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Home My WebLink About026-938-06-5811-LUP-1998-575 , � t�,�, . ,� �� Application for Land Use Permit ---- r y � County of Sawyer � a . ,•,_, PO Box 668 -Hayward WI 54843 �v � 715/634-8288 � � The undersigned hereby makes application for a Land Use Permit and agrees that all work shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance I i and the laws and regulations of the State of Wisconsin. Ir � PRINT—USE BLACK INK OR PENCIL I �c U. � � C FF'\L_�� V X��h�� 1��l�� D.�C.� 6 Owner Builder N � s ��l� S��-L 5:�- t��J 35qf�'1 �� ul'( l�� t31.-v� ° Mailing Address Mailing Address ��c.l�_�� v�..�t�v- Ss��y l-.�k�c=,-��lw.:�1, sso4� � City,State,Zip City,State,Zip so't- �-ss�-�9�3 ��Ei�E�� `1- z�z-&33� �sZ�b;-�Er� �� Daytime Phone Daytime Phone Building Land Use p ( )New ( )Filling Zone DistrictS A�,�y�.�,IL �� ( )Addition ( )Dredging � V i O Alteration O Grading Lot Size��,�u�'C��(} 2�r (��•z." 1 � )Moving On � ) �Q�� 3'az,�ts � (` O O Acres m g a, A L ,� � Primary Structure Accessory Building Addition # � ( )Dwelling ( )Garage-attached/detached ( )Deck �;� g (r�Yeaz round ( )#of car stalls ( )Porch � � o ( )Seasonal ( )Storage Building ( )Enclosed i � � O Frame built on site O Screenhouse O Living room � � ( )Modular/manufactured ( )Greenhouse ( )Kitchen �� uo ( )Mobile/manufactured ( )Other " �)Bedr� � ' � ( )Other primary structure ( )-,�'`� = Relocate/enlazge � `� ( ) ( ) (t)#ofnew pFs��a � � � ��( �cw`� W V, � Type of Constniction �?`� P �Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � o � ( )Other � G Construction Cost$ 3 Sy �h.� e � � -� Vol /�l5 Pg 7�_of Deed_ ` Certified Soil Test# %- �/% ' ' � " _ 7G-0 �c U CSM Vol Pg Sanitary Permit# O ��-� A-r� ��''' Plat Envelope Or: `' �``J-`'� C��r� � % Iz � 7y Condo Vol Pg Yeaz Installed �q=Z9 - Aff of ex septic V P Owner When Installed: `9 l��a L �Q�Q.:,K � ,�� 01"l la lco \ Application for Land Use Permit—Page 2 Describe Cop�truction:List dimensions of each structure,story,addition or alteration. � #1. fl u�•�� #z. �* �� #3. v a�a� .��,�a �a. Size__;S_��'��`"�J ��fr.wide i 6'E" ft.wide ft.wide 3 a. ft.long I L fr.long '3�r� ft.long ft.long Floor area_�_[��sq.ft. V 5 6 � sq.fr. �sq.fr. sq.fr. • Hgt from grade 1 3 1 to peak�ft.hgt. (3 t fr.hgt ft.hUt. Stories�_ stories �stories stories #of bedrooms J¢�k rear ' e or waterline of L,� (c 2,S�S`.��,A9,�.�l�ke/river �� In the box sketch in: ��'z � °Q t� �,�{ Location and size of a11 3�� existin�and nr000sed structures. �:.—R° ��, �r e�'~'i� - � .-.___--��vrt j__� _ _ �i Location of septic system. ' 3�5� � Indicate distance to: ��Y�—��, �� Waterline j' " l��/'°� Road 3�`�� Lotlines � I�� ,ro p.��u� Septic system �` ; A � Distance between structures. � �t ��Y i ��`� Indicate North. ' � Fire Number: 3�`� I � �/ --i_-0-}-��/�-�8�c�_-�,� ,'/ ---`JL.