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HomeMy WebLinkAbout026-939-14-5125-SAN-2020-157SAWYER COU^TY ZONING & CONSERVATION ADiMIMSTRATION10610 Main Street, Suite 49Hav"\vard, Wisconsin 54843-0676(715) 634-8288PI.UMBING/NON-PLUMBING SANITARY PERMIT APPLICATIONIn accord with Chapter DSPS 391, Wis. Adm. Code andSawyer Coiinly Private Sewage System Ordinance• Sec the attached infonnalion packet for instfiiclions for completing this application.AI'IMJCATIO.N INFORMATION-TYPE OR PRINTI■NProperly Owner Mane|4-$fetuarf Trus^Propenv l.egal DescriplioiiG^/ ' 'A */4. S iq T N,R 9 WProperly Owner's M.iiliiig Address ' '667 Cour^Loi Number5-^3Biock NumberCiiy. St.iierAetAfJfjfii. fJi'ijli^ 1 /VIA/Zip CodePIk'iic NumberSubdivision Name or CSM NumberTYPE OF BUILDING: (Check one) | | State OwnedQ Public ^ 1 or 2 Family Dwelling - No. of bedrooms 3U Ciiy□ Village j / yL..^ToivnofNearesiRoadgJ^^^^y Lr\.FireNurnber . ^PUBLIC BUILDING/LAND USE: [Explain llie usc'putpose for diispetmil, (i.e.. campgniiiiid. feslixai, rcerealion/eniert.iinineiu evenl eic.l]Parcel Tax Number: (12 digit legacy number)TYPE OF PERMIT:n Non-Plumbing (Privy, Toilet, Restroom. Etc.)® POWTS Reconnection (SAN # 1Z^.)□ POWTS Connection (SANt/ - )□ POWTS Revision (SANt? - )□ POWTS Repair (SANfii - )□ Other:1YPE OF NON-PLUMBING DEVTCE/SYSTEM/TOILET/UNJT:n Privy-Pit Toilet (CST# )d Privy - Vault Toilet (200 gal. min. capacity required)(Vault size: gtillons or cubic yardsVault Privy Type; dConcrete Q Steel QPolyelhylene Q OtherD Composting Toilet System O Incinerating Toilet Deviced Portable Resiroom Unit f"! OtherRESPONSIBILITY STATEMENT: (Check one or both [J as appropriate)Q !• 'lie undersigned, assume responsibility for the installation of the non-plumbing sanitary system for which this permit is issued.Plumber'^S2r/ -: '.A7ir,675-75-/Business Pliune Number:P. n- GC- t-dZ 5^^^/OFItlCy:. USE ONLY:Dis:i|)pru\eJ|iBri)\cd□ Owner Given InitialAifverse DolerminalionCOMMENTS:"^Expires 2 years from date of issue**1 feniiii I-ee:CST No,Dnie Issuedissuing Agent SignatureExpiration date:SHOREUNE PROPERTY: 0 YES □ NO if "Yes," Name of rite body of water: Idkiitit'.CONDITIONS OF APPROVAL/REASO.NS FOR DISAPPIWAL: UNO REFUNDS AFTERISSUE OF PERMITRev, 03/21/13SAWYER COUNTYZONINQ ADMINISTRATION Q7(rz.i nji. K'ZSS^a cX Al'fnBn^gcj 'pl'^,|;^^TtL»0 • SL%,zl ^ ^?T7UA-?5J<y. •-)MuZ .<?££- /Vi-gN -^uwH f.■15»5(X)o^ ,OQl = -^-,^(1,^ 'hn^Q1^730 ^rvra.5- ^ -'■y/^'5 O09/0go( "V I OhzJ?^\-^^S + ,(?*ijh - ftajp -3->rf~l 5r/^- h' -ije»)-'^YO JOT ''i^ ?:fi?7 p<^T75 7 o "joifU, C^b "3'ni>€ J.'hi S 'Tf '-td Ar3^j0 ^fl55 (1W ■c^v^'^UA ■p ^11^ C'onc'ej •)^ A4)?UJi Witcontin Department of Induttry,Labor and Human RelationiSafety and Buildingt DivisionGENERAL INFORMATIONPRIVATE SEWAGE SYSTEMINSPECTION REPORT(ATTACH TO PERMIT)Permit Holder's Name:'Btyetiir□ City □ Village B Town of:CST BM Eiev.: 1 Insp. BM Elev.:iOO* 1 loo'BM Description:c/C HfcOffiii. riuTCounty:Saujvee.Sanitary Permit No.:cfh-ias.state Plan ID No.:Parcel Taa No.:TANK INFORMATIONELEVATION DATATYPEMANUFAaURER.-CAPACITYSeptic-DosingLtJic^fff?.AerationHoldingTANK SETBACK INFORMATIONTANKTOP/LWELLBLDG.Vent toAir IntakeROADSepticNADosingZSi'f-6'iS'NAAerationNAHoldingPUMP/SIPHON INFORMATIONManufacturerDemand6PMModel NumberLoeo^uTDH Lift25.S frictior^^,ssir- TOHSftsftForcemain Length 3^^Dia. 2"Dist-ToWell 2^'STATIONBSHIFSELEV...Benchmark//2i7'Bldg^ewer. .St/Ht InletSt/Ht OutletDt inletDt Bottom7S.3-Header/Man.lAO.IDist Pipe(hti. SBot. SystemFinal Grade103**• •SOIL ABSORPTION SYSTEMBED/TRENCHDIMENSIONSWidthjS'Length .No. Of TrenchesPITDIMENSIONSNo.OfPiUInside Dia.Liquid