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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: <br />v1 Ink, <br />Site Address: cZq Y7� 11,191 <br />Legal Description: S % y -r <br />Town: Tack S c ti <br />County: BURNETT <br />Subdivision/C-W- e— CO/,, J Aa V V Lot No. 02^ Block No. <br />PIN: Q 7 �/� ` 6 i� /y 5 / � 65� G3aao0 <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 />Credential No.227691 <br />