—_-- ��b,� /1 � 1/�,�f�� ,,� ��Q�n'i �� ( � �� Signature of Owner j �'C �w The above certifies that the listed � information and inten[ions are true and � _ correct.The above person/s/hereby r—�-----�� --�-�- ... � � �ive permission for access to the � � property for onsi[e inspection. -------eC(Itetliri0 Of road------- P��n.m,r�s h�e�u��ssu�l hRsc�l o.��nroc��c�n�t-�c-�zov�.��s o�,��c�.�.�o �r� v�.os�us�`s�'k�r�-t�r�s�'Pnc.s y��, w��r ,��c�[.�l,� �,v� Trs��iy yr�,A.uas.x,� Issue Date n��,�e�. i� ,9�8 Expire Date_QctohPr 1 7 1 9Aq Office Comments: (��'�i C�C��1��! Signahue of Zoning Administrator � ____ SEPTIC INSPECTION REPORT � Owner l�' �/r�/ns/S �� Buyer Property Address S� . ��e ` Date of Inspection _Q�o�� As a result of my inspection, as of this date, I state that the system is as follows: Septic Type: Steel � Concrete Other Septic Tank Condition (-�cY�cV Septic Capacity: 75b gal. DRAINFIELD EVALUATION (check one) �There seems to be no evidence of system failure The system shows signs of failure. Explanation: An evaluation of the system could not be made. Comments: This inspection does not guarantee that this system will work forever. It is an inspection to let you know what system is like presently. The undersigned cannot guarantee continued acceptability of the private waste disposal system due to unpredictable factors which could later determine the life or compliance of the system. r Customer Signature �� d`'T �i�.lL�-�� Name of Firm: G0n2's Sanitary Service Signature: vLJ��1LZt�i��/ Date: � Sanitary License #SY 610 TOWN OF SAND SOUTH PART SEC.S TWP 3� I3.7 �13.4 � �`�� >. ' _\ � . n �1 a:y �� r�, \� � M .\'�F2 �`4c 6 g .; •.\3�� . :\�� '�3.� � ��a.�a� �. �13. .4.1 � � �� \ � � � � ��'9 °I3.3� � 0: �13. "' `�9a .,, 1 ��4.�7 :,4.�a m � � : � ;�4 �14 �14.1.1 :152 w ' , Y :' C g :�.i3 '�'° :1410 f � I � d� a II :14.14 �i4.1 � ~� ;�'* �i � II �14.11 � � \ ,« �14,7 �14.6 �14.5 �14. :14.3 \ ; � �� :�4.12 � ..� � N �19•� �1SIS ABAGl�A LAKE � .,s:3 �,,.._ ��._.�� . ��. � t�. n i vv r. ��s iv . rc. � vv. Y 1 I �6.1 �8.3 ,�8.2 �8.16 � 3 � :9.1 � I � � t8.3 � �9.10 ,8. 3 � � r .� � . I :9.11 \ �9.7 �. 2 � � r' �10.2 �+ � v '' ` ;:i :9.8 E ` '" � �H.IS ' s8.7 � e e ;-- — -� 4.3 � t :6.14 � :8.4 :9.9 5.2 +9.6 ` :8.6 \ :9.5 :11.8 :9.4 �8.8 � �11.6 s .12 � �11.9 s11.7 � � .�t�� ;8.9 \ .3 ,.c�'� � :B.II % �\``.; , �(� �� / � :e 10 ' � 5 � �b� ' �: SISSABAGAMA LAKE � � � ` � :; �-�3.� / � . � �-�\ f ; �4,� � � � '�� SCALE: I INCH= 400 FEET FOR ASSESSI�IENT USE O.NLY . DRAWN BY:�('{. DATE : 7/6/87 INTEND�D TO SHOW CON'`�L � ; ; �OLON (:) INDICATES GOVT. LOT EVIDENCE OF OWNERSH�P OR 80UNDA°RY LOCATIONS Form No.27�M—�U�T CLAIM DEED Minnesota UNtovm Conveyancing Iflanks(1u'ia) > '-" ' "' ' � Individual(5) to Individual(s) . No delinquent taxes and transfer entered; Certificate ,c: tJ � i i �i of Real Estate Value ( ) filed ( ) not required Certificate of Real Estate Value No. "�'�°`" �''�" � ' 19 Sowyar Co�nty � Aeceivcc loc record th�a��dn7 of � ...