P4274 Wood ValleyLOCATION O kfO C — OWNER
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Material �To A F
wood concrete
Number Dimensions _ ���! 1 S VA CASE NUMBER
New Volume
date
Repaired Type secondary
date treatment
WATER SUPPLY:
Source
If well, type
(Bored)
(Drilled)
(Dug)
Distance from nearest
pollution ft.
nitrification line
filter trench
No. of bedrooms
Permit Number Date
Approved Date'�—a-7
Approved by
Contractor or Plumb r
Address
Remarks
SEWAGE DISPOSAL RECORD
Form No. 473 (Rev. 9/58)