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August 10, 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: 08/10/2020 <br />DIVISION OF INDUSTRY SERVICES <br />10541 N RANCH RD <br />HAYWARD WI 54843-6462 <br />Contact Through Relay <br />hftp://dsps.wi.gov/programs/industry-services <br />www.wisconsin.gov <br />Scott Walker, Governor <br />Laura Guti6rrez, 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. 3143016 <br />SITE: Site ID No. 852467 <br />Northwest Passage Please refer to both identification numbers, <br />7818 Moline Rd above, in all correspondence with theagency. <br />Town of Meenon <br />Burnett County <br />NE1/4, NEIA, S19, T39N, R16W <br />FOR: <br />Description: East <br />Object Type: POWTS Component Manual Regulated Object ID No.: 1790587 <br />Maintenance required; 900 GPD Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, <br />R. 10/12); Commercial System, Effluent Filter <br />CONDI <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 t� ` <br />and located in accordance with the enclosed approved plans and with any component manual(s) reference ab�; <br />The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance wit all code <br />requirements. <br />sttbdju <br />A copy of the approved plans, specificationsand this letter shall be on-site during construction anpen to <br />inspection by authorized representatives of the Department, which may include local inspectors. 1 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 />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 />Sincerely, <br />Edw' Taylor <br />Wastewater Specialist, Division of Industry Services <br />(715)634-3484, Mon-fri, 8:00 a.m. - 4:30 p.m. <br />edwin.taylor@wi.gov <br />Fee Required $ 250.00 <br />Fee Received $ 250.00 <br />Balance Due $ 0.00 <br />WiSMART code: 7633 <br />APF <br />M AND <br />ON OF II <br />