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HomeMy WebLinkAbout25-0211Cs -0010(o 13AYFIELD COUNTY SANITARY PERMIT APPLICATION irr'vss l tt'rley DoY? r./)Svt� !dress of Property: wogs & i*•; r /%,y IPerty Owner's Melling Address: z.372Z/?r /,nq 1-L// Rd, State Owned Public (Explain the use/purpose I or2 Fams., rwsu:... ._ County: ZONna blaw'lct �— Lekes Class 2�-0211 Baynold NWT 5W KS /j T 43 N,R 3wnshi— p: — Gov. Lot A: Cable H tt Blodc # CSM #: CSM Doc II ix lD#: $6 ys New O Replacement [Ti County Private Interceptor EN Reconnection Repair Revision " Q Transfer of Owner (List Previous Owner below) B) A Sanitary Permit was previously issued. Previous Permit Numbar.Vo3qQ7 Iv. TYPE QF MnMsnnes,. Data lsstred C) ❑ Pit Privy Vault Privy (Vault size: _gallons or _cubic yards) ❑ Portable Privy O CampingTransferUnit Container ❑ Composftng Toilets matrons 2. Absorp. Area 3. Absorp, Area 4. Loading Rafe 5. Pere. Rats Per Day Required (Sq.Ft.) Proposed (Sq. Ft.) (Gels. / Day/ Sq.Ft.) (Min. Inch) ions I Total tot Manufacturers Prefab, Site EzistinFi Gallons Tanks Name Concrete Construe Tanks /oGp / RA .nos yy V- jansmes): (Pant) St goplying for SOcaon Cabove Rc V LIPML.Y OvNees vscvY barb Name: (Print) uegolying to, s., w r.. s/ otme Plug -0LWN/3 AS+�iussc7V C� bars Address. (Street, Clty State, Zip Code) 5y:i l 4 2c s KavkWAUG,a RD . Ct,9[c, . tN/ on 7rs -Sho-o : s4 ❑ Incinerating Toilet 6 .System Elev.(Feet) 7. Final Grade Elev. (Feet) erl Steel Fiber glass Plastic Exper. APP' Ill -ft1 stnesa Phone: 7/S 'J �C 'c'd.$i U Disapproved Sanitary Permll/Transrer Fee: Date Issued. Issuing Agent's Signature / Date: JRY Approved ❑ Owner Given Ininal 15o°_ s Ljt ZZI wr Given ,{ IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 'lL o ;m,4- tsst�4 {cr z e)R -,k,t 3 SR _&Ljjjef. was oadiRNi ) IAw% h ,.Ptt er ,v(bwl-i ftc-'- c -'- au PAcLtlrlxeto a c on cs- ool0c ______ SANITABAYRY FIELD COUNTY Zoning Disoltt I f PERMIT APPLICATION �, _ii±1I. APPLICATION INFORMATION � 3 (Please Print All Information) Soil lest nit Property Owners Name/: � No: Permit No: /t' j4% 1rr'�ss'r77re Dunca/uoi? County: Address of Pro Bayfield � � Pm /b Off L�>cfro'Tr /fWY y Property Location: Property Owners Mailing Address: ss�. '� S i$ T y. N, R o7 X(orS -3722 /fO,/,/./,//, fedr Townshihip: Gov. Lot City, state C ble Zip Code Phone Number Lot # Block #: CSM #: CSM Doc # Subdivision Name Le ,� n N Y'sz I1. TYPE OF BUILDING (Check One) II 7c<, ❑ State Owned Tax ID#:; q ❑ Public (Explain the use/purpose — t 1 or 2 Famil Dwellin - No. of Bedrooms ? Ill. TYPE OF PERMIT: Check onl one box on line A. Check box on line B. if a iicable A) ❑ New ❑ Replacement �1�s1 ❑ County Private Interceptor In Reconnection ❑ Repair ❑ Revision " ❑ Transfer of Owner (List Previous Owner below) B) ❑ A Sanitary Permit was previously issued. Previous Permit Number. IV. TYPE OF NON -PLUMBING SYSTEM: (Check One) ' Replacements need previous Date issued: �_ permit number and date filled out above C) ❑ Pit PrM,' ❑ Vault Privy (Vault size: _gallons or _cubic yards) ❑ Portable Privy ❑ Camping Transfer Unit Container Composting Toilets ❑ P 9 ❑ Incinerating Toilet V. ABSORPTION SYSTEM INFORMATION: 1. Gallons 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pore. Rate 5. System 7. Final Grade Per Day Required (Sq.Ft.) Proposed (Sq. Ft.) (Gals. / / S FL so Day q• ) (Min. Inch) &1v (Fee() Elev. (Feet) VI. TANK