Laserfiche WebLink
August 14, 2018 <br />CUST ID No. 227691 <br />WADE A RUFSHOLM <br />24702 LIND RD <br />PO BOX 514 <br />SIREN WI 54872-0514 <br />CONDITIONAL APPROVAL <br />PLAN APPROVAL EXPIRES: 08/14/2020 <br />SITE: <br />Richard Jacoby <br />1344 Roberts Rd <br />Town of Scott <br />Burnett County <br />Government Lot(S) 2, S24, T40N, R14W <br />FOR: <br />Object Type: POWTS Component Manual <br />Maintenance required; 450 GPD Flow rate; <br />R. 10/12); Effluent Filter <br />DIVISION OF INDUSTRY SERVICES <br />10541 N RANCH RD <br />HAYWARD WI 54843-6462 <br />Contact Through Relay <br />http://dsps.wi.gov/programs/industry-services <br />www.wisconsin.gov <br />Scott Walker, Governor <br />Laura Gutierrez, Secretary <br />ATTN.• POWTS Inspector <br />ZONING OFFICE <br />BURNETT COUNTY SPIA <br />7410 CTH K #102 <br />SIREN WI 54872 <br />Identification Numbers <br />Transaction ID No. 3145493 <br />Site ID No. 852681 <br />Please refer to both identification numbers, <br />above, in all correspondence with theagency. <br />Regulated Object ID No.: 1791498 <br />System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, <br />The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative CodeONDI TI01 �` <br />and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed APPR <br />and located in accordance with the enclosed approved plans and with any component manual(s) referenced above, pg) PRC <br />The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance w�c(QIv SIGN QF ltiDu <br />requirements. Q <br />A copy of the approved plans, specifications and this letter shall be on-site during constructiond open to <br />inspection by authorized representatives of the Department, which may include local inspector 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 additions ou d E <br />conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothin in this review <br />shall relieve the designer of the responsibility for designing a safe building, structure, or component. <br />Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address <br />on this letterhead. <br />The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any <br />others who are responsible for the installation, operation or maintenance of the POWTS. <br />Since Fee Required $ 250.00 <br />Fee Received $ 250.00 <br />Balance Due $ 0.00 <br />Edwin a <br />Wastewater Specialist, Division of Industry Services WiSMART code: 7633 <br />(715)634-3484, Mon-fri, 8:00 a.m. - 4:30 p.m. <br />edwin.taylor@wi.gov <br />