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HomeMy WebLinkAbout010-941-13-2307-SAN-2023-026 � � � SAWYER COUNTY ZONING & CONSERVATION ADMINISTRATION � 10610 Main Street, Suite 49 lU Hayward, Wisconsin 54843 � (715) 634-8288 n sanitarian�i sa����•crcount�•eo�•.or� � f COUNTY SANITARY PERMIT APPLICATION In accord with Chapter DSPS 383,Wis. Adm. Code and Sawyer County Private Sewage System Ordinance APPLICATION INFORMATION—TYPE OR PRINT Property Owncr's Name Property Legal Description BRIAN D & MIRJANA AHLGREN � `�/ '/4 N� '/4, Sec. 13 ,Twp.41 N,Range 09 w Property Ownci's Mailing Address Lot Numbcr E31ock Numbcr 10590N HAMBLIN ST — — City,State Zip Code Phone Number Subdivision Name or CSM Number HAYWARD, WI 54843 � > — TYPE OF BUILDING: (Check one) ❑ State Owned ❑c�ry Nearesc ttoad Risberg �, ❑ Public � 1 or 2 Family Dwelling—No. of bedrooms 3 ❑vitta�e �T�µ���f HAYWARD Firc Number ���24N PUBLIC BUILDING/LAND USE: [Explain the use�purpose for t1,is Parcel Tax Number: (12 digit legacy number) pemiit,(i.e.,campground,festival,recreation/entertainment event etc.)] � � � - g 4 � - � 3 - 2 3 0 7 TYPE OF PERMIT: Additional Information: � POWTS Reconnection(SAN# 95 - 149 ) ❑POWTS Connection (SAN#_- ) *Attach a Plot Plan with all required information per SPS 383.21 ❑ POWTS Revision(SAN# -_� ❑ POWTS Repair(SAN#_-_� xSoil Test Information(CST#�sss_ia�� ❑Other: * Gallons per day 450 RESPONSIBILITY STATEMENT: I,the undersigned,assume responsibility for the installation of the POWTS activity for which this pernlit is issued. Plumber's Name:(Print) Plu ignahue MP/MPRSW No: Business Phone Number. Travis Butterfield 652879 ( 715) 634 - 8176 Plumber's Address(Street,City State,Zip Code)� 14346W St. Rd. 77, Haywar , WI 54843 OFFICE USE ONLY: ❑Disapproved Review Date: ermit Fee: Dat Issue : lssuing Agent Si nature r �(Ap rov d ❑Owner Given Reason for lO�,� 3�•���-a� �'l/'�,f�4 % Q i-�(,4/Vt,yo. Denial COM ENTS: **Expires 2 years from date of issuc** Expiration date: f I�. ty � '�w� �'1 ""'�!J �D� �h tn ,� � M,,,,,�/�N9 VI� / f OC' �,.N .__T _ � CONDITIONS OF APPROVAL/REASONS FOR DISAP OVAL: � n '�`;1 _I''!`�'� .� — t� � �i� , � � ��i� 3� �d��-3 ��i� � � 20�3 �� �i �I� ' �if`Ir � �hk#..{'].S�8 ___ ------- � q^` I(� SAV'JYER G�'��"�:'��"',� l ) l-l� ' ' �� ONING ADMfN��7RAi'i' t� Rev.04/21/ ' V 1�%' 11 �� �5 NO REFJhDS aFTER I�.sUE OF PER,MIT ��\ � SW i��� 1� W ��� ��/ ��, s��-rroti r3 � Tu ! N � Z9 �.1 � NAM �1CPtt�Dl�1 �a�fW0. C, sT- i000 a\to,n TowN oF t' Qa��b9co�cfe4e ����_ SAW\�erCov �� y Se i�icT4hK� TYpJ' ` .�.��cd by ko@fc�t? � /� / �oncce4e � 1�c. \� �� ��avi <i- ✓� i /"lan.q j7�n ��"en DFn )2' z54� DcninFial�1 ✓ W/ +.ao dis�ci6�ikiDn �osq� N 1�. �» �/ �• S�'. t:nesspaced c�v�a�f at� 3� Prom al! �/ � / W� SYgY3 b�dewalls +endu�a�ls � I �Oj F� � w.,i- a�/ � � o �v -�yi - r3 � a3° � I'f- �� � d �,w �l Sp� t3 T y � N � �w r o� �` o u �� �'�.