTIC TANK AT: ~/~/~.6~- ~/z~z~ ~~ <br /> (~[icensed D.E.Q. pumper) <br /> <br />DATE TANK PUMPED: <br /> <br />THE TANK WAS: <br /> <br />[ ] FILLED <br /> <br /> FILL MATERIAL: ~ <br /> [ ] REJECT SAND <br /> [ ] BAR RUN GRAVEL <br /> [ ] CRUSHED ROCK ...... ~ ........... <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br /> <br />