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HomeMy WebLinkAbout25-0329BAYFIELD COUNTY I zoniigbistrict SANITARY PERMIT APPLICATION Lakes close Properly Owner's Name: - _ - i'1 !S / n MkQt County: aPR 272 �ll Bayfield Address of Pro arty: L,fs Yg— Property Cocain: ' / ri d % /+, S T.il N, R E (or) W Property Owner's Mailing Address: Township: Gov. Lot #: '3.m Ste mc hr. City, State Zip Code Phone Number Lot # Block #: CSM #: CSM Doc # Subdivision Name 2) c ,b'PK' WL 2'?3V9-9 3 - y a€- aPu 3i2 c c II. TYPE OF BUILDING: (Check One) V.?ez Z Q ❑ State Owned Tax ID#: ❑ ublic (Explain the use/purpose ) LS 1 or 2 Family Dwelling - No. of Bedrooms O btPE.OFPERMiT (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. Date Issued: IV. TYPE OF NON -PLUMBING SYSTEM: (Check One) Replacements need previous permit number and date nlledldutaboye C) 'Pit Privy l(J/ Vault Privy (Vault size: allons or / cubic yards) zD ❑ Portable Privy ❑ Camping Transfer Unit Container ❑ Composting Toilets ❑ Incinerating Toilet V.ABSORPTION SYSTEMJNEORMATION: 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 / Sq.FI.) (Min. Inch) Elev.(Feet) Elev. (Feet) rr. annn: <- Iapncny ' Fiber INFORMATION: In Gallons Total # of Manufacturer's Prefab. Site Steel - Plastic Exper. New Existing Gallons Tanks Name Concrete Constructed glass App. Tanks Tanks Septic Tank or Holding 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) itapplying far Section Cabove I Owner's Si et e(s): (No Stamps) /t4&J e: / !a,/) / lyLOG�G /-'A /%/E' P'r' I 2 Plumber's Name: (Print]if applying for Section A or a) above F Plumber's Signature: (o Stamps) I MP/MPR W . ,Vill:'.COUNTY:/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit/Transfer Fee: Date Issued: Issuing Agent's Signature / Date: Approved ❑ Owner Given Initial r'-' �{- _ _ Adverse Determination /L!/ Z5 R NSy4 ,iA1?PR0VAL /;RE%ASONS FOR'DISAPPROVAL: + "(v7 Vca x , n,mu rr c# ZGc� c Gt tkAfi c T t1 11 1,u 1 GIGt trams+ AU C(�l tins- of 57 ! ytrfi�l cllrnUl"` .s rt/(6c Ti(A d ,lncltcc�t `'VGyop cif on reverse side cm BAYFIELD COUNTY SANITARY PERMIT APPLICATION Zoning District Lakes Class 1; APPLICATION INFORMATION Soil Test County (Please Print All Information) No: No: Property Owner's Name: Rlul l R b'' f6c /i7 County: Bayfield ail/ d, �r Address of Pro eerrrtty::nn,' d�gerr DE/ Prope cation: �` �1{i�l?/c b/ Part. d. a 1/4 Ba field'&'oSZoning D€pi N, R E (or) W Property Owner's Mailing Address: Township: Gov. Lot #: /33s5 See -4, r. City, State Zi Code Phone Number Lot # Block #: CSM #: CSM Doc # Subdivision Name ct file WL 2/S -3 - p l /2os V? e ZR, W3R d Q 3 E OF BUILDING :'(Check One) ❑ State Owned Tax ID#: ❑ public (Explain the use/purpose ) /J q' 1 or 2 Family Dwelling - No. of Bedrooms O ,. PE 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. Date Issued: AV.TYPE YPE OF NON PLUMBING SYSTEM: (Check One) * Replaceme ;,M previous permit number and date filled out above C) APit 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 / 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 Holding Tank Lift Pump Tank / Siphon Chamber RESFffiu1ITY STATEMENT: I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Owner's Name(s): (Print) If applying for Section C above Owner's Si at re(s): (No Stamps) Li -hat / 4-4/ Eot6c/I7e er Plumber's Name: (Print] If applying for Section A or B) above Plumber's Signature: ( o Stamps) MP/MPR W . Plumber's Address: (Street, City State, Zip Code) 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: Plot Pion on reverse slae Lot Line 