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Marion County <br /> OREGON <br />EOMMUNITYD£V~LOPM~NT <br /> <br />SEPTIC TANK ABANDONMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTMTY NUMBER: <br /> <br />WAS PUMPED BY: <br /> ;; <br /> <br />DATE TANK PUMPED: <br /> <br />(liCensed D.E.Q~. pufiper) - <br /> <br />.jr <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <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~OCK <br /> ~ OTHER: ~..~.~ <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />COMPANY NAME: <br /> <br />abandon.m.k 4/97 <br />MC-15-S2 <br /> <br />Marion County Building Inspection <br />3150 Lancaster Dr. NE, Suite C <br />Salem, Oregon 97305-1398 <br /> Phone: 588-5147 <br /> <br />£1L E' <br /> <br /> <br />