�`-e ��.��,�.�. / ` ` �� �,l��� c���� �� SCAL� = l : C� O UC1 = 1 O O � .� j �34(tio,.. � = To P o-F � ' _�� � � 42 ,r DF �"o � s�d a� � O'c1 � � - - _� �' � ae�B3 .�-��A101�T ti - � � � ��� � � � �-- n � �� ELEVA� ► Ot�S l/� `� � � , � ��� , C� � �� IiH - ioo � � � C31 ' 94. .2 � � j �� r ' lOG> � 3z - 98 .� ' � M V"� � � � �� � 33 - 4 7. 7 � p�� �7 �/� � nRs w� z E� n � `Tra„ �s L�µ�'�� �� G� �--� � ! ' � ; sb � �- � � oaa , ���-�� Safety and Buddings Dw�sio� �■�r�Ci SANITARYPERMITAPPLICATION e�«��<,ie��ia��ew�«"sY,�e 7U1 E Washingron.l�vr� In auorJ wLLh II IIR H7 O5.Wn Adm CuAe P O BOx 7969 � � CST 95-147 Madison,W153707J969• • Atwch complete plans(to lhe counry copy only) (or the system, on paper not lers cuu„ry than 8 vz x 11 inches in size. �a W • See reverse side for instructions for compieting this application Sla[e Samtary Permit umbe� 230861 ihe inl�rm�Lun you provWe mny he mod by uthur guvernmenl agency pwyiamt (J(:h�.v.w il II.VI911�1 III pll!VItWti JVpI1G11N11 �Pnva[yLaw.s 7SOA(1)(m)� State Vlan I D Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION VeuPertyOwm�rNamc 'dIl � OrgHll _— _�•�ul��•rtylutatiun 7e rr � ,;.� N „�,s S 3 r y( ,N. R 9 e�■tw Prope�Ty ��r 5 Madi g Addmss ��rt NumLcr Nlock Numbe� ���• � 3 / Gty,SWtc IipCnJr Phuni Num6cr Suhdivitiuu Nameur CSM Num6cr a d w= 8y c�is �G3y-8QS6 II. T E OF BUILDING: (check one) p StateOwned " �-"r Nea��seao.��� �,� ,,�,,. wa a � • Pubhc t or 2 Famil Dwellin - No o(bedrooms _� i,,,.,,, �n :��. BU�L��N�7USE: (IfhuJdniytypeitVubh(.chedallthn�aPV!p) Perceiia.'Jumbrr(s) i ❑ Apartment/Condo 010-941-13-2307 � 2306 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 �] Outdoor RetreaUonal Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repai�s it ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ MobileHomePark 12 � Service5talion/CarWash 5 ❑ Hotel/Motel 9 ❑ Ofhce/Factory 13 Q Othen s;���,iy _ IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, i(applicable) q� � � New 2 � Replacement 3 � Replacement o� q � Reconnection ot 5 C Repair of an _ System Systcm T�nk Only Ezisting System ExiSling System --------- ------- B) ❑ A Sanitary Permit wis previously issued Permit Number Date Issued V. TYPE OF $YSTEM: (Clieck only one) Non Pressurized Dislnbut�on Pressurized DrsfnbuUon Experimental Other 1 1 �Seepage Bed 21 [�Mound 30❑Speci(y 7ype 41 ❑ Holding Tank 12❑Seepage Trench 22❑ In-Ground Pressure 42 ❑Pit Privy 13 ❑Seepage Pit 43❑Vault Privy 14 rj System-ImFill VI. ABSORPTION SYSTEM INFORMATION:�Z�x54 � 1 Gallons Per Day 2 Absorp Area 3 Absorp Area 4 Loading Rate 5 Perc Rate 6 System Elev. 7. Final Grade J� Required (sq It.) Proposed(sy ft.) (Gals/day/sq. ft � (Min /inch) [levation �-( V (o �/ . 7 ---' (o . 