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. Septic/holding tank to building f. Septic / holding tank to well g. Septic / holding tank to lake, river, stream or pond h. Privy to closest lot 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/fors/sanitary/bayfieldcountysanitaryapplication Revise: June 2018 Proofed by: I S'urrN fo t a4 rm, yr I / ≤ wv eJ J f J -.l ne 330 j� APR 2 3 2025 �PiVew¢v4 CCo/ F,ela ,(oT/ip€ 7 /�i PRIVY AGREEMENT (ATTACHED TO THE SANITARY PERMIT APPLICATION) DOCUMENT NUMBER 2O25R-6O7259 Owner(s): 1/4, 1/4, S 3 T ,$4N, R UO W I I Lot # I CSM#Set Vol & Pace I/ 9-76 CSM Doc. #. Return To: # Date: 1. NO PLUMBING will be installed in the habitable building. DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 04/23/2025 AT 1 1 :33 AM RECORDING FEE: $30.00 PAGES: 1 H fltllVED APR 2 3 20?5 Bayfield Co. Zoning Dept. 2. NO PLUMBING includes: water closets, sinks, bathtubs or showers, laundry facilities, or any other fixture or receptacle receiving domestic waste, will be installed in the premises served by the privy unless a code compliant soil absorption system or holding tank exists, or a valid sanitary permit to install such a system has been issued. 3. A privy vault I pit shall maintain minimum setbacks as specified in Table 1. Table 1 Well Building Lake /Additional County Setbacks Stream OPEN PIT 50 Ft. 15 Ft. Min. 75 Ft. SEALED VAULT 25 Ft. 15 Ft. Min. 75 Ft. 4. Privies for public buildings shall comply with SPS 353.63. 5. Privies used for one- and two-family purposes shall be constructed in such a manner so as to exclude flies, rats and other vermin. Doors should be self -closing and vault ventilators should terminate at least one foot above the roof. 6. Privies as per SPS 391.12 (1) states as follows: (a.) The storage chamber of a vault privy shall conform with the requirements of s. SPS 384.25 relating to holding tanks and shall have a minimum storage capacity of 200 gallons or one cubic yard. (b.) The storage chamber of a pit privy shall be sited and located in soil recognized to provide treatment and dispersal in accordance with s. SPS 383.44 (4)(b). 7. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR 113, Wis. Adm. Code. 8. This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the Register of Deeds in a manner, which allows its existence to be determined by reference to the property where the privy is installed. Printed Owner(s) Name(s) i Ow er(s) Signature: w This instrument was signed before me in the State of r s C,O' V`Slh County of BGLk�\ On this,,.. _day , 20�� by:� Notary Public[ My commission expires on: ()3-011-202 Drafted By: /^I drib 4€J ! ) (must be filled out by person submitting form) Notary Public f © December 2012 u/forms/sanitary/privyform -©October 2019 `` State of Wisconsin P -L 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 County Sanitary Permit: 1 Submission Number: CS -00110 Transaction Number: CS -00110-2967F Amount $150.00 Total: $150.00 Payment Amount: $153.57 Reference: 9842527165 Paid by: Michael Kahl 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 - Privy SIGN - SPECIAL - CONDITIONAL - BOA - BAYFIELD COUNTY iii :1►, WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 25-0329 Tax ID# 13497 Issued To: Michael Kahl & Roberta Meyer Location: NE '/4 of NE 1/4 Section 13 Township 46 N. Range 8 W. Town of Delta in Doc # 2023R-600703 Lot 1 CSM# 1205 Privy in an R-RB Zoning District For: Sanitation Permit Vaulted Privy (200 gallon 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 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 May 30, 2025 Date