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CONVENTIONAL IN -GROUND POWTS DESIGN <br />Residential Application <br />Index and Title Page <br />Owner's Name: ,� ° f} /�'J ,¢XW f ` <br />Owner's Address: <br />Site Address: 7a -7 5 X17, �r �� j <br />Legal Description: <br />Town: <br />County: <br />Subdivision/CSM: Lot No. Block No. <br />IV i I� a4 .r i •. ,.- r r <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 513, SIREN, WI 54872 <br />Signature: <br />Date: <br />"-cell <br />h — / Phone No.715-349-7286 <br />Designed Pursuant to the: <br />In -ground Soil Absorption Manual for POWTS Version 2.0 SBD- 10705-P (N.01/01), and <br />SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (0 1/8 1) <br />