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Owner's Name <br />CONVENTIONAL IN -GROUND POWTS DESIGN <br />WITH DOSE CHAMBER <br />Residential Application <br />Index and Title Page <br />_)_A c3 q 1.�J 7r/— 4 - t <br />Owner's Address:5 D� Q �G� ril� i l Aef <br />r!`�wq-1o.v -7:z-, <br />Site Address: <br />Legal Description: G <br />Town: s L O <br />County: BU1 RNETT <br />Sa }pn/CSM: V // P .2 s- / Lot No. 42 Block No.-- <br />PIN: O7 oaf %Z civ <br />Plumber Name: <br />Plumber Address: <br />Telephone: <br />Signature: <br />Date: <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 />WADE RUFSHOLM <br />P.O. BOX 514, SIREN, WI 54872 <br />715-349-7286 <br />F4F=_W_4W <br />Credential No.227691 <br />