1031 Milling RdPASTICTUBING, I NC.
Manufacturers of Corrugated Plastic Drainage Tile
PHONE AREA CODE 919-525-5121
ROSEBORO, NORTH CAROLINA
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QUALITY and SERVICE
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PRIVY:
SEPTIC TANK:
FHA CASE
NUMBER
Type
Material
Wood concrete
Number
Dimensions
VA CASE NUMBER
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Volume
date
Repaired
Type secondary
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date
treatment
nitrification
line filter trench j t' -
WATER SUPPLY:
No. of bedrooms
Source
Permit Number
Date
If well, type
Approved
Date
(Bored)
Approved by
(Drilled)
Contractor Or Plumber
(Dug)
Address
Distance from nearest
Remarks
11
pol-l-ution Df ft.
SEWAGE DISPOSAL RECORD
Form No. 473 (Rev. 9/68)