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Home My WebLink About25-0869BAYFIELD COUNTY I Zoning District SANITARY PERMIT APPLICATION Lakes Class CS-OOj4J- I. APPLICATION INFORMATION Soil Test I County [`, (Please Print All Information) No: Permit - No: J D Property Owner's Name: c,her'cYL ?cc-fcbr-' - K41JF6X_ County: Bayfield Address of Property: Property Location: So) O 13L' -c.'- 17"- . ft'�+ksor+, W St % SW %, S 3-3 T '16 N, R o -) E (or)'C) Property Owner's Mailing Address: Township: I Gov. Lot #: /V 36i C I' "Lb L- 1>ELTh- City, State I Zip Code Phone Number Lot # I Block It: I CSM #: CSM Doc # I Subdivision Name ELL5wc211-r,1rir Syot' 4s. -en II. TYPE OF BUILDING: (Check One) ❑ State Owned Tax ID#: RECEIVE LiPublic (Explain the use/purpose ) 3 1 H H .. ENTERED ® I or 2 Family Dwelling - No. of Bedrooms / 1 III. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) ❑ New ❑ Replacement ® County Private Interceptor Bavbeid Co. Plannin•' and L. ,rrs A, ❑ Reconnection ❑ Repair ❑ Revision " ❑ Transfer of Owner (List Previous Owner below) B) X❑ A Sanitary Permit was previously issued. Previous Permit Number? Z7 z2'( Date Issued: S/i /9 i 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 I 4. Loading Rate I 5. Perc. Rate I 6. System I 7. Final Grade Per Day j Required (Sq.Ft.) Proposed (Sq. Ft.) (Gals. / Day/ Sq.Ft.) j (Min. Inch) I Elev.(Feet) I Elev. (Feet) 7So J)d 7Z /080 I o.>I �H•dI 87 VI. TANK Capacity INFORMATION: In Gallons Total Gallons # of Manufacturer's Prefab. Site Steel Fiber - Plastic Exper. New Existing Tanks Name Concrete Constructed glass APP' Tanks Tanks Septic Tank or Holding Tank 80 o /600 Z r(A-VA-Vold X 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's Name(s): (Print) If applying for SectionCabove Owner's Signature(s): (No Stamps) Plumber's Name: (Print) If applying for Section A or B) above Plumber's S' attire: (No tam s) MP/MPRSW No: t}So? ILvetnL_ (�S7t Plumber's Address: (Street, City State, Zip Code) ome Phone Business Phone: 90 f7ox, l cv431t, Nr SY -Zt S i5t -33SS VIII. COUNTY I DEPARTMENT USE ONLY Approved ❑ Disapproved I ❑ Owner Given Initial Sanitary Permit/Transfer Fee: C 0. oo Date Issued: a./ b/ I Issuing Agent's Signature /JOat /y/�� j Adverse Determination ba-. /a3�i3 IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: — Grr7f�i. q vna1 Use yevm.1 r�%rwr � cA- .2./ Dwt//,,c accu/4n y nc> Plot Plan on reverse side Lot Line RECEIVED UEC 12 2025 Bayfield Co. Planning and Zoning Agen Name of Frontage Road ( ) 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 3. Show the location of the well, septic tank and drain field. DETAILED PLOT PLAN 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/fors/sanitary/bayfieldcountysanitaryapplication Revise: June 2018 Proofed by: S ca. e ' /" : '/0' Mason, w=. St(85(o ,Si -708- 9S 7c S/z) sW'4 S33, Ti/(e/`1, (7v') Parcel O/6 -/0L6 -O/ '#03 Town of ,De/'l'4 Bayf,eld Cc,, wz pec.K y"50440 Ex�5fin� PVI. 3 6R Home @) Rasmussen 80o S,Tan Rz5 A BM = tOO' @ goi1om O� wooct s;dcc'vC Mu) Corner of (xQ`v_ (,: ' aoove c4rct, j E I eycL+ on S RECEIVED aI = R 7,0' gz= 8�.5' DEC 122025 3 _ S l� . 