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OREGON <br /> <br /> SEPTIC TANK ABANDONMENT <br /> <br />II,E. CEI'VED <br /> <br />MARION COUNTY <br />BUILDING INSPECTION <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTIVITY NUMBER: <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />(licensed D.E.Q. pumper) <br /> <br />THE TANK~VAS: <br /> [,4~ REMOVED <br /> <br />[] <br /> <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: ,4.~t,o ~ <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br /> Mar~on County Building Inspection <br /> 3150 Lancaster Dr. NE, Suite C <br /> Salem, Oregon 97305-1398 <br /> Phone: 588-5147 <br /> <br />abandon.ink 4/97 <br />MC-15-S2 <br /> <br /> <br />