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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name. mke, 1nC_L-,1 q gf111, <br /> Owner's Address: V,b Rd <br /> c. l IPA <>_cvf} 9 <br /> Site Address: S'D <br /> Legal Description: per! 5 " --N'� IS9 T3/U� �C l bl 64' <br /> Town: <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. Block No. <br /> PIN: 07 0,26 og C/o> %6 09 a03 Dad o/y000 <br /> Page Index <br /> Page 1 Index and Title <br /> Page 2 Plot Plan(may include septic tank and filter specs) <br /> Page 3 Distribution Cell(s) Cross Section <br /> Page 4 Maintenance,Management and Contingency Plans <br /> Plumber Name: WADE RUFSHOLM Credential No. 227691 <br /> Plumber Address: P.O. Box 514, Siren, WI 54872 <br /> Telephone: 715-349-7286 <br /> �A r <br /> Signature: �1 J <br /> Date: a2 //7 <br /> Designed Pursuant to the: <br /> In-ground Soil Absorption Manual for POWTS Version 2.0 SBD-10705-P(N_01/01) <br /> I <br />