139 Wall StLOCATION lV(nZ) L"L2f/' OWNER %I, 'P 0-SGK.3'z
ADDRESS OCCUPANT
PRIVY:
SEPTIC TANK:
FHA CASE NUMBER
Type
Material
wood concrete
Number
Dimensions
VA CASE NUMBER
New
Volume
Q
date
�'
Type secondary
Repaired
treatment
date
nitrification line
filter trench
WATER SUPPLY:
No. of bedrooms
Source 4C1-4QV
Permit Number
Date
If well, type �,
Approved
Date
(Bored)
Approved by
(Drilled)
Contractor or Plumber
ol�l L
-
(Dug)
r
Address
Distance from nearest
Remarks
pollution ft.
SEWAGE DISPOSAL RECORD
Form No. 473 (Rev. 9/58)