P61174 Wood ValleyLOCATION ` a Q-) -rt- OWNER
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Materiall/4� fie✓/.
wood concrete
Number Dimensions /` VA CASE NUMBER
New Volume
date
Repaired Type secondary
date treatment
nitrification line
WATER SUPPLY:
Source
If well, type
(Bo red)
(Drilled)
(Dug)
Distance from nearest
pollution ft.
i
Q,-, &,e
filter trench
No. of bedrooms
Permit Number Date
Approved Date -1/-7
Approved byat-��_,.��
Contractor or Plumber
Address
Remarks
SEWAGE DISPOSAL RECORD
Form No. 473 (Rev. 9/58)'