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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: &kac,)5kif 7_Pw1 -I- <br /> � <br /> Owner's Address: / 1�.2o C l-,e_ef' da-2 4ss <br /> r <br /> uN e -�o N kg W,(), <br /> Site Address: 3 4`o 3 Locw LAAk w. kol <br /> Legal Description: pc.( G, <br /> Town: k S 0'e <br /> County: BURNETT <br /> Subdivision/CSM: Lot No. — Block No. <br /> PIN: 07 D/2 az yo /5`0/ s oS ooz D/ya©o <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 /> Plumber Name: WADE RUFSHOLM Credential No.227691 <br /> Plumber Address: P.O. BOX 514, SIREN,WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: <br /> Date: / 'v? <br />