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Marion County <br /> <br />OREGON <br /> <br />EPTI K B D T <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTIVITY NUMBER: <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />(licemed D.E.Q. pumper) <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <br /> [~FILLED <br /> (note: the bottom of the tank should~be perforated or cracked to <br /> pf015i§it the a~cumulation Of surface water in the tank) <br /> <br />FILL MATERIAL: <br /> [ ] REJECT SAND <br /> [ ] BAR RUN GRAVEL <br /> [ ] CRUSHED ROCK <br /> Ia.]-/ OTHER:~ <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />COMPANY NAME: ~.~ <br />SIGNED ~__~~ DATE:J~'//'- q'~ <br /> <br />abandon.mk 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 /> <br />