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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: <br /> Owner's Address: o� 6 / f fy� �, ;� L Q <br /> Site Address: 2 21 b U <br /> Legal Description: L{ Gc� <br /> Town: <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. — Block No. — <br /> PIN: o7 D -15' a5� oey o;23ooc7 <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: 4V411" "v <br /> 5 <br /> Date: 7w ` <br />