Capacity INFORMATION: in Gallons Total it of Manufacturer's Prefab. Site New Existing Gallons TanksFiber Tanks Tanks Name Concrete Constructed Steel - Plastic der• Septic Tank or glass App. Holdin Tank /0000 / 1�AnQs✓ ✓ Lift Pump Tank / Si hon Chamber VII. RESPONSIBILITY STATEMENT: I the undersigned, assume responsibility for installation of the onsi a wage system shown on the attached plena. Owners Name(s): (Print) #epply)ngrorsr ,caboro Rcs , S/ � 2lner s Signature(s): (No Stamps) NeY ��Nc<a:vscay Plumber's Name: (Print) lisypryhgrorsasm,Aoreiabove Plu er'sSi net ..Q_7vnr/S r9 (No Stamps) MP/MPRSW No: P/umber's Address: (Street, City State, Zip Code) � L/Si 6 4! 2c'Ly KSvd'V4UGr4 RO . 5•Y`d z l Home Phone: Business Phone: CQ.3CE 1N 705 -Sfs[ -6Z c.4 7/S- -.5430 ci4S-} VIII. COUNTY! DEPARTMENT USE ONLY Disapproved Sanitary PermiKTransfer Fee: Date Issued: Issuing Agent's Signature / Date: ❑ Approved ❑ Owner Given Initial Adverse Determination on reverse BAYFIELD COUNTY APk 15 2025 SANITARY PERMIT APPUCATION f'.n 7 ini' .. n fl.Jfl naPUation) $l (Pleas0 Print l Sell Test County / G 3 JOB ame:Uon) Property Owners Neme: mrs No: Permit No: Moss �•� O(J/1C.�II.�f� County: Bayfsid Address or Property; Property location: 16095 &'ciwT' 4WY /4 MI'/. SW %.S /5 T 43 N.R o/t'i Property Owners Mailing Address: Township: I Gov. Lot K: L37Z2 /?o//,n 14,// RJ, Cnble City. State Code I Phone Number 1st A elodt 1: CSM 01.. CSM Doe tf Subdlvlalon Name I L , n t.tjN SVSZ. I / II. TYPE OF BUILDING: (Check One) Tax ID#*. gG 9S State owned ❑ Public (Explain the uselpurpose l or 2 Famtl Dweliln - No. of Bedrooms 3--j iii. TYPE OF PERMIT: (Check only one box on line A. Check box on line B N icabie _ {I 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 filed out above C) ❑ Pit Privy ❑ Vault Privy (Vault sae: !gallons or _cubic yards) ❑ Portable Privy ❑ Camping Transfer Unit Container ❑ Composting Touts ❑ Incinerating Toilet V. ABSORPTION 1. Gallons SYSTEM INFORMATION: I 2. Absorp. Area yste Feet) T. EFinalGrade I 3. Absorp. Area 4. 5. PMin. Inch te I 6. System R (Feet) Per Day Required (Sq.Ft.) (Gals.Loding Sq.FL Proposed (Sq. ) ) ( ) MFORMATION: in Gallons Total Gallons a of Tanks Manufacturer's Name Prefab. Site Steil F.er Plastic tot Concrete Co trusted g App. New Existing Tanks Tanks Septic Tank or / oeap y Rn>r7lis;v Holding Tank LiftPump Tank J SCt)on Chamber VII. RESPONSIBILITY STATEMENT: I the undersigneo. assume responWDstty Tor InswsaIAn yr ur. u.vner� q I a Name(s): (Print) wswyagWS.awmC.bon V C'- .v wE r QvNc Mf SCW Plumber's Name: (Prim) sypragFs5.camAarajstova Pfury .IDt.7VN/3 RAsewssaw Plumbers Address: (Street. City State. ZJp Code) Svv'z i 4 2c:.:y K'v"Aauc,J RD C o9Cc, N// Vlll. COUNTY I DEPARTMENT USE ONLY Disapproved Sanitary Pam ❑ Approved ❑ Owner Given initial Adverse Detem nation 7•s -9z≥o-G.=54 Fee: I Date Issued: Business Phone: 7/s '5s'o I r*' V C' BAYFIELD COUNTY CERTIFIED SURVEY MAP LOCATED IN THE NW 114 OF THE SW 114, AND THE SW 114 OF THE SW 114, ALL IN SECTION 15, TOWN 43 NORTH, RANGE 7 WEST. TOWN OF CABLE, BAYFIELD COUNTY, WISCONSIN. s& i)ci:. . I .%:4/-. •''. y I o'�i S P a- 1992 i;1 :, •% I r.. ; •'7 : L...z,fil,ZveL !".rt,:cv } 1 ` 1 t i NORTH REFERENCE TO I. THE WEST LINE OF SECTION t5. 