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Home My WebLink About25-0188CS-ao (may BAYFIELD COUNTY SANITARY PERMIT APPLICATION InNag 111strict Lean Clans I. APPLICATION INFORMATION 1-[ �, (Please Print All Information) k 19 L� II �i t County too PennftNo-. -5 Property Owners Name: MAR 2 (2INcpun': Bayfield Address of Prope . 3Nv(ie!d Zoni Qop r.ty Location: S33o/ or�G�I IvB/ PiBl sIC;;; cv:e 300000 /0� RU 5 &) 1/ 5X- %. S /�: T 49 N, R (a W Property Owners Mailing Address: Township: Gov. Lot#: L City, St.le Zip C Phone Number Lot # Block #: CSM #: CSM Doc # Subdivision Name �- 11. TYPE OF BUILDING: (Check One) ❑ State Owned Tax ID#: ��,1� 7S El Public (Explain the usetpurpose ) 1 or 2 Fa mil DwelGn - No. of Bedrooms IL TYPE OF PERMIT: Check onl one box on line A. Check box on line B, if applicable) A) ❑ New ❑ Replacement ❑ County Private Interceptor ® Reconnection ❑ Repair ❑ Revision " ❑ Transfer of Owner (List Previous Owner below) B) ❑ A Sanitary Permit was previously issued. Previous Permit Number. Date Issued: IV. TYPE OF NON -PLUMBING SYSTEM: (Check One) ' Replacements need previous permit number and date filled out above C) ❑ Pit Privy ❑ vault Privy (Vault size: _gallons or _cubic yards) ❑ Portable Privy ❑ Camping Transfer Unit Container ❑ Composting Toilets ❑ Incinerating Toilet V. ABSORPTION SYSTEM INFORMATION: 1. Gallons 2. Absorp. Area 3. Absorp. Area 4. Loading Rale 5. Perc. Rate 6. System 7. Final Grade Per Day Required (Sq.Ft.) Proposed (Sq. FL) (Gals. / Day / Sq.FL) (Min. Inch) Elev.(Feet) Elev. (Feet) VI. TANK. Capacity Fiber INFORMATION: In Gallons Total Gallons #of Tanks Manufacturer's Name Prefab. Concrete Site Constructed Steei glass Plastic` App. New Easting Tanks Tanks r Holding Tank i�o,7 IWS N Ss'1� Lift Pump Tank / Siphon Chamber VII. RESPONSIBILITY STATEMENT: I the undersigned, assume responsibility for installation of the onsite sewage system hown on the attached plans. Owner'sName(s): (Print) ffapptyingfor SacbonCabow OwneesS re(s): (No ) Ga ,— i Plumber's Name: (Print) uapp P1 bees Signaf fe (NooStain MPIMPRSWNo: 209e-forsewonAdB)abwm Y� Plumber's Address: (Street, City State, Zip Code) Home Phone: Business Phone: P09WSZ, W11%9Uej W r - VIII. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary PernitfTransfer Fee: Date Issued: Issuing Agent's Signature / Date: [� Approved ❑ Owner Given Initial Adverse Determination /-1,.: l /} '�L�. j ( O Lr.!� ,L,�.%�.�' IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: --il$,a ('.1c'Ai), tobnvS 6vFand plot plan on reverse side �I/l� BAYFIELD COUNTY( P I zoning District ' SANITARY PERMIT APPLICATION Lakes Mass I. APPLICATION INFORMATION (�1 G C rr 1L S611 Ti' t County (Please Print All Information) II l P(o•^t1lPermit No: Property Owners Name: n 2 !LAW �Y Bayfield wr �, I ll MAR Address of Prope - 3ayfield Co, Zonl erty Location: / t s3 orL�loN, t PiBI sI 30(og0 /)i p� t D s� S T N, R o W _; Property Owner's Mailing Address: Township: Gov. Lot #: City, tate Zip Code)Phone Number Lot # Block #: CSM #: CSM Doc # Subdivision Name II. TYPE OF BUILDING: (Check One) ❑ State Owned Tax ID#: ❑ Public (Explain the usetpurpose 1 or 2 Famil Dwelling- No. of Bedrooms II. TYPE OF PERMIT: Check only one box on line A. Check box on line B. if applicable) A) ❑ New ❑ Replacement ❑ County Private Interceptor Reconnection ❑ Repair ❑ Revision " ❑Transfer of Owner (List Previous Owner below) B) ❑ A Sanitary Permit was previously issued. Previous Permit Number. SMY_Date Issued: IV. TYPE OF NON -PLUMBING SYSTEM: (Check One) •Replacements need previous permit number and date filled out above C) ❑ Pit Privy ❑ Vault Privy (Vault size: _gallons or _cubic yards) ❑ Portable Privy ❑ Camping Transfer Unit Container ❑ Composting p g Toilets El Incinerating Toilet V. ABSORPTION SYSTEM INFORMATION: 1. Gallons 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pero. Rate 6. System 7. Final Grade Per Day Required (Sq.Ft.) Proposed (Sq. Ft) (Gals. /Day / Sq.Ft.) (Min. Inch) Elev.(Feet) Elev. (Feet) VI. TANK Capacity INFORMATION: In Gallons Total Gallons #of Tanks Manufacturer's Prefab. Site Steel Fiber Plastic Exper. New Existing Name Concrete Constructed App. Tanks Tanks glass HoldiZ�n Holdin Tank Lift Pump Tank / Si hon Chamber VII. RESPONSIBILITY STATEMENT: I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Owner's Name(s): (Print) uappWgfa section cabow Owner's S• re(s): (No ) Plumber's Name: (Print) rlapptyinglorSedionAorB)above Pl bersSigna fe (No.Stam MP/MPR�SW�No: Plumber's Address. (Street, City State, Zip Code) Home Phone: BusinesQs Phone: PoBoxs VIII. