P32974 Burton RdLOCATION OWNER -1-3r,6«nl
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Material
wood concrete
Number
New
Repaired
WATER SUPPLY:
Source 10 y IP
If well, type
(Bored)
L/ (Drilled)
(Dug)
Distance from nearest
pollution XC ft.
Dimensions
Volume
date
Type secondary
date treatment
No. of bedrooms
VA CASE NUMBER.
/ Of 1 -4;ani 3 ",Y /,' STaN e -
nitrification line filter trench
Permit Number Date
Approved Date_ 9.7f�
Approved by
Contractor or Plumbe
Address
Remarks
SEWAGE DISPOSAL RECORD
Form No. 473 (Rev. 9/68)