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SEPT'I'C T~I'K <br /> <br />THE SEPTIC TANK AT: <br /> <br /> (licensed D.E.Q. pumper) <br /> <br />REMOVED <br /> <br />FILLED <br />(note: the bottom Of the tank should be per- <br />forated or cracked to prohibit the accumula- <br />tion of surface water in the tank) <br /> <br />FILL <br /> <br />MATERIAL: <br />[ ] REJECT SAND <br />[ ] BAlq RUN GRAVEL <br />[%-~ CRUSHEDROCK <br />[ ] OTHER: <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br />SITE ~: <br /> <br /> <br />