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Marion County <br /> OR£GON <br />CO~UNITY D£V[LOPI~,ENT <br />DEPARTMENT <br /> <br />NIARION COUNTY <br />BUILDING iNSPECTION <br /> <br /> SEPTIC TANK ABANDONMENT <br />THE SEPTIC TANK AT: ]_~O <br /> <br />ACTMTY NUMBER: <br /> <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />(licensed D.E.Q. pumper) <br /> <br />THE TANK WAS: <br /> [O~ REMOVED <br /> -LYf <br /> [] FILLED <br /> (note: the bottom of the tank should be perforated or cracked to <br /> prohibit the accumulation of surface water in the tank) <br /> <br />FILL 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 />COMPANY NAME: l~'e_~4'~x.~ (~e._ <br />SIGNED: ~ o~. "~ff.~ DATE: <br /> <br />Marion County Building Inspection <br />3150 Lancaster Dr. NE, Suite C <br />Salem, O~egon 97305-1398 <br /> Phone: 588-5147 <br /> <br />abandon.mk 4/97 <br />MC-15-S2 <br /> <br /> <br />