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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> Residential Application <br /> Index and Title Page <br /> Owner's Name:' <br /> Owner's Address: <br /> Site Address: <br /> Legal Description: <br /> Town: <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. _ Block No. <br /> PIN: ;,2 r�/7� a3 S 6� 002 C>,_27,06e) <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 /> Signature: c — <br /> Dater <br /> Designed Pursuant to the: <br /> In-ground Soil Absorption Manual for POWTS Version 2.0 SBD-10705-P(N.01/01) <br />