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CONVENTIONAL IN -GROUND POWTS DESIGN <br />WITH DOSE CHAMBER <br />Residential Application <br />Index and <br />/Title Page <br />Owner's Name: <br />Owner's Address: o? �� o �e ��y t� Aa/ <br />Site Address: <br />Legal Description: Vic_ S'c- � c-� -j % � % /0 X <br />r <br />Town: <br />County: BURNETT <br />Subdivision/CSM: Lot No. — Block No. <br />PIN: c% 036 02 VO /7 i7 dZ_ / ::5 00 d1- 000 <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 />715-3,,49� -7286 <br />e/vl— <br />Credential No.227691 <br />