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SEPTIC T~'K ~B~DOI~ENT <br /> <br />WAS PUMPED BY: ~-/~-~-~'t'7&W,~F'~,/~','~,-~' <br /> (licensed D.E.E~-0~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 />PERMIT #: ~ ~--~/~F <br /> <br />SITE #: <br /> <br /> <br />