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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> WITH DOSE CHAMBER <br /> Residential Application <br /> Index and Title Page <br /> t <br /> Owner's Name: E ri t: L N cl y <br /> Owner's Address: y/-57 ?m'k i.JDod L)(ii <br /> 5.4(4 C/A jre GJ.Z" 6-5/7o 3 <br /> Site Address: 6 7 S/ hike. LA.ke A ( <br /> Legal Description: �' G,L, 14-3 S as T 3 9n1 R l4(..J <br /> Town: /n e e i0 o it) <br /> County: BURNETT <br /> Subdivision/CSM: Yf P /6 Lot No. y Block No. — <br /> PIN: O7 0/g a 39/1 as S as o03 0/5-bee) <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 Signature: ie,r./c/Date: 7''//`-•2 X <br />