P61566 Ridge RdLOCATION Al c, IOWNER µ I�
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Material
Food concrete
Number
New
Repaired
WATER SUPPLY:
" 'k 7
Source
if well, type
(Bored)
(Drilled)
(Dug)
Distance from nearest
pollution =a ft.
Form No. 473 (Rev. 9/58)
Dimensions /
Vo I ume
date
Type secondary _
date treatment O _
nitrificatl n 1 ne
No. of bedrooms
VA CASE NUMBER
filter trench
Permit Number Icy Date (—/S^'�
Approved Date
Approved by
Contractor or Plumber �✓
Address
Remarks
SEWAGE DISPOSAL RECORD