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pEraRT'LtByr DIVISION OF INDUSTRY SERVICES <br /> 10541 N RANCH RD <br /> HAYWARD WI 54843-6462 <br /> Contact Through Relay <br /> http:l/dsps.wi.gov/programs/industry-services <br /> www.wisconsin.gov <br /> ssIoNr �e Scott Walker,Governor <br /> Dave Ross,Secretary <br /> June 06,2016 <br /> CUST ID No. 227691 ATTN:POWTS Inspector <br /> WADE A RUFSHOLM ZONING OFFICE <br /> 24702 LIND RD BURNETT COUNTY SPIA <br /> PO BOX 514 7410 CTH K 4102 <br /> SIREN WI 54872-0514 SIREN WI 54872 <br /> CONDITIONAL APPROVAL <br /> PLAN APPROVAL EXPIRES: 06/06/2018 Identification Numbers <br /> Transaction ID No.2717820 <br /> SITE: Site ID No. 824869 <br /> Ellery Vollrath Please refer to both identification numbers, <br /> 29123 Brozie Rd above,in all correspondence with theagency. <br /> Town of Scott <br /> Burnett County <br /> Government Lot(S)2, S9,T40N,R14W <br /> FOR: <br /> Object Type: POWTS Component Manual Regulated Object ID No.: 1605604 <br /> Maintenance required; Replacement system; 300 GPD Flow rate; 31 in Soil minimum depth to limiting factor from <br /> original grade; System(s): Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/0l,R. 10/12),Pressure <br /> Distribution Component Manual- Ver.2.0, SBD-10706-P (N.01/01,R. 10/12), SSWMP Pub. 9.6; 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 /> Reminders <br /> • Pursuant to outlet filter product approval stipulations,maintenance information must be given to the owner of <br /> the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening <br /> used to service the filter shall terminate at or above finished grade with a watertight cover. <br /> • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis.Adm.Code. <br /> A copy of the approved plans, specifications and this letter shall be on-site during construction and open to <br /> inspection by authorized representatives of the Department,which may include local inspectors. All permits <br /> required by the state or the local municipality shall be obtained prior to commencement of <br /> construction/installation/operation. <br /> In granting this approval the Division of Industry Services reserves the right to require changes or additions should <br /> conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review <br /> shall relieve the designer of the responsibility for designing a safe building, structure,or component. <br />