DepthSETBACKINFORMATIONSYSTEM TOP/LBLDGWELLLAKE/STREAMLEACHINGCHAMBEROR UNITManufacturer:TypedSystem:0«M«tf^^»700*4-20O'-»-^CO'iModel Number:DISTRIBUTION SYSTEMHeader/ManifoldDistribution Pipe(s)X Hole SizeX Hole SpacingVent To Air IntakeLength Dia VLength ^9 * Dia. Spacing ^ '20d *4-SOIL COVERX Pressure Systems Only xx Mound Or At-Grade Systems OnlyDepth OverBed/Trench Center 30 "fkDepth OverXX Depth OfXX Seeded/SoddedXX MulchedBed/Trench Edges 90**^Topsoil□ Yes □ No□ Yes □ NoCOMMENTS: (Include code discrepancies, persons present, etc.)Plan revision required? □ Yes Q^oUse other side for additional information.S8D-6710(R 0SI91)tys28r?DateInspector's Signature;?.agovoCert No . »ADDITIONAL COMMENTS AND SKETCHSANITARY PERMIT NUMBER:UJHtTiPPiSKT ScXVCSlIWlWU' £>'eismLOltSSait. (OdO/laOO C«VH0riU4^OA) TWAJKn sjtctfeA.^41^. 6* .0^ FouXAUrbUf@toeLUS30'-;}"^cJahofoftMrMlVi*'iZ—ZIJ1fiatfrtie. cootftL .*5>raoevOA-y Tto Real Estate Sawyer County Property ListingToday's Date: 7/29/2020Property Status: CurrentCreated On: 2/6/2007 7:55:48 AM^ DescriptianUpdated; 2/13/2003Tax ID:PIN:Legacy PIN:Map ID:2842157-026-2-39-09-14-5 05-001-000250026939145125:1.25Municipality:(026) TOWN OF SAND UKESTR:S14T39N R09WDescription;PRT GOVT LOT 1 LOT 2 GSM 18/84#5418Recorded Acres:1.100Calculated Acres:1.080Lottery Qaims:0First Dollar:NoWatertxxlv:Whitefish LakeZoning:(RRl) Resldentlal/Reaeatlonal OneESN:423? Tax DistrictsUpdated: 2/6/20071State of Wisconsin57Sawyer County026Town of Sand Lake572478Hayward Community School District001700Technical College• Rpcorrlefl Doriiments Updated: 12/13/2019Q WARRANTY DEEDDate Recorded: 12/11/2019 421570Q WARRANTY DEEDDate Recorded: 1/3/2003^06906 WD832/329Q CERTIFIED SURVEY MAPnatpRpfftrdprl: fi/4/1996 254644Updated: 12/13/2019MARY K STEWART REVOC TRUSTMENDOTA HEIGHTSMNMARY K STEWART REVOCTRUST667 IVY FALLS CTMENDOTA HEIGHTS MN 55118Mailing Address:MARY K STEWART REVOCTRUST667 IVY FALLS CTMENDOTA HEIGHTS MN 55118• Indicates Private RoadN/AProperty AssessmentUpdated: 9/28/20172020 Assessment DetailCodeAcresLandImp.Gl-RESIDENTIAL1.100211,60002-Year Comparison20192020ChangeLand:211,600211,6000,0%Improved:000.0%Total:211,600211,6000.0%Property HistoryN/A Real Estate sawyer County Property ListingToday's Date: 7/29/2020Property Status: CurrentCreated On: 2/6/2007 7:55:48 AM^ DescriptionUpdated: 8/30/2005Tax ID:PIN:Legacy PIN:Map ID:2842257-026-2-39-09-14-5 05-001-000260026939145126:1.26Municipality:f026I TOWN OF SAND LAKESIR:S14 T39N R09WDescription:PRT GOVT LOT 1 LOT 3 GSM 18/84#5418Recorded Acres:1.790Calculated Acres:1,759Lottery Oalms:0First Dollar:YesWaterbody:WhiteOsh LakeZoning:(RRl) Residential/Recreational OneESN:423^ Tax DistrictsUpdated: 2/6/20071State of Wisconsin57Sawyer County026Town of Sand Lake572478Hayward Community School District001700Technical College. Recorded Doruments Updated: 3/11/2019Q QUn CLAIM DEEDDate Recorded: 3/5/2019416784Q WARRANTY DEEDDate Recorded: 6/27/2005 331425Q CERTIFIED SURVEY MAPDate Recorded: 6/4/1996 254644OwnershipUpdated: 3/11/2019MARY K STEWART REVOC TRUSTMENDOTAHEIGhfTS MNBHIIno Address:MARY K STFMART REVOCTRUST667 IVY FALLS CTMENDOTA HEIGHTS MN 55118MARY K STEWART REVOCTRUST667 IVY FALLS CTMENDOTA HEIGHTS MN 55118PSite Address * Indicates Private Road6222N BREEZY POIhfT LNSTONE lJi«<E 54876S Property A<Mes.smentUpdated: 9/28/20172020 Assessment DetailCodeAcresLandImp.Gl-RESIDENTIAL1.790218,900216,9002-Year Comparison20192020ChangeLand:218,900218,9000.0%Improved:216,900216,9000.0%Total:435,800435,8000.0%N/A^Progert^^jjstot^ HYCRO*0269391^511026939145126026939145125—0269391451136939 45124026939145 1 02026939145121