�'7L�i�•IA D 19 a`i et ,�.o'dgck M �nd fecozded 1n �d�_ '�� C,011ttt}' E�UCi1tOT I ol llrecorci on peg� �'� ' � G c�« ��U,S-. .. -----�--` rie�idcr bY Deputy :�-..._,_ y,-y�.�,,,_.� STATE DEED�'AX DUE HEREON: $ Date: �/ "`�y ! � — ' 19 $$ (reser��ed for recordinc datal John R. Veloske sin le FOR VALUABLE CONSID�RATION, , Grantor�sl. imarital stalusl Carol I. Veloske, hereby convey (s) and quitclaim(s) to , Graz.tee(s1. real property in Sa er County, I�aso�, described as follo��'s: Lot No. 3 of Certificate of Survey Map recorded in Volume 6, Page 62, CSM, said lot being located in and part of �Government Lot 8> Section 6, Township 38 North, Range 9 West, and a part of Government Lot 13; Section 5> Township 38 North, Range 9 West. Exempt Number 8. (if mora sp�ce is nceJed,continue on back) together with all hereditaments and appurtenances belonging thereto. �\�� J -- John R. Veloske :AI'lis Ireed Tax tiLntnp I I�;r�� STATE OF MINNESOTA - ss. COUNTY OF OLMSTED The foregoing�instrument was acknowledged before me this day of / � , 19 ��. bY �•. 4 �'� , Grantor(s�. � �' / NO�TAti�'`f '�'CAy N n�y��AL,(OR OTHEA'fITLE OR RANK) ' .I. / /� � /�T� 1 �NOt PU�IlC '�•�/\/ � � I,*�DJ�-' � �i- ' ML" �Y SIG TURE OF PER ON TAKiNG ACKNOW LEDG�IENT Ola�s "' Y� t�iinnesota � � Tex 5[etemen s tor the real proper[y described in this ins[ewnmt sGoWd I. j�i .�ry'�S Tl e�pires: May 3� 1.99� ��.. be�cent to Qnclude neme and address o(Grancee): ., �5�� a ?�• � ' , FD CU'�� , . Carol I. Veloske 1311 - 32nd Street N.W. THISINSTRUMENTWASDRAFTEDBY(NAMEANDADDRESS):�� ROCt105C0T� MN 55901 �� DINGLE, SUK, WENllLAND & MELLUM, LTD. � Attorneys at Law �. Suite D--Kahler East j , P.O. Box 939 I ' Rochester, MN 55903 ', (507) 288-5440 i i � � � 96��:; _ ,�. c�n � �� __ _ ---- -__ ___ u...r Ls. �� -� �'n�.7 � _.__ -� .:rk. • c. - - ' _ _ _ Office of � Sawyer County Zoning Administration . P.O.Box 668 Hayward, Wisconsin 54843 ��is>eaa-azsa � URL: www.sawvercountv�ov.org E-mail: scezone(c�win.brieht.net September 2, 1998 Carol Veloske 2611 55`� Street NW Rochester, MN 55904 Dear Ms Veloske: In reviewing you application for land use permit I find that you are adding a bedroom to your home on Lake Sissabagama. Since your septic system is 19 years old we will request that you have a licensed plumber or septic pumper test your system and fill out the enclosed Zoning Administrator's Association Septic System Inspection Form. We appreciate the form you sent us from Gene Shimko; however, we find it lacking information that we need. Please have the enclosed form completed and return it to our office. If you have any questions please contact me at the above address and phone number. Sincerely, Debra Hammerel Permits Secretary Sawyer County Zoning Office Encl. ��G.C� �� „ � 0. ��.