0 Feet Feet VII. TANK Capauty ing<illons Total qof s�ie INFORMATION — — -- -- Manufacwrer's Name �'"'�°�' �'�" Ni�si�< �"�'°' NBW Exislin� Gallons Tanks Cunuc�r �°O' S��i� ylass App st r uU cd Tanks Tanks SePlic IaM ur Hulding lank �pQQ �— �Q�Q � H�' ���� ❑ ❑ ❑ ❑ ❑ ._ _ .______..___'._'— 1 dt Nump Idn4 /S�phun C6nmLw ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersi9ned, assume responsibility for instaliauon of the onsite sewa9e system shown on the atta<hed plans. Plumbe�'s Nam�. (Nnnt) �herlSignalurc. (Nu Slarnps) ARMMPHSW Nu Uusine55 Phune Num6er�. Zor� S�cecKe \S Sc . ��,�ey,b��,,..�. Q .3�SSo C��S) -�3y-3Z.SZ) Plumhcr'tAdt cst(Slrt�et.Gty.Slatr.lipCoJr) Zk z C�oX zoo � -� �G.� wo,�-� , wr S�/2 y3 IX. COUNTY/ DEPARTMENT USE ONLY m�,�.,.i�.�„����A...�.�� )ateltwri I mn A�cn�Si n.lurc(NoStampt) ❑Dnapproved S.uut.uyPv�mtl 4rr 9 J' 9 $]Approved ❑OwnerGivenlnitial $150 .00 6/20/95 - ` 1J AdverteDetermin�iion �INf�! ��11�Z�.r��Y�.. X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: �'—'-�` Sw���i N w�/y ��/ \��. . s6���oa i3 � ' T41 N� R9w \NAM�Kt�d�n1 HaYWac� sr=i000 a�tov� TOwN OF P�te69Cn�crC�C � '[�\V E� Sww�e�Cov I�} se p+;�ro..K,m>��- � � � .fi�Wed by N.+Fh�N ��e}ei�..c. � DFo 12'x54�D�e.inQta�� � . w!a..�o d1s1c:Wl�On Te��y nac90.1� �i.x��poced c��rt ar�+ 3.prer.�a/1 s�dewa l�s+e ndr.�a��s Zt.3 3ox 3y'7 I �� I L0� FtaYwcAC��W i Sy8y3 ���- �( j�e�a\d A . S'�ecKe�Jc. �� �-- i2�.� 36x zoo�-C 1/,.(�_--,,� � ����" No.y�cd,w? sysv3 '"�""'�'� �.^\,� /KP�so 336D SCALE = l: (,O �/�(`f� y���c 3 8dn� •�-;-�.. �� = I OOr WELL wll��•ry� �� D.>�F.�C�C� = To P o� � a� ' sT_ J ■II2 �DF �Fo�nan�;or �� ` -- -- �yi +��B3 �'`N OZT H ^ �_ C �. � `-�� �- � �- �� �� ELEVP'��oNS l� � � ,' ��✓� Q M- �o c' � � �'-`-- � E� P�1- R9..2' �( / � �� G � 'Q2- 98.2� " �O �2�� � �� m � � I.`�3- 97.7� �CD � �� O f} ��O/��T a �, w�Z(� � � k ` n/p39� � \� �� \� � � '� S `�J 2�C`CJ '-� �0.Ci wisco�s��oepartme�tof�ndustry, pRIVATE SEWAGE SYSTEM ounry: La6orandHumanRelations INSPECTION REPORT Safety and Buildings Division � GENERAL INFORMATION �'�'TTACH TO PERMIT) Sanitary Permrt o.: 'z-3o86 R -� - /Y � Permit Ho er s Name: City � Vi lage Town o : State P an ID No.: (Ja r � T BM E ev.: � Inip.BM ev.: BM Descnpfion: Parce TaK No.: l0('� $c . "� �Xp -4 -(3 - zao6 zso (o TANK INFORMATION ELEVATION DATA TYPE MANUfACTURER CAPACITY STATION 85 HI FS ELEV. Septic �� H� ��� Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet q Z � TANK SETBACK INFORMATION St�Ht Outlet 45.9 f� TANKTO P/L WELL BLDG. ventto ROAO Dl Inlet ' Air Intake Septic { yp � � +10 f �.$ � NA Dt Bottom Dosing NA Header/Man. • 9$,S$ Aeration NA Dist. Pipe c�$•1.