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INSPECTION REPORT
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GENERAL INFORMATION (ATTACH TO PERMIT)
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June 24, 2020 J-
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES 2022-06 24
Plan RenewP W TS 06200124E C
Marc Humorn
28497 King Arthur is
Danbury, col
Sli
Jahn It Candace gttlenEmF
980 Coulee Tral
Rolens, WI54017
Lot
Tar ID 022-1017 ED 020
51 Croix County
Parcel 012 0900-07 000
SEX NE%-57-T28N-Rl8W
FOR
Desnip4on Gm Mal Mound Component Manual lEditwnl,
4 beJmom Mound-F GPD-New-$4' 201]I,IN 4/ll�
to limiting factor- 'Effluent Filters pressure Distobutum Component Manual
to
MamtenanCe required 2 0 SBD-10J06-PIN O1101 R 10/12
The submittal described above has been reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconam Statutes The submittal has been CON0ITIONALLY APPROVED This
system is to be constructed and located m accordance with the Enclosed approved plans and with any
component manuaal referenced ab0ve The owner as rebore m chapter 101 mnOl. Wisconsin
Statutes, is responsible for compliance with all coderequirements
No person may engage in or work at plumbing in the state unless licensed to do so by the
Department per s 145 O6, state
The lollowrng conditions shall be met during construction or installation and prior to occupancy Cr use
Reminded
• The site shall be properly prepared prior to plowing Any grasses longer than 6' shall he cut shod
and removed To avoid mamn& any leaves or loose organic matter shall be raked up and
removed Cut and shruM ve flush to the ground and leastumps. Avoid operating equipment
n them and site If neessary, use only trarked equipment, during dry conditions, with minimal
passes, to awld mmparrop
• Asanitary permit must be obtained from the county where this project 15 l0cated in accordance
with the regmrements of Se[. 145 19, Wis. State
• Inspection of the private sewage system installation is required Arrangements for inspection shall
be made with the designated county official in accordance with the provisions of Sec.
145 2(l Wis Stars,
d fifters; required I mthe s nk or]^° pump chamber, I Poultice Wher ofteir the sul • A
Improve Effluent II r j net rEaVogel bot does nor provide access for the
momIhtdn Of On effluent filter Maintenance information must be given to I he owner of the tank
explaining t hat periodic cleaning of the filter is required
Off shields lire required.
A coca or the approved Plans souncificalana hspurned and
lude local
Inspectors
p
emm� by amhor red a :mro
Owner Rimpormil trts
• The current owner, and each subsequent owner, shall receive a copy of tors letter Owners shall also
receive a Copy of the aPromole operation and maintenance normally l and be responsible for
ensuring that POWTS is operated and maintained in accordance with l his Chapter and the approved
management plan under s SP539354(l)
• In the event this sod absorption system or any of is component pans malfunctions so as to create
health hazard the property owner must follow the contingency plan as described in the approved
plans
The owners responsible for submitting a maintenance verification report acceptable to the county
for maintenancetooking Purposes Report shall be submitted at intervals appropriate for the
components) utilized in the POWTS
In granting this approval the no¢ron of Industry Services reserves the light to require Changes or
emotions should conditions arise making them necessary for code compliance. As per stale state
101 n(l). nothing in this rmlew shall relieve the designer of the responob fty for designing a safe
budding, structure, or component
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or
at the address on this letterhead
The above left addressee shall provide a copy of this letter and the POWTS management plan to the
owner and any others who are responsible for the installation, operation or maintenance of the POINTS
Sincerely,
.jDAM111i90U&W
Joshua Rowley
POWTS Plan powewer, Division of Indutry Services
(I15) 813 9111
Joshua rowley4ws o i gov
INDEX AND TITLE PAGE
Protest Name
JOHN O b CANDACE R
BETiENDORE
Morels Name.
(SAME)
_
(Vwner's Address
WO COULEE TRAIL
_ Cweponetry
ROBERTS wl 54017
APPROVED
_ _
�OF 9EEiV AND PROFESSIONAL
ERVICES
-- DIVISION OF INDUSTRY SERVICES
DFLY Info
peal Ransil
ProPeM Actions 980 COULEE TRAIL
SEE CORRESPONDENCE
Legal DescgLon SW NE S > T 28 N R 18 W
Towel Nmnakrne County St Croix
SUMrvupn Name NA
Lot Number 0 Block NumEer NA CSMN NA
Pal I Number
Plan Transac9on No
Pagel Index and title
Page Tank cross sections
Page 2 Data Cary
Page 10 Plat plan
Page Germat moeM drawings
Page 11 Soil rest
Page I Lateral and dose lank
Page 12
Page 5 Ol4nbution mesa
Page 13
Pape 6 System mamterunce swificalnns
Page H A_eral
Pagel Maru3 t and contingency plan
Pp88 Pump Curve and seeddhona S
,.MAR$ O'H_UPPERT
License Numner 185g-007
Date 0PIW
Phone NUMI 715<25-W75
85 210Pa
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State or well Approval stamp
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107N P IN 0101. R 10112)
Geohlal Mound Edson 1 2011 Page 1 of 14
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Pmarec1 JOHN D &CANDACE R BETTENDORF Page 6 of 14
Mound System Management Plan
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Project JOHN0 &CANONCER BETTENOORF Page 7 of 14
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