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary PermiUTransfer Fee: Date Issued: Issuing Agent's Signature / Date: ❑ Approved Owner Given Initial Adverse Determination IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Plot Plan on reverse side lvT la�trr� -ro �- $►tu..v/aba�-lop' _ N ;2- I, Pop H T' � °1P6 RAurluss6e'el hD wG RAO aB� Swt:K ANAPV STaeaoe _ _I WE++- GitRAtu° Name of Frontaqe Road (30roff /I%ftAO-0 1. Name the frontage road and use as a guideline, fill in the lot dimensions and indicate North (N). 2. Show the approximate location and size of the building. = 3. Show the location of the well, septic tank and drain field. 4. Show the location of any lake, river, stream or pond if applicable. 4 A 5. Show the approximate location of other existing structures. 6. Show the approximate location of any wetlands or slopes over 20 percent d14 7. Show dimensions in feet on the following: a. Building to all lot lines ;=-IOD t b Building to centedine of road 7ICO c. Building to lake, river, stream or pond 4R d. Septic / holding tank to closest lot line T f 00 t e. Septic/holding tank to building ai) t f. Septic / holding tank to well? 75 t g. Septic / holding tank to lake, river, stream or pond tJjA h. Privy to closest lot line 0),q i. Privy to building WA J. Privy to lake, river, stream or pond �l� k. Drain field to closest lot line 4A I. Drain field to building/ f}/� ,* m. Drain field to well n. Drain field to lake, river, stream or pond d1A o. Well to buildingc.AOLSE' 0' Submit To: Bayfield County Zoning Department, PO Box 58, Washburn, WI 54891 u/rorms/sanitary/bayfieldwuntysanitaryapplieation Revise: June 2018 Proofed by. APPLICATION FOR PERMIT BAYFIELD COUNTY, WISCONSIN 0 10I�� LAND USE SANITARY ® WELL f�7( Land: 1_01_ t/y of - __ % of See. f-L.3-- T. Y_L_d _N. R. _ -_ W. Application No. Date _ -�k-y-1 ---- Zoning .District _A-G-I�j -- - �Ei(Vfi3F-��'E Town of -- Volume ---------- Page ---------- of Deeds. Fire Number -------------- --------------- —_------ Name __If _ ------------------------- Contractor ------------------------ Address_LZ12fi_L.2�2�---f.S%4_Sh��Cn'---- Plumber---- Telephone ----------------- ---------------------- - Well Driller --- o�---/1%Oli`h ----=------------- Structure— New --- ----------- Addition _____________ Number of Stories ------------------------------- Basement — Yes ---------------- No -------------- Square Feet of Floor Space ----- 1280-____------- Estimated Cost of Construction $______________________ Structure Use--------------1_� 1i(J�C/j�------------------------- ----------------------------------- (Residence, Garage, Storage, Drugstore, Tavern, Ete ) Sanitary — Septic Tank & Disposal Field --------------- Privy ---------------- Holding Tank _V/------------ -------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- ------------------------- °'-b'J-i Remarks:------------------------------------------------------------------------------ Fee: ji�T9----- $-------------------- Amount Paid: I, the dte undersigned, att at the information coutai ed herein is accurate and true. 0 Owner(or Agent) -- ---- --- ---------------------------------------------------------- Address (if differen from above) -------------------------------------------------------------------------- Note: Submit completed application and fee to: Zoning Department, Courthouse, Washburn, WI 54891. Do not start construction until all permits have been received by the applicant. Changes in plans must be ap. proved by the Zoning Department. A permit may be revoked if misrepresentation of any of the infor• mation conveyed herewith is found to exist. Zoning Department: (715) 373.2392 or 373-2878. APPLICANT- PLEASE COMPLETE REVERSE SIDE OFFICE USE ONLY — pp Permit issued: e� G!/r^ State Sanitary Number -- °� L_�✓'_--____ Date _____rQ_1q $ Permit Number---SPl7gj-_-_- Permit Denied (Date) -_____ Reason for Denial: Inspection Record: Variance Condition ------------------------------------------------------------------------- --------------------------------- By -------------- Date --------------- ---------------- Signed --------------- Inspector 1. Using the frontage road as a guideline, fill in the lot dimensions and indicate North (N). 