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Home My WebLink About25-0192CE -coos BAYFIELD COUNTY zoning District_ SANITARY PERMIT APPLICATION Lakes Class I. APPLICATION INFORMATION Soil Test County f/1 _ 1 2 (Please Print Al Information) No: Permit NO: O Property Owner's Name: County: Bayfield Susvu M Ltoral t sc Address of Property: Property Location: '4501 TL13 NRO1 W Property Owner's Mailing Address: Township: 0303 sw na"4 C , Sttaate � (—� Zip 3 oSib Phone Number Lot # Block #: CSM #: CSM Doc # Subdivision Name Y ' 162-9 ii. TYPE OF BUILDING:. (Check One) Tax ID#: ❑ State Owned ❑ Public (Explain the use/purpose 3 5 3L{ t-� 1 or 2 Famil Dwellin - No, of Bedrooms II. TYPE OF PERMITi Check onl one box online A, Check box an line B. if a licable A) ❑ New ❑ Replacement ❑ County Private Interceptor Reconnection ❑ Repair ❑ Revision " ❑ Transfer of Owner (List Previous Owner below) B) ❑X A Sanitary Permit was previously issued. Previous Permit Number. 07-211 S Dale Issued: 10/29/07 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: y 7 . Final Grade 1. Gallons 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. R Ch) 6. Elev.(Feet) Elev.Fina (Feet) Per Day Recuired (Sq.FL) Proposed (Sq. Ft.) (Gals. I Day 1 Sq.Ft.) , L: I ZooI ZCU J I IL VI. TANK Capacity Fiber Exper. INFORMATION: In Gallons Total # of Manufacturer's Prefab. Site Steel - Plastic App New Existing Gallons Tanks Name Concrete Constructed glass Tanks Tanks Septic Tank or 'Z I ' • (((,A }/\ Holdin Tank Lift Pump Tank! �Ll ( ( t �(.yM 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) aappMngtarsectlonCebove Owner's Signature(s): (No Stamps) MPIMPRSW No: Plumbers Name: (Print) It applying for section A ae) above Plumber Si tore: Q Stamps) / R93 Ms C ≤ p" v ¼Business Phone: Plumbers Address: (Street, City State, Zip e) Home Phone: ---ingt-t -S L. R o E;.lv w�4z <--- �11S.3 Qcv�'B VIII. COUNTY I LErRt lmcry r .+o= �+��• ❑ Disapproved SaniPermit pproved ❑ Owner Given Adverse Determination tary .hEA\'5 ( ip/&u ;n sac /ol'Ctln Bayfield Co Zoning Dept. Agent's Signature I uate: 4 on CS -S 00106 BAYFIELD COUNTY Zoning District SANITARY PERMIT APPLICATION Lakes Class I. APPLICATION INFORMATION Soil Test County , d 2i 6 (Please. Print All Information) No: Permit No:O1' Property Owner's Name: SUSAN M. • cQ L-(uI m , S ` County: Bayfield Address of Property: Property Location: //r��,,,, / /� IL 4LI51 5 G - C48LE CA" Ja-� Y, Y.. S 01 T43 N, R O1 W Property Owner's Mailing Address: Township: Gov. Lot#: 10303 Suo `lAi^6 Aye a City, State Zip Code Phone Number Lot # Block #: CSM #: CSM Doc # Subdivision Name M I VS M"z r L- 3'3 cb Ib2q II. TYPE OF BUILDING: (Check One) ❑ State Owned Tax ID#: ❑ Public (Explain the use/purpose ) J rJ Say Li I or 2 Family Dwelling - No. of Bedrooms Ill. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) ❑ New ❑ Replacement ❑ County Private Interceptor 9 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 Rate 5. Perc. Rate 6. System 7. Final Grade Per Day Required (Sq.Ft.) Proposed (Sq. Ft.) (Gals. / Day I Sq.Ft.) (Min. Inch) Elev.(Feet) Elev. (Feet) VI. TANK Capacity Fiber INFORMATION: In Gallons Total Gallons #of Tanks Manufacturer's Name Prefab. Concrete Site Constructed Steel - glass Plastic Exper. App. New Existing Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank / Siphon Chamber VII. RESPONSIBILITY STATEMENT: I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Owner'sName(s): (Print) If applying for Section C above Owner's Signature(s): (No Stamps) Plumber's Name: (Print) If applying for Section A orB) above Plumber' Si turn: Stamps) MPIMPRSWNo: Y(&.t c. s.,t,L:,J 0 6Tr93 Plumber's Address: (Street, City State, Zip de) Home Phone: Business Phone: VIII. COUNTY I DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit/Transfer Fee: Date Issued: Issuing Agent's Signature / Date: ❑ Approved ❑ Owner Given Initial Adverse Determination IX. CONDITIONS OF APPROVAL! REASONS FOR DISAPPROVAL: D ECk0�1[ Plot Plan on reverse side Bayfield Co. Zoning Dept. D flU Lot Line APR NL7 Bayfield Co. Zoning Dept. J��Id I lk Z(� twt)& (,Go L�r~ A j 50 Y jIf) fA� Name of Frontage Road t-, 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. IMPORTANT DETAILED PLOT PLAN 3. Show the location of the well, septic tank and drain field. IS NECESSARY, FOLLOW STEPS 1-7 (a -o) COMPLETELY 4. Show the location of any lake, river, stream or pond if applicable. 