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032-540-31-4402-PVY-2022-012
SAWYER COUNTY ZONING&CONSERVATION ADMINISTRATION � 10610 Maia Street,Suite 49 � Hayward,Wisconsio 54843-0676 � (715)634-8288 iJ www.sawvercounrieov.ore �J NON-PLUMBING SANITARY PERMIT APPLICATION ' In accordance with Chapter DSPS 391,Wis.Adm.Code and (� Sawyer Counry Private Sewage System Ordinance — APPLICATIONINFORMATION-TYPEORPRINT PAGE:lof3 � P�°pertY Own°r Neme Property I.c I Descriptian /t� ,f �G=n �✓S���� Q�_'/. SE '/., S�_,T yG, N,R U�_W Propcny Ownci s Mailing Address I.ot Numbcr Biock Number i a� c�% ;�h-�s�„ ,� — — Ciry,Srote Zip Codc Phonc Numbcr Subdivision Namc m CSM Number I�G( L°<rG�� GL�L ������� ���5/)���/-.���%/ ^— s TYPE QP SSJILDIN.G:(Check one) State Owned ciry Neartst Rond � ❑Public �1 or 2 Family Dwelling-No.of bedrooms ( ��'��� � ����� t� — Townof U/��/I`F`i� FircNumber# �jGy� (-�'����� f+ � PUBLIC BUILDINC/LAND USE:[Fxplein mc uu�pwp�se for�his Parcel Tax Number.(12 digit legacy numbe 61 i r d F1 �R ,;�� permiL(i.c..campgrcwnd.fcstival,rccrcalionlemrneinment cvent etc.11 7 �3�-s��-�L-�'� c � •��� TYPE OF PERMIT: TYPE OF NON-PLUMBIIYG DEVICFJSYSTEM/POILET/UNIT: ❑Privy-Pit Toilet(CST# ) Non-Plumbing(Privy,Toilet,Restroom,Etc.) ❑Privy•Vault Toilet(200 gal. min.capaciry requ'ved) (Vault size:�allons or cubic yards ❑Other: Vault Privy Type:❑Concrote❑Steel❑Polyethylene❑Other Composting Toilet System ❑Incinerating Toilet Device Portable Resaaom Unit ❑Oth �'G� ' � u��f�r � Uc��� — RESPONSIBILITY STATEMEIYT: I,the undersigned,assumc rcsponsibiliry for�hc ins�allation of the non-plumbing sanitary rystcm for which this pertnit is iuued. 1 furtha agce tha[ any dwelling in conjunetion with this permit µill not be provided with indoor plumbing and/or waia hookup. 1 will uu ihe non-plumbing ryAem indica�ed as a means of waste disposal,end I�vill carty wnter to ond from the strucwrc. 1 undersmnd that beforc indoor plumbing end wnter hook ups arc installcd,thc proper Smte nnd County PcrmiLa will be applicd for. 1 furlher understand that any dcviotions Gom lhe above will constitutc a vialution of Smrycr County Ordinances and would subjcet mc w the penelties of ihc Ordinantts. 8y signing�his npplication,I am ulso granting permission io thc zoning deparlmenl personnel to cn�tt my propcRy at any reasonable lime for thc purposc of inspection lo acwre compliance with thc mning and senitation laws relativc co thc issuence of this permit. Umer's Nemc:(Priml.� Oxna's Si�e�ure: � - � �-G. % L � ;�1�� . J p ... - OFFICE U E ONLY: Disopproved Pcm�it Fec: CST No. Da�c Issued Issuing Agrnt Signaturc �A v d ❑Owna Givcn Ini�iel S I50.00 -�/����� /��� jj�,, 1 Advcru Dcluminalion � I 1 �.� '�I`^'�^�-�-`^��`^'`'�'�� COMM NTS: •Expires 2 years from date of issue `NO REFUNDS AFTER ISSUE OF PERMIT SHORELINE PROPER7'Y:❑YES NO If"Yes;'Name of the body of water. 