118-124 Calahaln Rd (2)LOCATION Call( -JA in Rt a'
ADDRESS RT l - Moc.k�v'.
,� tA ) OWNER �'o�.�. �ncQGc5or.-
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
C�jeclt��
Source
Permit Number
Date
If well, type
Approved
Date
(Bored)
Approved by
(Drilled)
Contractor or Plumber
(Dug)
Address
Distance from nearest
Remarks
pollution ft.
SEWAGE DISPOSAL RECORD
Form No. 473 (Rev. 9/58)