P111864 Greenwood LakesLOCATION p '—tJ7'f'N/11.CI pWNEResy ! �c RCC.C( S d h •/
s
PRIVY: SEPTIC TANK:.yL FHA CASE NUMBER
Type Material aSl ?)jC'r
Mood concrete
Number
New
Repaired
WATER SUPPLY:
Source V1(2
If well, type
1 fi (Bored)
(Drilled)
(Dug)
` Dimensions
date
date
Volume 9D C->
Type secondary P,e
treatment
nitrification line
No. of bedrooms 67
Permit Number _
Approved
Approved by
Contractor or Plumber
Address
arvQ
VA CASE NUMBER
filter trench
Date
Date1/
Distance from nearest Remarks h eQ U 41��l D
pollution ft. 11eq 1r` /n e pS � eh DY -
T n a ori (
Form No. 473 (Rev. 9/58)