4853 Hwy 158LOCATION OWNER 461 Pr`s �U �
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Material
wood concrete
Number
New
Repaired
WATER SUPPLY:
Source
If well, type
(Bored)
(Drilled)
(Dug)
Distance from nearest
pollution aD T` ft.
U
Form No. 473 (Rev. 9/58)
date
date
Dimensions>
Vol ume
Type secondary
treatment 9.0eo -
nitrif c do line
No. of bedrooms 17
Permit Number
A roved
VA CASE NUMBER
filter trench
Date
Ft, Date
Approved by j,- 'PL I:L-ed .-
Contractor or Plumber'
1 umber -
Address
Remarks
SEWAGE DISPOSAL RECORD