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Marion County <br /> <br /> OREGON <br />COMMUNITY DEVELOPMENT <br />DEPARTM[NT <br /> <br />SEPTIC TANK ABANDONMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTIVITY NUMBER: <br />WAS PUMPED BY: <br /> <br />9%02000 <br /> <br />DEQ License # <br /> <br />DATE TANK PUMPED: <br /> <br />THE TANK WAS: <br /> <br />[ ] REMOVED <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 />FILL MATERIAL: <br /> [ ] REJECT SAND <br /> [ ] BAR RUN GRAVEL <br /> [ ] CRUSHED ROCK <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />COMPANYNA~'~') ~-~ /~/~& <br /> <br /> Marion County Building Inspection <br /> 3150 Lancaster Dr. NE, Suite C <br /> Salem, Oregon 97305-1398 <br /> Phone: 588-5147 <br /> <br />abandon.tnk 09/99 <br />MC-15-S2 <br /> <br /> <br />