HomeMy WebLinkAboutSEP2018-00137 - DECOMISSIONED.j.
:
I
Pu tc
,)i I i,,,,,,,,
('<tuttLl
Heolth
615 Sheridon Street
Port Townsend, W,A 98368
www.Jeff ersonCountyPublicH eolth "org
CERTIFICATION OF TANK DECOMMISSION ING
parcel number 9618049'18
Address 40 West Swaney ST, Port Hadlock, WA 98339-9630
Property Owner Samuel Bain
Septic Permit # (if applicable sEP18-00137
lndividual/Company Certifying Abandonment
Jake Johnson
phone Number (360)379-9709
I certify that all sewage was removed from the septic tank and/or pump chamber
on the above referenced site by a Jefferson County Certified Septic Tank
Pumper, the lid was crushed and the tank filled with soil or gravel.
I certify that the septic tank and/or pump chamber on the above referenced site
has been decommissioned to Washington State and Jefferson County Public
Health Requirements.
1 May 2019
Print Name Johnson
Pump receipt r11r.6u6 No-Goodman Sanitation
RECE.IV ED
MAY 0 2 2019
JEFFERSON COUNTY
ENVIRONMENTAL PUBLIC HEALTH
Commr.rnity Heclth
Developmentoi Disobilities
360-385"?400
Snvironmentol Heolth
Woter Quolity
360"385-9444
360-38s-940i (i) Alwcys working for o soler snd heolthier community {t) 36a47e-4487
HIWEB\EH-WQ\SEPTIC\App li cations-Forms\c ert_tank_abandon. doc