P51766 Farmington RdLOCATION °� D' ' 6WHERT�
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PRIVY: //1) SEPTIC TANK: FHA CASE NUMBER
Type Material
Mood concrete
Number Dimensions VA CASE NUMBER
New Volume
date
Type secondary
Repaired
date treatment
WATER SUPPLY:
Source _
If well,
type
(Bored)
(Drilled)
(Dug)
Distance from nearest
pollution G °Z ft.
Form No. 473 (Rev. 9/58)
No. of bedrooms
nitrification line
filter trench
Permit Number Date t; --t 7 -6 6
Approved Date
Approved by P y�pa y4e —
Contractor or Plumber
Address
Remarks c
SEWAGE DISPOSAL RECORD