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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 <br /> Owner's Address: T,�', 719 A-V e <br /> —y,1V3cn <br /> Site Address: S/f/1'l -e <br /> Legal Description: -.5 7 v —rVe'/i J� /Z, 4 C11 <br /> Town: Q AK`i4 cy <br /> County: BURNETT <br /> Subdivision/C'9M: 111114 e c rllf ll u) L k &L_ , / Lot No./_Block No. / <br /> PIN: n 7 o2 D 07 92D /6 Pes 5 i 5 ry j n cx�e7o <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"4/9-7286 <br /> Signature: 14 aelell <br /> Date: -Z�—,R3 ~-/3 <br />