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CONVENTIONAL IN -GROUND POWTS DESIGN <br />WITH DOSE CHAMBER <br />Residential Application <br />f Index and Title tPage <br />Owner's Name: <br />Owner's Address: <br />Site Address: C 6 <br />Legal Description: p c ;, L; _z %/e1 /cam <br />Town: <br />County: BURNETT <br />St b&Vision/CSM: -7 /:5— Lot No. Block No. -- <br />PIN: D 7 C9 9 2 yv /�/ / / 5- C,Y od,z 0/yooG <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 />-S---•/7 /,-5" <br />Credential No.227691 <br />