304 Dyson Rd (2)LOCATION ��� l3 �� -D�ISOOWNER %�� "�'r f,f urnj
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Material
Mood concrete
Number
New
date
Repaired
date
WATER SUPPLY:
Source FTD)"N
If well, type
(Bored)
(Drilled)
(Dug)
Distance from nearest
pollution ft.
Dimensions
Volume 10-2-0 04�7
Type secondary
treatment
nitrificdtion line
9
No. of bedrooms
Permit Number
Approved
Approved by
Contractor or Plumber
Address
Remarks
SEWAGE DISPOSAL RECORD
Form No. 473 (Rev. 9/58)
VA CASE NUMBER
filter trench
Date ��� `ry a
Date