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THE SEPTIC TANK AT: <br /> <br />ACTIVITY NUMBER: <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />THE TANK WAS: <br /> [ ] P~MOVED <br /> <br />FILLED <br />(note: thc bottom of the tank should be perforated or cracked to <br />prohibit the aceuraulation of surface water in the tank) <br /> <br />RErscr SAND <br />BAR RUN GRAVEL <br />CRUSHED ROCK <br />OTHER: ......... <br /> <br />ENCLOSE A COPY OF THE PLrMPrNG KECEiPT WITH THIS FORM. <br /> <br />COMPANY NAME: <br /> <br />Marion County Build~ng Inspeetio~l <br /> <br /> Salem, Oregoa 97301-3q'/0 <br /> Phone: <br /> <br />abandon.mk 5/96 <br />MC- 15.q2 <br /> <br /> <br />