1 � ���'��i�`ry n��'1 CONDIT[ONS OF APPROVAIJRE SONS FOR DISAPPROVAL: ' - ' `- ` ; q �Y O���I��,rn� ��� � � 1______ ,� AIIC 29 2022_ _' I i�,� _. . -- — ---—_ NQW_inlo�i���o'L,�� , .._, ,.. . Rev.04/29/16 � NO REFJNDS AFTER ISSUE OF PE(iMIT M�� 3l�3'�J NON-PLUMBING SANITARY PERMIT APPLICATION PAGE:2 of 3 �I Privy Plot Plan �y�� /���LJ l�d t l. � �� _�. Q�.i Prf-` PS � � ��I � � � � il ��� ��� ��� � � �� w � / � 3°° - s�� i , � �v - J e �, I i' ,�1' :-i5�( I� , � ' ' _— --- --�- _ _ _ _ _ _- - e T ; i�a �� �3 `-� /�% � — �r� L -{� ' Please include t6e following iaformation with distances on the above plot plan: 1 � I'a North Arrow ` �Nearest Road o Site Address ---• t, ;�� � �,��' S k���� t-F C%C�� o Swctures ,.._ � c u,� �„+ g�i-,-,,i c -ra�,--C � f}?Pl,'C<•��� ���� �r- �,r�,� � o Well-- P"i a�� � �l ❑ Property Lines ❑ Lake, River and/or Stream �5 L�;•��� c>r f fr��r--� - ------ \o Wetlands -- -- � /-__---�._�`I \ I ' � �+��,�� ,_ � �i��- a � Minimum Setback Requirements: ` � R�"� �� � i � • 10' from any slab constructed accessory ilding �G r�` SU�� +�D� • 25� from any habitable building � J� �.� � �i �-�' (,.r �r�t C t�� GtJ� • 45 from any property line �� d j • 50' from any water supply well • 75' from the ordinary high water mark of navigable waters / • 130' from the centerline of state highways or 66' from nght-c�f-way line, whiehever is�re$t�r'� Rev.04l29/I6 NON-PLUMBING SA1�iITARY PERMIT APPLICATION I'AGE:� of� General Requirements,Recommendations and Standards: 1) The privy structure should be insect and vermin proof. 2) All windows, ventilators and other openings should be screened with #16 mesh to prevent entrance ofinsects. 3) The privy struc[ure should be provided with cross ventilation of 2 square feet of screened opening for each seat. 4) Privy doors should swing and be self-closing. 5) Privy seats should be provided with hinged covers. 6) The entire installation should be kept clean and sanitary. 7) Freshly slaked lime or other equally effective disinfectants should be used at frequent intervals for odor control. 8) Floors, walls, seats and urinals should be scrubbed as often as possible. 9) The outer base of the privy should be banked with eaRh. ]0)Concrete, cement block or metal flashing should extend 6"above the ground and 12" below the ground to prevent entrance by insects and vermin. 1 I)The footprint of any privy structure shall not exceed 40 square feet and not be used for storage. 12)Maximum height of any privy structure is limited to 10'. i 13)Privies for public buildings shall comply with SPS 353.63 l4)For open pit privies the bottom of the pit shall be a minimum of 36"above any restrictive factor (ground water, saturated soils, bedrock, etc.). 15)A certified soil test is required for open pit privies and must be filed in the zoning office before permits will be issued. 16)A certified soil test is not required for a sealed vault privy. 17)Seaied vauit privies shall have a water tight vault made of materials approved by the Department of 3afety and Professional Services (DSPS). 18)Sealed vault privies should be ventilated with a pipe of at least 3" in diameter which terminates at least 1' above the roof of the privy and in accordance with s. SPS 382.31 (16)(a}to(fl. 19)The sealed vault privy should be pumped out when nearly full by a licensed septic hauler/pumper in accordance with ch. NR 113. 20)According to DSPS 391.12, the storage chamber of a sealed vault privy shall have a minimum stora�e capacity of 200 gallons or one cubic yard. 21)The storage chamber of a sealed vault privy shall conform with the requirements of DSPS 384.25 refating to holding tanks. 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