� o�. � � � � � '� — G 5 7 0-1, �,v,,�l.�s,� � _� _.___._ __.__ . .. _ ._._. .__e_�___ � �__..—---_____. _ a WISCONSIN'S NORTHWEST DISTRICT - ZONING ADMINISTRATOR'S ASSOCIATION COUNTIES OF: ASHLAND DOUGLAS PRICE TAYLOR BAYfIELD IRON RUSK WASHBURN BURNETT LINCOLN SAWYER SEPTIC SYSTEM INSPECTION FORM Requested by:� t�;� 1 � �Lt�s u -Q- County: � ��z��2- Address:� L � t - S�L �Tr- .v w Town, Ciry, Vlllage: �- ,��c n 1.,�k�= -c-- Ciry, Sta�e, Zip: �c�t�� .a�r-�� - Ssc°u l Phone: i - 'Z� S -�,'b.r� -4 b � 6� t -sG�7-zb�z�33}' Legal Descrip[ion: _ '/a of %a of seRion T N, R E/ W Owner/Otcunanr:�-A�,�, A �> ,�_�,< u � Sepric Address, �, Name: Address: Septic Serves: Ciry, State, Zip: (ex. # of homes, barn, school, church, indusuy, etc.) Tax Parcel # Date of consvucuon: If consuucted after ]anuary I, 1979 enter DILHR sanitary permit number (iF available). �! SEPTIC TANK INFORMATION Information ob[ained from: owner pumper ✓ other Tank Construction ILHR 83.15(1): concre[e steel � fiberglass other Approximate tank size (iF known) _ _ '7$CJ (o AL Has the tank been pumped on a regular bas(s per county maintenance agreemenc� n Yes No ✓ Per owner Per pumper Pumper's name l�t/'<K `�'?N't �----- Has the tank been pumped prior to the inspecdon? Yes No c� Per owner Per pumper_ Was inspec[or on siee during tank pumping? Yes No � Was sludge/scum level greacer t.han 1/3 of total volume prior to pumping? Yes No �/ Evaluate condition of baFFles: General condition of septic cank: Iniet vutiet i.e.: crackpsinoies in cover, sid1ewafis, ootcorn 'q Good . � _ � explain: C 'i//J`�� YUIY�" d- ��LU'�''� 6�G�+ Need replacement C°I�N� �'f�urt)• ___ Missing _____ MANHOLES D :'i;�.r.�: ' __ ;' n �� Is service cover more than 6" underground? Yes � No } � Is service cover above grade? Yes__ No_ � ,- SEP 2 � �998 � Does cover have a warning label, chain and locking device if above grade? Yes No t/ �>t1'YEH Cq,y,��ry Is service por[ in code compliance? Yes No ��'��'u ��;N��j�ON Is there a manhole riser on tank? Yes No '� Is service cover riser properly sized and watertight? Yes ✓ No Is there a 4" or larger inspection opening a[baffle opposi[e service cover? Yes No � Is inspection opening or pipe at least 6" above grade? Yes No c� SEPTIC SYSTEM � Con�entional Bed Trench Pit (circle one) Ir Ground Pressure Mound A� Grade Privy Approximate Age: Other (explain) Total'Area: sq. ft. Is septic tank and dosing tank in setback compliance from: Distance in feet: building? Yes No lJnknown We�� Yes No llnknown high water mark? Yes No llnknown lot line? Yes No llnknown pool? Yes No llnknown o[her? Yes No llnknown is tnere a dosing chamber� Yes No Pump — Floats — alarm siphon checked for proper operation? Yes No Is absorption field in setback