4 eayesid co. Planning and Zoning Agency SYsrEau = 8�.0 / tX :.e3a u 63 0 Owe/'t Ig'x (00 Cc',,Q U5G RGyui�<� I1. u" caL 3oay Nc (i ANDRY RASMUSSEN AND SOW P.O. Box 66 Cam,W154821 (715) 798-3355 1,-Jz/z5 12/12125, 9:33 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Today's Date: 12/12/2025 r Description Updated: 6/6/2019 Tax ID: 13144 PIN: 04-016-2-46-07-33-3 04-000-20000 Legacy PIN: 016106603000 Map ID: Municipality: (016) TOWN OF DELTA STR: S33 T46N R07W Description: S 1/2 SE SW IN DOC 2019R- 577657 540A Recorded Acres: 20.000 Calculated Acres: 19.778 Lottery Claims: 0 First Dollar: Yes Zoning: (F-1) Forestry -1 ESN: 110 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 016 TOWN OF DELTA 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE I Recorded Documents Updated: 3/15/2006 ® QUIT CLAIM DEED Date Recorded: 2/25/2025 2025R-606660 0 WARRANTY DEED Date Recorded: 6/3/2019 2019R-577657 O CONVERSION Date Recorded: 611-208;637-135 Property Status: Current Created On: 3/15/2006 1:15:16 PM a Ownership Updated: 3/12/2025 CHERYL] PERRON-KAUFER ELLSWORTH WI Billing Address: Mailing Address: CHERYLIPERRON-KAUFER CHERYLIPERRON-KAUFER N3615 COUNTY RD C N3615 COUNTY RD C ELLSWORTH WI 54011 ELLSWORTH WI 54011 10 Site Address * indicates Private Road 15010 BLACK BEAR RD ® Property Assessment 2025 Assessment Detail Code Gl-RESIDENTIAL G5 -UNDEVELOPED G6 -PRODUCTIVE FOREST MASON 54856 Updated: 8/29/2011 Acres Land Imp. 3.000 75,000 358,300 4.000 100 0 13.000 41,000 0 2 -Year Comparison 2024 2025 Change Land: 116,100 116,100 0.0% Improved: 358,300 358,300 0.0% Total: 474,400 474,400 0.0% Imo' Property History N/A RECEIVED DEC 12 2025 Bayfield Co. Planning and Zoning Agency https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=13144 1/1 Safety and ldins SANITARY PERMIT APPLICATION 201 E.Washn'gtonAve. Division Wisconsin Depa"ent of Commerce In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less county. ,�fl F - than 81/2 x 11 inches in size. t ttiCC • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION P perry Owner Na e y ' 1 _ I..KO WOOd SV1G. !e At-+ 4"c ocL Pro erty Location - s SuJ1/4, S 33 T 4(O , N, R r7 l5kj W Property Owner's Mailing Address LotNumber - Block Number z-- a Box aqs City State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned O i Nearest Road G Public 1 or 2 Famil Dwellin - No. of bedrooms ..J O Town OF b 1t Skc-k Bear Rd . III. BUILDING USE: (If building type is public, check all that apply) - Parcel Tax Number(s) 1 ❑ Apartment/Condo O I (o "-I0lo% - O 1 "03 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs - 11 ❑ Restaurant/Bar/Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office / Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. g Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System Tank Only Existing System Existing System ----------- ------- B) ❑ A SanitaryPermit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21E] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In -Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation '75D lo -7a /O$O % — 84-O • Feet gr7 Feet VII. TANK Capacity INFORMATION in gallons Total Gallons # of Tanks Manufacturer's anu's Name Prefab. Concrete Site Con' Steel Fiber- glass Plastic Ex er. APp New Existin Tanks Tanks strutted Septic Tank or-Holdi..g look }3O ((coo 2- RawuAsGen ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) �cLsm tier's Sig e. (No Stamps) MP/Me&4rIVr Business Phone Number: eA 4 zzo (13 7/-798 — 3ssr Plumber'sAc dress(Street, City, te, ip ode): - - BoxvP �€ S4S z.I wT IX. COUNTY/ DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (Include. Groundwater Date Issued Issuing Agent signature (No Stamps) ❑Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OFAPPROVAL/ REASONS FOR DISAPPROVAL: (''ronnsswoocs,C rr re ri' 4LLF-�Coc-k R1. a [3oX 245 Mason, wz g49sl0 6rs)7%- a971 SYzJSW" £33, Tsf&/V, R7vJ three! O/-loG6-ot O3 7-ow✓of b€/fa. Baj Yee Id Cv,, wz A BM = I0O' @ 8o*}orn oc wood sdes, @ MW Earner of (ja(aje (.a'aLmieY , ) Eleuct+ on5 el ` 3rl.ol (3z= 8(0,5' 63 = 8L0. R' `- RI 80o S.Tanks ANDRY RASMUSSEN AND SOMA P.O. Box 66 Cable, WI 54821 (715) 798-3355 220173 4�Z9199 3z Crosswoocis 1140t