2. Show the approximate location and size of the building. 3. Show the location of the well, septic tank, and drain field. 4. Show the location of any lake, river or stream if applicable. 5. Show di"nsions in feet on the following: A. building to all lot lines b. building to centerline of road c. building to lake, river, or stream d. septic tank to closest lot line e. septic tank to building f. septic.tank to well g. septic tank to lake, river, or stream h. drain field to closest lot line i. drain field to building j. drain field to well k. drain field to lake, river, or stream 1. well to building Lot Line Frontage Road Indicate whether or not the following locations are staked: Structure . . . . Yes______ l\To_._____ (Train Field . . . Yes______ No______ Septic Tank . . . Yes______ No______ Well . . Yes______ No______ BAYFIELD COUNTY ZONING DEPARTAAENT Bayficld Counly Courthouse -- Post Office Box 53 -� 117 East Fifth Street Telephone [715] 373-2392 ! --- [7I51 373-2878 WASHBURN, WISCONSIN 54891 Date: 16 0C ( Bz-. i' 8 �f To: TIM MKi The Certified Soil Test conducted on the above real estate has bee received by this office, from your Certified Soil Tester Vj-, ROB «� . j —I . Please find enclosed a County Application For Permit form, and a Fee Schedule, Please contact our office for :further zoning and Sanitary regulations and for information on steps to be taken to obtain proper permits for your proposed construction activity, The zeport.on soil borings and percolation tests has been placed on file at -this office. Thank you. Sincerely, David K. Lee Zoning administrator DKL : j j�.. Lnc: F 'Vora HAV ANY °EPARTME OF . REPORT 'ON SOIL BORINGS AN D •limit � ." . LABOF�A.D PERCOLATION JESTS (115) HUMAN `PELATIONS �.i l.. _.. •>1..,_.� �r A, • .. 5 ��_ - � (H63,09 i1 i & •Chapter"l45:045 � • SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON. WI 53707 LOCATION:-, - N: ::. TOWNSHIP/MUNICIPALITY: OT NO.•BLK.NO.: SUBDIVIS O N NAME: '/ 4/ J 3 1100/R 3�E (o .614 ry ��' COUNTY,9 W E NAME: : l, USE UA I t5 Ut$b2ZKVA11UN, WtAN1: N0. R O DNS I TESTS: Qlii�asidence ew ❑Replace RATING: Ss Site suitable for.systam "U= Site unsuitable for system If Percolation. Testa are.NOT:tequired '. ]DESIGN RATE: If any portion of the tested area is in the under s.HS3.09(5)(b),'ind11cate: Floodp{ain, indicate Floodptain elevation: PROFILE -DESCRIPTIONS BORING NUMBER TOTAL DEKH IN, ELEVATION DEPjkj IQ gEJOUPD BSERVED .. - ATER-INCHES •• S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO'BEDROCK.IF OBSERVED SEE ABBRV.ON BACK.) �. -- SG B_ 2 Go 018 -b- � 7 0 r .� �. � 7 �R } Nro -tom artl-0/, B- 6 0 7. S it/a�V ,� ~ f G 4 �lt7T�''Lt� .3 �— y �WoNF — I err E PERCOLATION TESTS L�1!.i�:l�il® �7- • • �Td:TT�I�3•i•�]�:ll•] �>� PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION f _.i.-- _.— _ _ tN _—•�-_-_ _..�.__.�...----_' _ � � ...;- _._._��..._�-- __i __�._ �---��-•• -------j-� ---- 1. 30' -- tr-1 1, tb un ers!gned,-hereby certify that•the soil tasts'reported :oh this C, 44e re -Wade by me in accord with the procedures and methods specified in the !s nsin -Administrative Code, and that the data recorded and the location of the tests are'corract to ;thebast of my kn6*ledge and belief.. SBD 6678!B.08/83) (Plb 100a) (Wis Stats. S. 145.02) Detach And Return Upper Portion Of This Form With Any Return Correspondence STATE OF WISCONSIN DILHR DIVISION OF SAFETY & BUILDINGS BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 P.O. BOX 7969 MADISON, WI 53707 608-266-3815 DATE: I PROJECT: [PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above -indicated project. Preliminary review indicates the required fee is $ Fee Received is $ ❑ Plan accepted for review. ❑ Underpayment— Please submit additional fee. Plans will be held in abeyance. ❑ Plans being returned. ❑ Overpayment —Refund forthcoming. ❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. I. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and - ❑ Plans not clear, legible or permanent notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local H. