HomeMy WebLinkAbout236-941-22-4467-INS-1999-045 Sawyer County Zoning Administration o n O
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Inspection Report � �,
Owner(s) Hayward Family Dentistry SC x
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Address P.O.Box 1220 Hayward Wisconsin 54843-1220 � '--�
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Inspection � Private � Public Violation � Zoning � Sanitation z
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� Dwelling � Mobile Home � Commercial � Garage � Addition � �
Q Setback-Lake � Setback-Road � Setback-Lot Line � Soils Verification � ,.�
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WD Vol 540 page 470 Acr s:0.860 G1 #10541 N Ranch Road Lot 2 CSM Vol 8 page 30 °� �
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Discussed with Dr.Patrick Duffy �
Date&Time June 7, 1999 9:00 A.M. =uN� �g„�q 9q. �?;Lf 5 p,„/�,
Signature oflnspector �9y.,
yN�o'tv
Town of Hayward
County of Sawyer
23 June, 1999
Date
SUBJECT: Variance Applica[ion
To: Sawyer County Zoning Administration
P. O. Box 668
Hayward, Wisconsin 54843-0668
Owner: Hayward Family Dentistry, SC 634-2011
Address: P.O. Box 1220 Hayward Wisconsin 54843
Property description: Parcel in part of the SE 1/4 of the SE I/4, S 22, T 41N, R 09W
010-941-22-4442, Parcel .16.42
Lot 2 CSM Volume 8 page 30
#10541N Ranch Road
Volume and page no. of deed: WD Volume 540 Records page 470
Acreage and lot size: 0.86 acres
Zone district: Commercial One (C-1)
Application is for: the construction of a 28' x 41' addition onto an existing office building at a setback of
109.5 from the centerline of State Highway 77.
Variance is requested as: Section 421(1), Sawyer County Zoniog Ordinance, would require a setback of
130' from the centerline of a State highway.
Name and address of agent: Signatures of property owner and agent and/or
purchaser. The above hereby make application for a
variance. The above certify that the listed
information and intentions are true and correct. The
above person/s/ hereby give permission for access to
the property for onsite inspections.
_-
COMPUTER N0 . PARCEL NUMBER --------- VALUATIONS ---------
NAME AN� CODE/ADDRESS OF OWNER LEGAL DESCRIPTION CODE ACRES LAND IMPROVE
�__ PROPERTY ADDRESS
10-941 -22 4439/2-41-09-22-4 . 16 . 39 SEC/TN/RNG ZBMp SCHOOL ACRES PT . SESE 62 . 950 13,500 60, 800
�___ 6IDLEY, CAREY GIPL01 22/41 /09W 2478 . 950 L 2 CSM 4/263 7/13
PLUMBING HEATIN6 6 EXCV ---------- HISTORY ----------
10585N RANCH ROAD 507/303
_ HAYWARD WI 54843 CHG : 1/O1 /98 CHV : 1 /O1 /94 HO
105$SN RANCH RD HAYWARD 54843
_10-941 -22 4440/2-41-�9-22-4 . 16 . 40 SEC/TN/RN6 ZNMN SCHOOL ACRES PT . SESE G2 1 .580 10 , 600 11 , 100
FRED C 6 ROBERT J SCFR03 22/41 /09W 2478 1 .580 LOT 1 CSM 72/75
SCHEER ---------- HISTORY ----------
__ PO BOX 221 497/101
HAYWARD WI 54843-0221 CHG : i/22/94 CHV : 1l01 /94 HO
15544W STATE ROAD 77 HAYWARD 54843
10-941 -22 4441 /2-41 -09-22-4 . 16 . 41 SEC/TN/RNG Z#MN SCH00� ACRES PRT . SE3E G2 . 700 10 , 000
6ERALD L TUGE02 22/41 /09W 2478 .700 LOT t CSM 8/30
___- TUTTLE ---------- HISTORY ----------
PO BOX 1137 566/84
HAYWARD WI 54843-1137 CHG : 1/01 /96 CHV : 1 /O1 /94 HO
10-941 -22 4442/2-41 -09-22-4 . 16 . 42 SEC/TN/RNG ZNM# SCHOOL ACRES PRT . SESE G2 . 860 13,500 134, 200
-_ HAYWARD FAMILY DENTISTRY HASCOS 22/41 /09W 2478 .860 L 2 CSM 8/30
S C ---------- HISTORY ----------
PO BOX 1220 540/4T0
--- FIAYWARD WI 54843-1220 CHG : 1/06/96 CHV: 1 /06/96 HO - -------_-___
10541N RANCH RD HAYWARD 54843
--ID-941 -22 4443/2-41-09-22-4 . 16 . 43 SEC/TN/RNG ZNM# SCHOOL ACRES PT. SESE 62 1 . 750 20, OOQ __ __ _
NORTHWOODS PHYSICAL NOTH01 22/41 /09W 2478 1 .750 LOTS 1 � 2 CSM 15/146
THERAPY 6 FITNESS CTR ---------- HISTORY ----------
-- 600 SHELL CREEK RD ST 2 _ -- 518/6-__ _. -- --_ -- -- --__. _
MINONG WI 54859 CHG � 1/O1 /97 CHV : 1 /O1/94 HO
�'_- _ _
_ _ --
10-941 -22 4444/2-41 -09-22-4 . 16 . 44 SEC/TN/RNG ZNMN SCHOOL ACRES PT . SESE G2 1 . 150 13,500 52, 200
ROBERT C � JEANNE K HOR011 Z2/41 /09W 2478 1 . 150 LOT 3 6 OUTLOT 2 CSM 15/146
- -- HORNAK_. _. _ . _ _ _ _ __ _--- ---------_ HISTORY ---------- _
_ - ---- _-__ . __ . _ _ _.___ -- ---
PO BOX 719 518/5
HAYWARD WI 54843-0719 CHG : 1/01l96 CHV : 1 /03/95 HO
-�_ __ --___
i '
DOcun4EN7 No. S :E BAR OF WISCON3IN FORM 1-1982 TNIB BPAC¢ RESEflVEO FOP PECOROIN4 DATA
���� � 2 WARRANTY DEED
--— -- --—
--- ---- --- -- --- --_ __._.
