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Marion County <br /> <br />OREGON <br /> <br />SEPTIC TANK ABANDONMENT <br /> <br />THE SEPTIC TANK AT: ~ ~ <br /> <br />ACTIVITY NUMBER: <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />(licensed D.E.Q. p~mper) <br /> <br />THE TANK WAS:. <br /> [ ] REMOVED <br /> <br />I~ILLED <br />(note: the bottom of thc tank should be perforated or cracked to <br />prOhibit'th¢ a~unulatiOn of surfi~ water in the, tank) <br /> <br />FILL MATERIAL: <br /> [ ] RFJECT Snt~ <br /> [ ] BAR RUN GRAVEL <br /> CRUSH]ED CK <br /> [ ] OTHER:~ <br /> <br />ENCLOSE A COPY OF THE PUMPING RECENT WITH THIS FORM. <br /> <br />COMPANY NAME::~ <br /> <br />BATE:~ <br /> <br />Marion County Building lmpec6on <br />3150 Lancaster Dr. NE, Suite C <br />Salem. Omgort 97305-1398 <br /> Phone: 588-5147 <br /> <br />abandon.ink 4/97 <br />MC-tS-S2 <br /> <br /> <br />