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P81968 Hwy 158LOCATION ADDRESS Z3 PRIVY: Type wood Number New Repaired WATER SUPPLY: Source If well, type (Bored) 42 I/ O 6 (Drilled) (Dug) Distance from nearest pollution /Od ft.'s" OWNER ---- SEPTIC TANK: FHA CASE NUMBER ,��u' Material 4 / Dimensions D VA CASE NUMBER Volume Type secondary treatment nitrification line fl ter tre ch l l S, l✓ta-�+�- No. of bedrooms /LAJ,Si Permit Number Date Approved Date Approved by�1_ r %��hh•-2�_� %�.cr . /(, C� Contractor or Plum r Address Remarks SEWAGE DISPOSAL RECORD Form No. 473 (Rev. 9/58) .r\■ �C■■■■■//■■■■■/■�...� zonal i..af '/' ■■ s// r=900-.-- ■■■ r,. O■■ r ■ N■N _ = ■// r. O■■ to o/■ b■ on MEN ii OEM .0 mom on son no won on 1MEN ■■ no now !■■ in" MEN M■■ P"