1781 Hwy 801S (2)LOCATION OWNER 14
ADDRESS %-�"���`� OCCUPANT,
/ c L
PRIVY:
SEPTIC TANK:
FHA CASE NUMBER
Type
Material
wood concrete
Number
Dimensions
VA CASE NUMBER
New
Volume%
date
Type secondary
Repaired
treatment
date
nitrification line
filter trench
WATER SUPPLY:
No. of bedrooms
Source
Permit Number
Date
If well, type
Approved
Date
(Bored)
Approved by
(Drilled)
Contractor or Plumber
.Lt,
(Dug)
Address
Distance from nearest
Remarks
pollution ft.
SEWAGE DISPOSAL RECORD
Form No. 473 (Rev. 9/58)