HomeMy WebLinkAboutEldred SanitaryRec'd foMssuance
JAN o 1 2024
Secretarig
1. APPLICATION INFOF
(Please PrintAII InfonnaSon)
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BAYFIELD COUNTY'-
SANITARY PERMIT APPLICATION
Bayfield Co.
Zoning District.
Lakes Class
Property Owner's Name: /^cU\ ^Ufe^ ^7
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Soil Test -Ptemrrnn3 an|
No: ^0»~"^0
pG8iUhly"l.':.'e'.cy
Permit No:
County:Bayfield
Address of Property: 8^SS^W<k ^
^^A.^X'S^814
Property Owner's Mailing Address:
Property Locatkm:
S\isi % S\j0 1/4-s \\ T 50 N,R C^
Township:"i£^eU Gov.Lot#:
City, State Zip Code Phone Number Lot #
II. TyPE OF BUILDING: (Check One)
B(ock#:CSM#:
1418
CSMDoc#Subdivision Name
D State Owned
Public (Explain the use/purpose
TaxlD#:
1 or 2 Family Dwelling - No. of Bedrooms ~^45^
111. TYPE OF PERMFT: (Check only one box on line A. Check box on line B, if applicable)
A)
B)
Dl New
ReconnecBon
D Replacement II County Private Interceptor
n Repair F~\ Revision ** Q Transfer of Owner (List Previous Owner below)
A Sanitary Permit was previously issued. Previous Permit Number. 3-\~\06^ Date Issued:
IV. TYPE OF NON-PLUMBING SYSTEM: (Check One) * Replacements need previous permit number and date fflted out above
_cubic yards)C) F~l Pit Privy D Vault Privy (Vault size: _gallons or.
[~1 Portable Privy [_] Camping Transfer Unit Container II Composting Toilets !1 Incinerating Toilet
V. ABSORPTION SYSTEM INFORMATION:
1. Gallons
Per DayH^-o'
2. Absorp.Area
Required (Sq.Ft.)
3. Absorp.Area
Proposed (Sq. Ft.)'^'
4. Loading Rate
(Gals./Day/Sq.Ft.)
0.-
5. Perc.Rate
(Min. Inch)
6. System
Elev.(Feet)J^d'
7. Final Grade
Elev. (Feet)
VI. TANK
INFORMATION:
Capacity
In Gallons
Tanks
Existing
Tanks
Total
Gallons
# of
Tanks
Manufacturer's
Name
Prefab.
Concrete
Site
Constructed Steel
Fiber
Plastc Exper.
App.
Septic Tank or
Holding Tank ,000 M^_UI^(2s^6}ftcteU K
Lift Pump Tank /
Siphon Chamber
VII. RESPONSIBILITY STATEMENT:
I the undersigned, assume responsibility for installation oftheonsite sewage system shown on the attached plans.
Owner's NamefS^: (Print) If applying for SecSonC above~^Ai^ \^i^^ ^-[f^.ij Signature(s): (No Staipn^)
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7'.^
11
Plws /S Name: (Prit\t). If applying ft/r Section A or B) a6o
>&k\
we
Plumber's Address: (Street, pity ?(ate. Zip Code)
l40\\r-kylLuC. liV&Uu^lAH: S48CV\
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Home Phone:
~Ll^~il^-OS6($
MP/MPRSWNo:
\^88SO^
Business Phone:
"ILS-^.-IS^V
VIII./DEI USE ONL'
Disapproved
Owner Given Initial
Adverse Determination
Sanitary PermiVTransfer Fee:
so
Date Issued:
^-fa-si
Issuing Agenfs Signature / Date:
»/3//2C/-
IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
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Plot Plan on reverse skte
H M'CHAEL ELDRED & KATHERINE P KITCHELL
Reconnection Plot Plan
86255 BETZOLD RD
SW1/40FSW1/4
LOT 4 CSM #1418 IN V.8 P.302
IN DOC 2020R-581227
S11 T50N R04W
TOWN OF BAYFIELD, Wl
SCALE 1=40'
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pl^"'n;Sucn .
w.-.,,
^ETZOLD ROAD
^
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House Site
4" PVC
Insulated after 30'
Polylok 525 Filter
1000 Gallon
SepticTank
LOT LINE
PROPOSED
POLE
BUILDING
>100'TO LOT LINE
-^-
2 rows of 16 Infiltrator Quick 4 Chambers
4" Sewer Pipe
^
98.6'98.28'97.32-
1.6% SLOPE
>100'TO LOT LINE
A = BM 18" OAK NAIL IN BASE= 100'
1C 40'R-
SHEET 2 of 2
Tax IDS:.LI i32L
Review Checklist
Address:^£iSS_&±aM
Legal Description : /..^ t ^^ ^U^ -r^ \/^ P.?o2
Zoning District: D R-l D R-2 D R-3 D R-4 D R-RB DC D I D M^ A-l D A-2 D F-l D F-2 D W D M-M
Overlay District:.
