Laserfiche WebLink
• MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> �-��%��"` 555 Court St NE/PO Box 14500 <br /> Salem OR 97309-5036 <br />, (503)588-5147 FAX(503)588-7948 <br /> http://publicworks.co.marion.or.us/building/ <br /> SEPTIC <br /> TANK ABANDONMENT FORM <br /> THE SEPTIC TANK AT: "—°1—T-A M A <br /> ACTIVITY NUMBER: <br /> WAS PUMPED BY: ONa <br /> DEQ License# <br /> DATE TANK PUMPED: 3-1Qr P <br /> ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> THE TANK WAS: <br /> [] REMOVED <br /> k]" FILLED <br /> • (NOTE: The bottom of the tank should be perforated or cracked to prohibit the <br /> accumulation of surface waterin the tank) <br /> FILL MATERIAL: <br /> [] REJECT SAND <br /> [] BAR RUN GRAVEL <br /> t°' CRUSHED ROCK <br /> COMP• • I : ,\ C(AfOCC\W\ . <br /> SIa\ D: 1 a'Ott DATE: 1D" l <br /> MC S-02 <br /> rev:6/03 <br />