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HomeMy WebLinkAbout26-0341C -s- oo I G4 BAYFIELD COUNTY SANITARY PERMIT APPLICATION Zoning District Lakes Class I. APPLICATION INFORMATION Soil Test I County (Please Print All Information) No: �f O�,J Permit No: v _ _l Property Owner's Name: i/ Rc-fitn'Y CLG County: Bayfleld Address of Property: Property Location: 18870 /lft//1/Et H/LE ac Y< ,ve S 3S T SI N, R It Vj %(or) W Property Owner's Mailing Address: Township: I Gov. Lot #: A0 • Ax git AU cI EI L City,State I Zip Code I Phone Number Lot # I Block #: I CSM #: I CSM Doc # I Subdivision Name £r,r/col ./ S-4d''lSf 7/r-2 -?/Z9 I II. TYPE OF BUILDING: (Check One) ❑ State Owned Tax ID#: 3Pz3O RECEIVED ❑ Public (Explain the use/purpose ) ELATE ED ❑ 1 or 2 Family Dwellin - No. of Bedrooms ' III. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) © New ❑ Replacement ❑ County Private Interceptor sayfield c;. Planning and Zcr,lr,'i `rncy ❑ 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 X Vault Privy (Vault size: ZZO 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 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 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 Section C above I Owner's Signature(s): (No Stamps) MZ?clStfl l 't'ts at-) Al 2 '7Lr7 CL v w— Plumber's Name: (Print) if applying for Section A or B) above Plumber's Signature: (No Sta s) MPIMPRSW No: Plumber's Address: (Street, City State, Zip Code) Home Phone: Business Phone: VIII. COUNTY / DEPARTMENT USE ONLY Approved ❑ Disapproved ❑ Owner Given Initial Sanitary Permit/Transfer Fee: Date Issued: / 1/' V / .oa-6 filature /Date'/L, Issuing _Agp s 5i(Id//c7 � �'IEj 6' 7/W4 Adverse Determination IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: �r. Plot Plan on reverse side ® Bayfield County Land Re,.,,..,'- and GIS 1.3 M REALTY LLC X Q Show search results for M REAL.. _.� A 11 ER I f„v KATHLEEN A'J�ST �� +" .t. Tax.16# 38239 '.�M REALTY LL ? Tax ID# 382? Sr •� t 7 I E ILE sd DORIS H & KEVIN A EIN2IRL" ' • - T 0 20 40ft t � _ U H. Rwk weD JUL 10 2826 day geld Co. S pperrY pannin_ r4: . .. ___ • io r Lot Line RECEIVED JUL 10 2026 BaylIeld Co. Planning and Zoning Agency e Name of Frontage Road (MFl t -1 N.= e H t LC— 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. /l- 5. Show the approximate location of other existing structures. N' . 6. Show the approximate location of any wetlands or slopes over 20 percent. N/A 7. Show dimensions in feet on the following a. Building to all lot lines NI r} i. b Building to centerline of road N I j. c. Building to lake, river, stream or pond U I" k. d. Septic! holding tank to closest lot line I. e. Septic/holding tank to building m. f. Septic / holding tank to well n. g. Septic I holding tank to lake, river, stream or pond N/A-- o. h. Privy to closest lot line Privy to building N (9 - Privy to lake, river, stream or pond A//4 Drain field to closest lot line u/ A Drain field to building N I /q Drain field to well Drain field to lake, river, stream or pond P/fl Well to building Submit To: Bayfield County Zoning Department, PO Box 58, Washburn, WI 54891 u/forms/sanitary/bayfieldcountysan itaryapplication Revise: June 2018 Proofed by: PRIVY AGREEMENT DOCUMENT NUMBER (ATTACHED TO THE SANITARY PERMIT APPLICATION) 2O26 R-6 1 2894 t -f ,ee<tC7 t "L Mailing Address: Property Address 10. lox 122. d'W77O H92iNC/Z Hitt Legal Description: Section, Township, Range JC 1/4, NC 1/4, S 3._ T S/ N, R ' W Gov't Lot Lot # CSM# Vol & Page CSM Doe. # 2/2? ✓12 ?Z7% Zoto2- 522736 Lot(s) # Block(s) # Subdivision Return To: DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 07/10/2026 AT 2:25 PM RECORDING FEE: $30.00 PAGES: 1 Tax ID # Date: a ct IVED 33 23 0 7�f 1-wz6 JUL 17fl?6 1. NO PLUMBING will be installed in the habitable building. Bayfield Co. Planning and Zoning Agency 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 / 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) This instrument was signed before me in the State of riosc��A /t/EC.Cf7hl MterJX•— ----.— _ . - _ County of Owner(s) Signature: On by: My commission expires on: IlL Drafted By: 4On'J'/'ft Vh/y' (must be filled out by person submitting form) ® December 2012 ulorms/sanitary/privyform - ®October 2019 B^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 -00169 Transaction Number: CS-00169-49C3F Amount $150.00 Total: $150.00 Payment Amount: $150.00 Reference: 5729 Paid by: M Realty, LLC 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 SIGN - SPECIAL - - Vault Privy CONDITIONAL - BOA — No. 26-0341 Tax ID: 38230 Issued To: M REALTY LLC BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION Location: S35 - T51 N - R04W Town of RUSSELL Legal Description: LOT I CSM #2128 (LOCATED IN NE NE, SW NE & SE NE) IN DOC 2022R-593321 Residential Structure in R-RB Zoning District For: Sanitation Permit — Vault Privy [200 Gallon] (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. This permit may be void or revoked if any performance conditions are not completed or if any prohibitory conditions are violated. Emily Macgillivray, AZA Authorized Issuing Official July 16, 2026 Date