16 IS 21T22. —s es• 2S• XM,r. k ELENA O e I I/4" r3O" LP, WEIGI US LBS PER LML PT. • • PD IRON mom# mr -s es.?S•I6'•E as:• `x'-200: 1 0T I 1 , 3972/ SO. FT. 0.91 ACRES ro MEANDERLINE vavr 0 S3S9? so. FT. L23 ACRES: TO WATERS EDGE 1 TAM O 3 S4's A --lg� SURVEY LARRY T. KELSONL itLS - 1278 amn s,w eaaseruo NELSON SURVEYING r. so• AND a sao� ENSINEE uus. INC. �� •.��: WisconsinD emofS epartm efetyBProfessional Services Division of Industry Services '; + SOIL EVALUATION REPORT Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must Include, but not limited to vertical and horizontal reference point (BM), direction end percent slope. scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. I SR-0OL Page f of 2 AxLS. . 49S I.D. 04--0/2- ? Personal Information you provide may be used for secondary purposes (Privacy Lew, a. 15.04(1)(m)). I I V'i / Property Owner Property / ,/ Property Location ❑t y Ross &w Ne Zv'vcX/Uscw Gov#. Lot N Y.. y. $ /S T 43 N R O7 (or W Property Owner's Mailing Address Site Address or CSM and Lot # tor C61 77 231Z2 Rom u lIitcs RD /6Oeou4rY (1L( P4 City, State, Zip Phone Number ❑ city ❑ Village ES Town Nearest Road /a.asTDN MN ( ) CASCT/f M ❑ New Construction Use:❑ Residential/Numberofbedrooms _,3 Codededveddeslgnfowrate, 45O GPD ❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable f. Parent material G^LSGJSL eVrWoP(Qt <i�con�iV,EGi General comments and recommendations: © Boring# Boring ©Pll 87 Ground surface elev. 99.Z f1. Depth to limiting factor�in. / elev. g? 1 t Sail Annlloadon Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cant. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Recta GPD/Ft •Eff#1 • fr#2 I ci -4 YA 3/s NA .s 2 s , v 2 4-/4 Yk NA s 2msMk m i >,.tp - •t •9 14-32 "y hd O≤c my/v 1/ — i7 /.Z n-3 d Y/! IVA /(S 2e Sb x M C !• Z 3$. 71. 5YR NA eS 6 rn - - ,1 (, ❑ Boring # Boring ❑Ph Ground surface elev. ft. Depth to limiting factor in. I elev.,lr. sole Abdication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 •ENk2 CST Name (Please Print) Slgnat CST Number Z��llo Address 4z5 aV/) ) d e , Data Evalu tion Conducted 04122 'Z Telephone Number 7/S G-dz a / 7TD4( Effluent#1=BOD> 30 s 220 mglL and TSS 3D511550 mg/L • Effluent 02- BOD,s 30mg/L and TSS s 30mg/L Po So •cc 3oI as SBD-8330 (R03122) 2�2 ♦tom t'1W .4 '� 1 W. :s18z/ 1oT 1 eY 77.. NW Slit,/ S/., 743M '.7W reiX3,1:dd e94YPieio e. Liz /4' fLs Aw tt?Bf g$ 0 dye J'AAA/ ,l AkE \ \fl S h P7 , c4 vr ® �Shcg I°' Pi4e 2 Z2// 4 E 7i FYFIELD 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 -00106 Transaction Number: CS-00106-28EDE Amount $50.00 Total: $50.00 Payment Amount: $51.95 Reference: 3519087875 Paid by: Ross Duncanson Payment Type: Debit 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 [163905] SIGN - SPECIAL - CONDITIONAL - BOA - BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 25-0211 Tax ID# 8695 Issued To: DUNCANSON, ROSS E & CORTNEY A Location: Section 15 Township 43 N. Range 7 W. Town of Cable in Doc # 2025R-606142 Gov't Lot Lot 1 CSM# 766 Residential Structure in an R-1 Zoning District For: Sanitary Reconnect to 1 1000 gallon Rasmussen Tank (Disclaimer): Any future expansions or development would require additional permitting. 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 CeCe Rudnicki work or land use has not begun. Authorized Issuing Official 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. 4/30/25 This permit may be void or revoked if any performance conditions are not completed or if any prohibitory conditions are violated. Date