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Marion Coun_ty <br /> <br /> OREGON <br />COMMUNffYDE¥[LOPM~NT <br /> <br />SEPTIC TANK ABANDONMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTMTY NUMBER: <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <br /> <br />(licens& D.E.Q~. pumper) - <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 />RFJEcr SAND <br />BAR RUN GRAVEL <br />cr us mD ocac <br />OTHER: <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT VvTrH THiS FORM. <br /> <br />COMPANY NAME: <br /> <br />SIGNED: za, t <br /> <br />DATE: <br /> <br />Marion County Building Inspection <br />3150 Lancaster Dr. NE, Suite C <br />Salem. Oregon 97305- 1398 <br /> Phone: 58g-5147 <br /> <br />abandan.tak 4/97 <br />MC- 15 -S2 <br /> <br /> <br />