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County cnsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification to Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system — provide soil ❑ Cross section of dosing lank showing pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. TO: BAYFIELD COUNTY ZONING COMMITTEE FROM: „$ TOWN BOARD SUBJECT: TOWN BOARD RECOMMENDATION We, , the Town Board, Town of do hereby recommend the pproval / disapproval • ircle one of the issuance of a permit to 'rw, (Name of applicant) whose property is located in the �'ya of the _S.fh Section _, Township North, Range J� West. For ?b &jWoF / t&--PAMY— - - za ♦ 6 ♦sr� cr. •• State what applicant is requesting i Because' (State reason for recommendation of approval or disapproval) Signed, �Q �ey 1 g w Town Board 41 Chairm Supery Supery Clerk 1;� OILHR Project Name PLAN APPROVAL ❑ General Plumbing Plans ❑ Private Sewage Plans Safety and Buildings Division Bureau of Plumbing P.O Box 7%9 Madison, WI 53707 Telephone: (608)266-3815 Plan Identification No. Gallons Per Day PRIORITY PLAN REVIEW ONLY Plan Review Petition For Modification Project Location - Street No. or Legal Description C DD ty" ❑ City ❑ Village � Town of: . �ilf�vi The plumbing plans and specifications for this project have been reviewed for compliance with a e co a requirements. This apprgJa)ris based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the City, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. jO FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: `r -Z, James Sargent Bureau Director _ If Questions Plans Approved By: Date Approved: Contact ♦ ---j1 '. r cc: I OWS ❑ DPS ❑ H&R & Rec. San. Section I'd County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture _ DILHR-SBD-6099(R. 01/84) 0 Owner 0 Other - O OILHR PLAN APPROVAL ❑ General Plumbing Plans ❑ Private Sewage Plans Safety and Buildings Division Bureau of Plumbing P.O Box 7%9 Madison, WI 53707 Telephone: (608)266-3815 Plan Identification No GallonsPer Day r, PRIORITY PLAN REVIEW ONLY Plan Review S Petition For Modification S Project Name L I Project Location - Street No. or Legal Description Coynty� � ❑ City ❑ Village /b Town of: q 1 V i (.- L) A -Y The plumbing plans and specifications for this project have been reviewed for compliance with appRt.'kTi a coe co�ments. This apprq\i0ris based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by & city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the departments approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. ,'El FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: y fames Sargent Bureau Director If Questions PI4ns Approved By: Date Approved: Contact \ DILHR-SBD-6099(R. 01/84) cc: .L7 OWS ❑ DPS :] County ❑ Local PI ❑ UW-SSWMP ❑ Plumber ❑ Owner ❑ Other ❑ H&R & Rec. San. Section ❑ Facilities Need Analysis Section ❑ Department of Agriculture P YFIELD Bayfield County Planning & Zoning Department 117 E 5w Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373.4010 Property Owner: Description Private Sewage System Reconnection Submission Number: CS-00104 Transaction Number. CS-00104-26557 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference:2109 Paid by: DENNIS BACHAND, 31800 MAKI RD, WASHBURN, WI 54891 Payment Type: Check Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. Town, City, Village, State or Federal Permits May Also Be Required LAND USE — SANITARY — Reconnect [59813] SIGN — SPECIAL — CONDITIONAL — BOA — BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 25-0188 Tax ID# 6846 Issued To: Gibb, Robert W & Joey J Location: SW % of SE'/ Section 13 Township 49 N. Range 5 W. Town of Bayview in Doc # 2012R-543419 Residential Structure in an A-1 Zoning District For: Sanitation Permit Reconnect to 2 1000 gallon Rasmussen Tanks (Disclaimer): Any future expansions of development would require additional permitting. Condition(s): Ensure existing tanks are watertight and structurally sound. 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 or modification 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 a department of natural resources service center (715) 685-2900. NOTE: This permit expires two years from date of issuance if the authorized construction work 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 found to have been misrepresented, erroneous, or incomplete. This permit may be void or revoked if any performance conditions are not completed or if any prohibitory conditions are violated. CeCe Rudnicki Authorized Issuing Official 4/24/25 Date