5. Show the approximate location of other existing structures. 6. Show the approximate location of any wetlands or slopes over 20 percent 7. Show dimensions in feet on the following: a. Building to all lot lines b Building to centerline of road c. Building to lake, river, stream or pond d. Septic / holding tank to closest lot line e. Septictholding tank to building f. Septic / holding tank to well g. Septic / holding tank to lake, river, stream or pond h. Privy to closest Jot line i. Privy to building j. Privy to lake, river, stream or pond k. Drain field to closest lot line I. Drain field to building m. Drain field to well n. Drain field to lake, river, stream or pond o. Well to building Submit To: Bayfield County Zoning Department, PO Box 58, Washburn, WI 54891 u/forms/sanitary/bayfieldcountysanitaryappl ication Revise: June 2018 Proofed by: PRIVATE ON SITE WASTE• TREATMENT SYSTEMS �sconSYn ( POWTS) Department of Commerce INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION Personal information you provide may be used for Pe It Holder's Name: •Lev Ali CST B Elev: I Insp BM Elev: ;•a*rr! WITtNOMAATIr kl ses I Privacy Law, s. 15.04 (1)(m) ] O City , O Village `Town of: M Descrlpdon TYPE MANUFACTURER CAPACITY Septic Q Dosing ' 1 Aeration Holding iJill /�Vftli!1LIl 1L119aI!Jtit'A\U{a1►0 TANK TO P/L WELL BLDG Tp° ROAD Septic 1 7/'NA Dosing L(' Sp -I- J, i '41 NA Aeration NA Holding PUMP I SIPHON INFORMATION Manufacturer Q?j Demand 30 GPM Model Number 2, TDH A41 fJft Friction Loss System Head TDH4v.13 3 Forcemain Length Di Dist. To Well , IIIG`QG OCAI .VI I IIVIrI IiditIILI I It III — DIMENSIONS •• _- — _ ____ Width _ _ Length Noof Cells Lf SETBACK P/ L Bldg Well W W of Nav INFORMATION/ CELL TO 1- 'OD /-1 /5o #7i DISTRIUUTIUN SYb I ttw Header! anjfold Distribution Pipe(s) Length I t DIa Length Dia SOIL COVER Depth Over Depth Over ii Depth of Cell Center J Cell Edges Topsoil COMMENTS: (Include code discrepancies, persons present, etc.) r —O P. tTj'e r LA i c Avt', •L4. N � � E2�(ow S w. rsc\'y O\O.'/ 7 eoo a�A C -en v rv� Hpc- h `�'av►� a o Qer Plan revision required?❑ Yes No I/c' ? Io /1.i 7 Use other side for additional Information Date POWTS Inspector's Signature Bureau of Field Operations, PO Box 7302, Madison, WI 53701-7302 SBD-6710 (R.3/01) ELEVATION DATA County Sanitary Permit No: O7-caitS State Plan Transaction ID#: Parcel Tax No: STATION BS HI FS ELEV Benchmark 18. J7.5 Jo Bldg. Sewer 7.55 .7/. 3 St/ Ht Inlet 71.73 St 1 Ht Outlet Dt Inlet a7, Dt Bottom - 31,5 ° . d o Installation Contour Header / Man. Dist Pipe Infiltrative Surface 6.(75 f1 t 0 6a Final Grade /1 1.D j,. i6 Type of System Manufacturer. LEACHING s (.j" ' CHAMBER Model Number: X Pressure Systems Only X Hole Size X Hole Observation Pipes Spacing Yes O No Seeded 1 Sodded ❑ Yes JR No,—;'s;:c ctj ❑Yes ..No L3H 'I] CenNo eL V d. 10303 S.W. 7,r Ave S.� c�) ts�0 3-791 a (00 Ta' uoe.. Lt_ f1�.cP -22.I,a tto to, ( t� e i0 r Its `� (4) 3"x 4o' C.LL wl E- -' F % oV►J VJw'k R) .. ,vv.1.� APPROVED 'V' iF o 'OUNTY A Wet_ ± 2S0' —zto I,,6_ 4v 1 P--YFIELD Bayfield County Planning & Zoning Department 117 E 5th 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 -00108 Transaction Number: CS-00108-28F7E Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 8039 Paid by: SHEEPFARM CONSTRUCTION LLC, 77794 HILL RD, GLIDDEN, WI 54527 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 [07-211S] SIGN - SPECIAL - CONDITIONAL - BOA - No. 25-0192 Tax ID# Location: Section 7 & 12 Township 43 in Doc # 2008R-522245 CSM#1629 BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION 35344 Issued To: Susan M Racher Livi N. Range 7 & 8W. Town of Cable Residential Structure in an R-1 Zoning District For: Sanitary Reconnect to 1 1260 -gallon & 1 760 -gallon Rasmussen Combo Tank Trust li?f..(-1. lln,t-li! Aiiy I-)ohr- (- (" -Ions of dev(�k)lltii-l-) would If gUlrt 'dHldItlrjnaI permiflirig Condition(s): To meet all setbacks. To be constructed per plan. Adhere to privy agreement. 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 4/25/2025 Date