1525 Ridge Rd (2)LOCATION OWNER rr 1`N� me
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Material
wood concrete
Number Dimensions VA CASE NUMBER
New Volume
date
Type secondary
Repaired treatment
ae«e
WATER SUPPLY:
Source
If well, type
(Bored)
(Drilled)
(Dug)
Distance from nearest
pollution ft.
Form No. 473 (Rev. 9/58)
nitrification line filter trench
No. of bedrooms
Permit Number Date
Approved n Date iia,! 77/,�G
Approved by
Contractor or Plumber-
Address
lumber-Address
Remarks
SEWAGE DISPOSAL RECORD