P32874 Wood ValleyLOCATION 4 -4— �! �— OWNER
PRIVY: SEPTIC TANK: FNA CASE NUMBER
Type Material
wood concrete
Number
New
date
Repaired
date
WATER SUPPLY:
Source
If well, type
(Bored)
(Drilled)
(Dug)
Distance from nearest
poll-ution ft.
Dimensions
Volume
Type secondary
treatment
No. of bedrooms
1,3a X 2 -"X / VA CASE NUMBER
nitrification line
filter trench
Permit Number Date
Approved Date
Approved by
Contractor or Plumber
Address
Remarks
SEWAGE DISPOSAL RECORD
Fore No. 473 (Rev. 9/58)