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SEPTIC TANK AB~NDONMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />(liCensed D.E.Q. pumper) <br /> <br />THE TAN~ 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 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 <br /> <br />SITE #: <br /> <br />FILE' <br /> <br /> <br />