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Safety and Buildings <br /> merce.wi. ov 10541N RANCH ROAD <br /> com <br /> g HAYWARD WI 54843 <br /> 4 <br /> Contact Through Relay <br /> ti sco ns i n www.commerce.wi.gov/sb/ <br /> Department of Commerce www.wisconsin.gov <br /> Scott Walker,Governor <br /> Paul F.Jadin,Secretary <br /> May 13,2011 <br /> CUST ID No. 227691 A77N:POWYS Inspector <br /> WADE A RUFSHOLM ZONING OFFICE <br /> 24702 LIND RD BURNETT COUNTY SPIA <br /> PO BOX 514 7410 CTH K#102 <br /> SIREN WI 54872 SIREN WI 54872 1P,0 <br /> CONDITIONAL APPROVAL Coed. <br /> PLAN APPROVAL EXPIRES: 05/13/2013 Identification Numbers D <br /> Transaction ID No. 1938261 A <br /> SITE: Site ID No. 767042 09aR�t <br /> Sara Stadler 14-BED Residential Facility Please refer to both identification numbers, <br /> 5788 Cth C above,in all correspondence with thea enc <br /> Town of Jackson see <br /> Bumett County <br /> Government Lot(S) 10, S18,T40N,RI 5W <br /> FOR: <br /> Description:Non pressurized in ground, 14 bed assisted living,6 employees <br /> Object Type:POWTS Component Manual Regulated Object ID No.: 1314236 <br /> Maintenance required; Replacement system; 1,482 GPD Flow rate; 72 in Soil minimum depth to limiting factor from <br /> original grade; System(s):In-ground POWTS Component Manual, SBD-10705-P(N.01/O1); Commercial System, <br /> Effluent Filter <br /> The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes <br /> and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed <br /> and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. <br /> The owner, as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code <br /> requirements. <br /> No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, <br /> stats. <br /> The following conditions shall be met during construction or installation and prior to occupancy or use: <br /> Key item(s) <br /> • In the event this soil absorption system or any of its component parts malfunctions so as to create a health <br /> hazard,the property owner must follow the contingency plan as described in the approved plans.In addition, <br /> the owner must insure that the operation,maintenance and monitoring duties as described in the "In-Ground <br /> Soil Absorption Manual System"are complied with.A copy of this information must be given to the owner <br /> upon completion of the project. <br /> • This approval does not include plans for the general plumbing systems or sewer piping leading to the <br /> septic/holding tank that may be required for this project. See section COMM 82.20,Wis.Adm. Code,to <br /> determine if plan submittal and approval is required. <br /> • The plumbing for this project discharges to a private sewage system. The approval covers only <br /> domestic/sanitary wastes directed into this system. The Department of Natural Resources()WDNR)must be <br /> contacted regarding the treatment and disposal of all industrial wastes,including those combined with <br /> domestic/sanitary wastes. <br /> • The float switch shall be a type that does not contain mercury.2009 Wisconsin Act 44 prohibits the installation <br /> of float switches or relays that contain mercury. <br />