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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: o(.��� f7Art517o/-/) <br /> Owner's Address: /2 3s S✓'e/`SoU AV e- 4) <br /> LAKe ZVA) 5'SoaS� <br /> Site Address: 2_ar L od 4,2 Gt <br /> Legal Description: Jr/3 T�D A) !5 <br /> Town: C, o� <br /> County: BURNETT <br /> Subdivision/C-�&M: be e r 1 odd e A0 Lot No._4_0_Block No. — <br /> PIN: 0 7 oia 4Z VP Z S 13 s /s <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: 715-3''49//-7286 <br /> Signature: 44-�� <br /> Date: 1 —� oZ 3 <br />