� (P Holding Bot. System �f�f .S� PUMP/ SIPHONINFORMATION FinalGrede S ± Manufacturer and Model Number GPM TDH Lift F � � 5 stem TDH ft Fo in length Did. Dist.To Well SOILABSORPTION SYSTEM � BED/TRENCH Width IZ Length S4, NOAf Trenches PIT No.Of Prts �nside Dla. Liquid DeDth — D SETBACK SYSTEMTO P/ L BLDG WELL LAKE/STREAM LEACHING Manuacturer: INFORMATION iype � +�O ZS �p } 1S� OR UN T R Mo e nlum er: Syztem: DISTRIBUTION SYSTEM Hea eNManiod Dirtri utlonPipes xMoleS�ze zHoeSpaGng VentTOArclntake Length _ Dla _ Length _ Dia. Spaong _ SOIL COVER x Pressure Systems Only xx Mound Or At•Grede Systems Only DepthOver DepthOve� xx DepthOf �x SeededlSodded xx Mulched 8ed/TrenchCenter Bed/TrenchEdges To soil P ❑ Yes � No � Yes ❑ No COMMENTS: (Includecodediscrepancies, personspresent, etc.) Plan revision required? Q Yes No Use other side for additional inform ion. � � S Mi,J �� S 2 3 8 580•6710(R 0591) Date Inspeno�i5ignat�re Cen No � ADDITIONAL COMMENTS AND SKETCH �. SANITARY PERMIT NUMBER: � S — ��E q � ` -�� ".t \ �� \ � � �/ , ' � Q \ � �� � � � � � a� \ ��Ve � ��i . . � � �� �_ f bo' � �000s.r 3olY � �`r cI 3• y ;4 6� 3oav O 3 Ld �K +io Cy� Sy S7(i�'t pk� � �i .� . . 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'fi;' . rcqs. . � 9� Q1� 4}y,y YaC` � C :. �'�y�r {• ' � ��<� �,.�r, s � � a�. � fl . ,�y�''h�' = a �''' � �`�� ��+�� . - , s � � ��� � ���" ^ ���,L. „ _�,� x ,s ;z a i� � 'i�,!' .r�.j 4. � t'�-�a � �. a "^ �f �-�.�P �, `"�r�. ��''!,._ 5•�.�v '`�`� �"'C.�'+_�3;� `' '�= � E';',f 3/21/23, 1:16 PM Real Property Listing Page Real EStat2 Sawyer County Properry �isting Property Status: Current Today's Date: 3/21/2023 Created On: 2/6/2007 7:55:21 AM �°'Description Updated: 3/25/2008 =� Ownership Updated: 9/30/2020 Tax ID: 11985 BRIAN D&MIRJANA AHLGREN HAYWARD WI PIN: 57-010-2-41-09-13-2 03-000-000070 Legacy PIN: 010941132307 Billing Address: Mailing Address: Map ID: .7.7 BRIAN D&MIRJANA BRIAN D&MIRJANA Municipality: (O10)TOWN OF HAYWARD AHLGREN AHLGREN STR: 513 T41N R09W 10590N HAMBLIN ST 10590N HAMBLIN ST HAYWARD WI 54843 HAYWARD WI 54843 Description: PRT SWNW Recorded Acres: 2.940 � • Calculated Acres: 3.079 "� Site Address * indicates Private Road Lottery Claims: 0 111Z4N RISBERG RD HAYWARD 54843 First Dollar: No Waterbody: Namekagon River " Property Assessment Updated: 11/30/2015 Zoning: (R-1) Residential One 2023 Assessment Detail ESN: 444 Code Acres Land Imp. G1-RESIDENTIAL 2.940 65,400 0 < Tax Districts Updated: 2/6/2007 1 State of Wisconsin 2-Year Comparison 2022 2023 Change 57 Sawyer County Land: 65,400 65,400 0.0% O10 Town of Hayward Improved: 0 0 0.0% 572478 Hayward Community School District Total: 65,400 65,400 0.0% 001700 Technical College Recorded Documents Updated: 9/30/2020 �� Property History TRUSTEES DEED N�A Date Recorded: 9/14/2020 426409 CORRECTION INSTRUMENT Date Recorded: 8/2/2018 413663 CONVEYANCE RECORDED NOT USED Date Recorded: 6/11/2018 412735 WARRANTY DEED Date Recorded: 1/14/2008 351307 https://tas.sawyercountygov.org//system/frames.asp?uname=Eric+Wellauer 1/1