Shoreland:o D Yes If yes/is impervious surface form required D No D Yes
If yes, is impervious surface form attached D No D Yes
FloodpIain:']a.Mo D Yes If yes, which zone? D X D AE DA
WetlandJ&No D Yes
Ownership Information Accurate?
'^application signed D Letter of Authorization (if applicable] Js^ffidavit of Authority (if appiic
Legal Information Accurate? D No- QKYes
Proposed project previously granted or granted by variance? ^No D Yes, Case #:
fs Structure Nonconformin^!?XlNo D Yes
If yes, attach documentatfOn
Is Mitigation Required? J2^Jo D Yes If yes, is Mitigation attached? D No D Yes
Boundary Line Determination:
Is Structure within 30 feet of required setback/s? C] North Lot Line D South Lot Line D West Lot Line D East Lot Line
Applicable tot lines were:
D Visible from one previously surveyed corner to other previously surveyed comer
D Verified by staff with corrected compass
D Marked by licensed surveyor
Is Structure within 10 feet of required setback/s? d North Lot Line D South Lot Line D West Lot Line D East Lot Line
Applicable lot lines were:
D Visible from one previously sun/eyed corner to other previously surveyed corner
D Marked by licensed surveyor
Section # | Regulation Required Applicant's Lot
13-1-60 Lot Area -LR~'-^\I.?..
13-1-60 Lot Width ^00 '>t-^Q}
13-1-26 Is lot Sub-standard? D Yes^No
Buildabie^Yes D No
If yes, atfach Deed of Record or Variance
13-l-22(h)Height (Shoreland)35'
Is Sanitary required for project? D No ^Yes Ifyes,Sanitary# ~2.l-jo(?^ i- ^rtu/'nrt-cf-4-fcA
Sanitary Date:Zz^E.# of bedrooms: 3
Ifaddition/alteration, were Access, Carmody, files reviewed for prior additions that would exceed the 250 sq.
lifetime maximum?
D No D Yes If yes, sanitary #
ft.
Are fee payments correct? D No ..SS^Yes
Hold For:.
D Sanitary
DTBA
D Fee payment
a .
a.
D.
D_
D.
a.
Inspected Uy:
/\\c^^u ^/)
Date of Inspection:
I AY? ^
Inspected By:
Date of Re-lnspection:
Denied by:
Date of Denial:
Commerrts/Notes:
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Comments/Notes:
Reason for Denial:
Are Town, Committee, and BOA conditions attached? D Yes D No If no, they need to be attached
Approved by:
Date of Approval:
'/^//^
Permit #: ' .^/
Date issued: • • • ?
Condition(s): ; I
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\mount Paid:j
)ate: ' .• . .
Refund:
Date:
Town, City, Village, State or FederalPermits May Also Be RequiredLAND USE - XSANITARY - Reconnect (21-106S)SIGN -SPECIAL -CONDITIONAL -BOA -No.24-0038BAYFIELD COUNTYPERMITWEATHERIZE AND POST THIS PERMITON THE PREMISES DURING CONSTRUCTIONTax ID: 4533Issued To: H MICHAEL ELDRED & KATHERINE KITCHELL LIV TRUSTLocation:1/4 Of1/4 Section 11 Township 50N.Range 4 W. Town of BayfieldGov't Lot Lot 4In V.8 P.302 in DOC 2020R-581227BlockSubdivisionCSM# 1418Residential Structure in Ag-1 zoning districtFor: [ 1-Story ], Residence on a Slab (30' x 48'): Screen Porch (12' x 16'); = 1632 sq. ft. ] at a Height of 19'11"(Disclaimer): Any future expansions or development would require additional permitting.Condition(s): Meet and maintain setbacks including eaves & overhangs. For personal residence only.Town/State/DNR permits may be required. A Uniform Dwelling Code (UDC) Permit from thelocally contracted UDC Inspection Agency must be obtained prior to the start of construction.Build as proposed. Existing pole shed not approved for human habitation.You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal ormodification of construction that violates the law or other penalties or costs. For more information, visit the department of natural resources wetlands identification web page or contact the department of natural resources service center (715) 685-2900.NOTE: This permit expires two years from date of issuance if the authorized constructionwork or land use has not begun.Changes in plans or specifications shall not be made without obtaining approval.This permit may be void or revoked if any of the application information is foundto have been misrepresented, erroneous, or incomplete.This permit may be void or revoked if any performance conditions are notcompleted or if any prohibitory conditions are violated.Alessandro Hall, AZAAuthorized Issuing OfficialFebruary 12, 2024Date