cock y12 / 2 4" SCE 40 PVC FRESH AIR IDIL7^T, TERDM1ATIING MIN 12" AEOVE GRADE *Provide min. 6" gravel under dist. pipe @ vent end of system. *Distribution pipe to pitch @ 2" - 4" per 100'. *Provide min. 2" gravel over all distribution piping. *Provide synthetic cover material or 9" of marsh hay or straw over all aggregate. T 'B' 87.0' tr V I ' I -�O SYSTEM ELEVATION Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of 3 Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Atlach'complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference poi percent slope, scale or dimensions, north arrow, and location d t s Parcel ID. # cctt o f /04G -o3 APPLICANT APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). L.Yosc Dods ytc rt s 0 Govt. Lot 5%a 1/4 k) 1/4,S 33 T y6,N,R 7 -E c) W Property Owner's Mailing Add sa Lot # Block# Subd. Name or CSM# R+ a >r a9s- City State Zip Code Phone Number ❑ City 0 Village ®Town Nearest Road /'/Cisorl wr sWs-6 ( lis»y6-a97i I Q/cc% Re,, Rd ❑ New Construction Use: Residential / Number of bedrooms S Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow 7sb gpd Recommended design loading rate bed, gpd/l12- _trench, gpd/ft2 Absorption area required /O7a bed, ft2 3& trench, ft2 Maximum design loading rate - 7 bad, gpd/ft2_- _ trench, gpd/ft2 Recommended Infiltration surface elevation(s) gfZ0 ft (as referred to site plan benchmark) Additional design/site considerations Parent material G le tw / '%r // - Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound I In -Ground Pressure I AT -Grade I System in Fill j Holding Tank U = Unsuitable for system S U V5 S ❑ U ®S ❑ u iR S❑ U j ❑ S ® U Os , u Boring # Ground el!7o Depth to limiting factor 7?jn. Boring # ri Ground elev. Depth to limiting factor am. cTiljl RFPART Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh.Bed Consistence Boundary Roots GPO/ft2 , Trench 0-7 7sy,c 3/I SL a-1s6� m �r A.$ �d . s-:. G 7-a9 7≤ Y2 ifs sic rnvf - Gs 3 SYre Y/ r� e sL /MsGh r,+✓ a s — s7 sy yly icvr� cos IMfj xs — 51- 5y2 y/3 nn Cos Osv rM — — Remarks: /)61-twh S— 5 % 9r 4- eh c I-,- •� /3 r7enc SL 02 G-I`l ?s yllr ✓lohq- LFS 9 ryDc -yR r /Y ,lo'to- 5L He ,� Gel Remarks: (Please Print) RR Telephone No. 96s= YGo2 WI 54856 v Y Date y-27_ J -jN of T€/h —i dap Scu/ - / " Vo ' —gm.- ha/fm o�woo�s�,^5 NW Co rnW o Y 4Grti QF = i00. r %ve f ) — E�2p�JG 1/oc�s Bi = FS%U'. Sewer O ¢f = 5%-Sw-33-TV6v-i 7W — S bJ..w fep/atew,?w T = 7S0 P — ftCo,gne`jeqG[S�S fi IoGc/ij talc=.JJ'T�,d/s, 7sa,d/ Tit°/s? = /072 X e 'o' 4eJ vecomene..je " N So5e f4 Z,r., n02239l9 2 -nq I3AYFIELD 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 -00142 Transaction Number: CS-00142-3A01C Description Amount Private Interceptor $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 14915 Paid by: Andry Rasmussen & Sons Inc. 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 - Private Interceptor SIGN - SPECIAL - CONDITIONAL - BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 25-0869 Tax ID# 13144 Issued To: PERRON-KAUFER, CHERYL Location: SE'/a of SW'/a Section 33 Township 46 N. Range 07 W. Town of Delta Legal Description: S 1/2 SE SW IN DOC 2019R-577657 540A Residential Structure in F-1 Zoning District For: Sanitation Permit — Private Interceptor [Previous Permit # 327224] (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): Conditional use permit required for 2nd dwelling occupancy. 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 Tracy Pooler, AZA 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. December 16, 2025 This permit may be void or revoked if any performance conditions are not Date completed or if any prohibitory conditions are violated.