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CONVENTIONAL IN-GROUND POWTS DESIGN <br /> WIT' DOSE CHAMBER <br /> esidential Application <br /> Index and Title Page <br /> Owner's Name: 71/14-4) /,4 � 1444 > <br /> Owner's Address: 7 973 Gc',4.,.VA-cJ4 Q'* ' S <br /> G e7/'4y e G i- ('e. m <br /> Site Address: y2 /7/3 nNc_ i c>c- - ",ick 4 e/ <br /> Legal Description: pc_/ G'. L., a S Ty yx., j <br /> Town: lie 11/4e- <br /> County: <br /> f P— <br /> County: ,:URNETT <br /> Subdivis4on/CSM: V / p • 2 Lot No. Block No. — <br /> PIN: 07 o/9 ,;2 3 /�` eS- .date" o 2 a/5006 <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 ,Pose 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: WA IE RIJJFSHOLM Credential No.227691 <br /> Plumber Adel,ess: P.O. :OX 514, SIREN,WI 54872 <br /> Telephone: 715-349-7286 <br /> Signature: <br /> ©ate: 7-7-7,20 <br />