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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> WITH DOSE CHAMBER <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name: 0 Iaits I itjo p/ k <br /> Owner's Address: 6 3 3 S !(A/A-4-F L-/J, <br /> GJ e.6s7e.�- w..r sva'13 <br /> Site Address: -5;4/s'I <br /> Legal Description: ,De./ G.L. .3 S a C T39.v�P J b GJ <br /> Town: /92-e-e, <br /> County: BURN/ETT <br /> Su uision/CSM: V p 38 9 Lot No. Block No. —PIN: r� 7 o/57 a 3 9 /6 vZ6 S 003 0/60oo <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 Dose Chamber Cross Section (with ST &filter specs) <br /> Page 5 Pump Curve and Specs <br /> Page 6 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 /> Signature: <br /> Date: Y-.23 -a y <br />