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SEPTIC TANK ABANDONMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTMTY NUMBER: <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />TFIE TANK WAS: <br /> [ ] REMOVED <br /> <br />FILLED <br />(note: the bottom of the mnkjhould b~ perforated or Cracked to <br />prohibit the accumulation of surface water in the tank) <br /> <br />REIECT SAND <br />BAR RUN GRAVEL <br />CRUSIIED ROCK <br />ovm R: ,qOon J <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br />COMPANY NAME: V~l~'q~ <br /> <br /> Marion County Building inspection <br /> 3150 Lancaster Dr. lqE, Suite C <br /> Salem, Oregon 97305-1398 <br /> Plmne: 5854147 <br /> <br />,,ho/q? <br /> <br />abandon.ink 4~97 <br />MC-15-S2 <br /> <br /> <br />