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HomeMy WebLinkAbout25-0842BAYFIELD COUNTY Zoning District CS-ooi3l SANITARY PERMIT APPLICATION Lakes Class I. APPLICATION INFORMATION Soil Test I County a1 5- 0 (Please Print All Information) No: Permit No: d Property Owner's Name: County: Bayfield ece.1& E 4 mU 1 IN Tahn in Address of Property: Property Location: 6C,695 NGc4 L..Ke Rd ENTERED '/. '45 =) T L)'7 N,R O8 €E—(er W Property Owner's Mailing Address: Township: Gov. Lot #: LG535 14er+ LcKe Rd Iron Raver City, State Zip Code Phone Number Lot # Block #: CSM #: CSM Doc # Subdivision Name r Ivey, WV 5912Y7 PLAT OF II. TYPE OF BUILDING: (Check One) - 117 ELLENWOOD ❑ State Owned Tax ID#: O g a3 RECEIVED a ❑ Public (Explain the use/purpose ) o' 1 or 2 Family Dwelling - No. of Bedrooms 3 NOV 1 4 2025 Ill. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) Baeld Co. A) ❑ New ❑ Replacement ❑ County Private Interceptor Planningy; a:a-:....: ,.-nc, Reconnection ❑ Repair ❑ Revision ** ❑ Transfer of Owner (List Previous Owner below) B) Ex A Sanitary Permit was previously issued. Previous Permit Number. I9' (s° Date Issued: 09/6q/9S 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 I 3. Absorp. Area 4. Loading Rate I 5. Perc. Rate I 6. System I 7. Final Grade Per Day Required (Sq.Ft.) Preposed (Sq. Ft.) I (Gals. / Day / Sq.Ft.) I (Min. Inch) I Elev.(Feet) I Elev. (Feet) ysb Tao 7Zo e)r.3&; a. Gas <lO 4Y.► 99.00 VI. TANK Capacity 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 Holdin Tank I0 — 1000 1 RCSMO55En5 K' Lift Pump Tank / o9 j' jpC& 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 SectionCabove Owner's Signature(s): (No Stamps) Plumber's Name: (Print) If applying for Section A or B) above I Plumbe' ignature: (N Sta MP/MPRSWNo: Yrnv;p E3•.++e r A, . f/ OS a e3-7 9 Plumber's Address: (Street, City State, Zip Code) Home Phone: Business Phone: ) 3 WSiat d77 I-Wa wcrd,WX 5Y3 7!5-634-S17Cv 7/5-43Y- 8176 Vill. COUNTY! DEPARTMENT USE ONLY A] Approved ❑ Disapproved ❑ Owner Given Initial F Sanitary Permit/Transfer Fee: Date Issued: Issuing Ag is Signature / gate: /1 1%Ozb✓ Adverse Determination I IIU'i 17r -s on rever5A Lot Line RECEIVED NOV 14 2025 Bayfield Co. - Planning and Zomn9A©eRcy - _ .. LkC &4 p aer' Pv„n S ya`e� G q 4 ivaInc ui rwnraye nudu . ./ 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 i. Privy to building b Building to centerline of road j. Privy to lake, river, stream or pond c. Building to lake, river, stream or pond k. Drain field to closest lot line d. Septic / holding tank to closest lot line I. Drain field to building e. Septic/holding tank to building m. Drain field to well f. Septic / holding tank to well n. Drain field to lake, river, stream or pond g. Septic / holding tank to lake, river, stream or pond o. Well to building h. Privy to closest lot line Submit To: Bayfield County Zoning Department, PO Box 58, Washburn, WI 54891 u/forms/sanitary/bayfieldcountysanitaryappl ication Revise: June 2018 Proofed by: PLoi \\ i y ++P.r G 4ch 40 AS, A F89I c) r / (To Conn6eh ke ew:y> I.vt l SCAL€- io JS vo S -o eo s I t t I- Gc059S HART LAKCAD Lor 17 f LATor. ELLENt+.1oCrD Scc., T'17N, Ro8W RECEIVED To -s aF lran Rc.-er 13ny Cr Id Coin.#y NOV 142025 rn<x ,fit o1Qaa3 Bayeeid co. Planning and Zoning Agency BM: M&J w / Rb�n l°I' Rea 2 'z = 100. °o CF Ekv. (5cme he,yh#- a5 prev;ovs aM (�c°Qer3y Owntr 5'. c>sc\LE4 [ ly Ml 7vhnSo7 1 r .',; o 13�sa97g 1� 3 0 Private Sewage System Maintenance Agreement Owners) Name 7 cAn So 17 EAereYt E + Errs: iy 11 •YchnSc,n 6$'9S l-i&r4' Lc)4c Rd IaAruff Z)osa3 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with roles established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal Is required) 1/4 of 1/4 Section JZl Township -y 7 N. Range OS W Additional Legal Description: Doe- ' O'ata- SA7599 Town of Ica.. (k; g e r (Acreage) 3.Q13.tO Gov't Lot LotI, Block Subdivision PLAT OF ELLENWOOD Lot _ CSM # Vol. _ Page _ CSM Doc # DOCUMENT NUMBER 2025R-609995 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 11/14/2025 AT 1 1 :25 AM RECORDING FEE: $30.00 PAGES: 1 Return To: Planning and NOV 172025 Bayfield Co. nning and oning Agency In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: El Mound ❑ At -grade Sewage System ❑ Other Area Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1)3) of the volume occupied by sludge and scum. Pump Chamber (system types B. C, 0, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds Atarade and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is Inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided bylaw. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s)—Please Print 1 �yoh��, D��, ©i Subscribed and swom to before me on this date: a�emb" 13, 2025 �uamr P �• .. Notarized Owners) — Signature(s) N ubllc oti s}} 49nw JCb4 s y Comm res: s �.• Drafted by: QDate: 11 / i3 I as i-. sGO�ya Proofed by: u/forms/sanitary/septicmaintenceagreement Revised July 2020 A FIELD 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: Submission Number: CS -00139 Transaction Number. CS -00139-38813 Description Amount Private Sewage System Reconnection $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 22831 Paid by: Sipsas Excavating & Trucking 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 - SAN ITARY - Reconnect SIGN - SPECIAL - CONDITIONAL - •1 BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 25-0842 Tax ID# 20823 Issued To: JOHNSON, DEREK E & EMILY M Location: Section 22 Township 47 Range 08 Town of IRON RIVER Legal Description: PLAT OF ELLENWOOD LOT 17 IN DOC 2021 R-587599 Residential Structure in R-1 Zoning District For: Sanitation Permit — Reconnect (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): 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. Tracy Pooler, AZA Authorized Issuing Official November 17, 2025 This permit may be void or revoked if any performance conditions are not completed or if any prohibitory conditions are violated. Date