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Community Development <br />Bu, ildin8 Inspection Division <br />Marion County <br /> <br />OREGON <br /> <br />~ AUG 12 1996 <br /> MARION COUNTY <br /> BUILDING INSPECTION <br /> <br />SEPTIC TANK ABKNDONMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />WAS PUMPED BY: ~ ~ <br /> (licensed D.E.Q. pumper) <br /> <br />THE TANK WAS: <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 />[ ] BAR RUN GRAVEL <br />~ CRUSHED ROCK <br />[ ] OTHER: <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />SIGNED: <br /> <br />PERMIT #: <br /> <br />SITE #: <br /> <br />DATE: <br /> <br />(503) 588-5147 Senator Building 2nd Floor <br /> 220 High St. NE. Salem, OR 97301-3670 <br /> <br />MC15-S2 <br /> <br /> <br />