compliance from: Distance in feet: lot line? Yes No linknown high water mark? Yes No llnknown pool? Yes No Unknown well? (except for schools) Yes No llnknown other? Yes No lJnknown Is there an approved vent present? Yes No Is the vent functional? Yes No Is there water present in the vent? Yes No # of inches Was a soil boring conduc[ed 3' below existing sys[em? Yes No Llnknown Dep[h to groundwater? inches Depth to mottled soil? inches Was boring done by a CST (Certified Soil Tester)? Yes No llnknown Is owner aware of any backups, surface seepage or discharge, odors, slow drainage, etc.? Yes No If yes explain ! certify that the above information is true and correct to the best of my knowledge as observed on , 19 Operational aspects and observations reported are based on the conditions noted at the time oF inspection. This inspection does not in any way guarantee or warrantee the continued operation of the system described herein. Inspector's Signacure Credendal Number Date Attachments required: ❑ Approved plans ❑ Soil test report ❑ Copy of maintenance records (if available) ❑ 8"x 10" plot plan of house, well, tank(s) and soil absorption sys[em � 9-.�-9� . �v -�.-f� C�� _ `";;��,��.,;;� �� /�j� �✓� (�� ; SEP 3 0 1998 �� ?G�c..a.u��, l� -s`f�'�/3 , ,.;`."�;R�;.-��,.-y-_ � ��,; :.a�;;�sr.��u-��y � a� � � ��e.�. ,�.�,�--��. i�.�.�, ��, ,s�-�.- �r,�� ,�-� � � y�- �n�� .� �.� � a-� ��-�� , �.� ��. �� . � �� .�-�-e-�-,�-�--� ��--ti- �--�e �� --� >�.70.�� _ ;�7'.1� t�� .� ��. s�-c� �.�L �� -� , ` =e-'�-e- a�/° Qhe..c_ � �k.x� `-�t-e��-' � .�'e-�L,a�(��' � �2 G��n�J bi4( �fc�G.e.a.o-tL.�-<,9-, ,1�,�. �c.c�c.2-� 0�-�--o G/ zIE�� .�t,L c.� �-e-�� -,�-,C� B'7� `�-rl-�_ d�c� ,C-c��--4--�-� � cJc�G--�.0 �l.cJ.�� /,�-� �C.e��. �cC� -,�-�a--r� d� ��mjo � c�i� �Gc�z-o�=Ll�/ �C1 e�--r��¢� �,e.. �� .�C�-� �2-�-C�(.,e� ..�.�J,e--2� aC-da-u.f-e-� �u�u- �' �c.cJ� ,c.�J.c�- �ccJ,�.�..EJ �-�-Lr-�- /� — GC/� .�--C�l� �� '�C ..�cJ�-e �� . _ _ _ __ _ _ _ _ . . r � • , � • �� x— ,��a�.1- e�r�.� ' -- - - � �� . ��.�.� ��-� �� _ �� G��-� .�� z��G� �� -� - ��-��.� :�� . � a--�-� . --. �� rp ( _1� Q�os �t -��- �ess�.--- ---- -- `\1� - ?��-l( -�S f`'' s�- K.1_c.J ' R� ,�.� _ �-t. r� _ �S O�F € ". �� _, _ __ - • '-_i ----- . --_�e—'• LV P • �x�s��-� s.�`�`_ s�-s�t`'�- �@r M$ v �IOS�Q � We a�e dQ�;_�:�5 � o� r l��_ vte --�w«_ c�uc +o,_ -E-Le C�ck o� _ i-� ��c �a� w--. c� � � o�r Cv� <:c / �...t¢n i� s/L�ct.,p� � ��or IZJ ISSu� "-��' �, ._.� ' �-_ -_ � __- Dv� ��.��.5 ls-�w .'t � �-e OWK�r N-�US�t �� CW��r OU � ��.,�.�—__._ .. �'1-�'� �.__ccccu �'�..'�< , -1-� oc' ov� l.� �ek <S'��5 �1'` c . �u��.- ___ _ _- -"� `--- E11ac�J.c��4_, . }� ,r 5��.�,..�coc j.., s `r�c�+%� fS 'Jrt�- !+-� �oc-.-P�4'�C. c<I ��-<��.-,� r �..�k� ��d��-�� a.n o�- s. � cn."� .. ,., )..�, �a T..ti. 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