- hiyiir�dUo� �
This Deed, made between GERALD L. TUTTLE and (��p��
- -� - — -- --- - .. .-
__JEROME._E.__GAWLIK,..an _undiyided one-half interest to reoord �6e ds� �1
. each as t�AaAtS in._�.o[mnon .. _ _ _. ._ .. ___. � A D 19 et o'dool
I M and tecorded In �oL 'S
--- -"- --- -' --- --- - Grantor�
� and ..._ -HAYWARD .EAMZI,X .D$NxZS2AY� S,.0 � _1_WiScon�in_. _ d Re�ci� an � �17
- �orporatinn - - - -- - - ------ - -- -�- -�--._........
� -�--------------------�----------�-----------�---�-----------------------�-----..._, Grantee, � �
......_..-----�---------------...-'------...-'--------------------------...------ '
Witnesseth, That the said Grantor, for a valuable consideration...__.
_._.Df..Dne_�o1Lar..and.o.ther..valuable._.cons.i.d_ex�t�ons--- = L ,-��_ -_ = �
HETURN TO � ,/
conveys to Grantee the following described real estate in _.-SdFIy�[ ... ... 9 aQ�iK OF h�Jqyuprd
f}ef,tR t
County, State of Wisconein:
Taz Percel No: --------------------•----------••_
i
That part of the Southeast Quarter of the Southeast Quarter (SEZSEZ) , Section
Twenty-Two (22) , Township Forty-one (41) North, Range Nine (9) West, described
as Lot 1t�o (2) , recorded in Volume Eight (8) of Certified Survey Maps, pages 30-31
Survey No. 1582.
Description obtained from Abstract No. 22190 prepared by Hayward Land Title Co.
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FEE ,
This 1s not________ homestead property.
'-..----'-----. .
(is) (is not)
Together with all and aingular the hereditamente and appurtenances thereunto belonging;
And-----grantors...------- �- -.. ....
. . . ..--------"--�----..---------------._...........---................_._.------.-.-.....
warrants that the title is good, indefeasible in Yee eimple and free end clear of encumbrancea except
all easements, exceptions, and reservations of record
and will warrant and defend the aptpe.
_f-)
Dated this ..--------------��-'------ -----...... day of ---�.4--�-.. .. . .._�---................-------------_, 19.9,`/...
�--�-�--�---------�--��--�-��-----------------------..(SEAL) 1"c%�5\\.—`-._'_`_�_'�--.�.`��_--.._(SEAL)
. Ge ald L. Tuttle
` -� -�--� - � ------ -...-- - .........-- - ...- - -- - ---- - -
i '
"_ ' "'"_ "_-'"
.....---...-�-----(SEAL) `� . .___..._........--- - - -��- --- --....I----. .(SEAL)
. . __..Jerome_.E. Gawlik
--- - ..... - - -. - - - -. ............. .. -._. . .... - - - - -- --...._.
AUTHENTICATION ACHNOWLEDCiMENT
Signature(e) --------------------------------------�---------------- STATE OF WISCONSIN
� es.
-----------------------------------'---------'-------'----------------------
-�'-' '-"— ��---"--'—County.
authenticated this ......._day oY........................... 19__._.. Per ona(ly c e before me this .._�:_G____day of
_------•---�.t��-.�-•--_..__. 19.Y_Y.. the above named
'-------'---'--'-----'--"--......--'-----------------------------------
_.__GQ_��_�,�,_L,__T���le_and_Jerome__.___
'---------------
'- -�---�---------- �-- ---�- --�-- - ----- - - - `- Y PUB ---Ga�l.ik----------- ---- -�---.....-�---- --------- - -------
TITLE: MEMBEA STATE BAR OF WISCx_ Y]P� (/�
'----�--._._---------------------...--'--._...-----'-----'---------
(If not, ----------------------------------s-f^- '----""-- -'- '-'--'--..-"-'..._"-------------'------------'------"-----
authorized by § 706.06, Wis. Stats.YJ
� 7HOMASW. known to be the person _5_-_... who executed the
�� DUFFY e ing instrument an knowledge the same. _
THIS INSTRUMENT WAS �RAFTED BV � MyCO�'� � � '�� �
/�� �� S�_ '_"_"'" ""'_"_ "__"__......."_"'"...�"__ "_"_"".._.._.
�- --_Duffy_.I.aw..9�����---- ----- - - �� 4
�riqj F OF W�S�� � -- -- -- ---- - -- -- - - - - -
...Ha�eard,--h'�---...�4843...-.--------.----h� NotarY Public _.__._..'._..........'..__.'._.__...CountY. Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration
are not necessary.)
date: ....................�---�--�----�----------�---y-y..., 19-------•1
•N�men o[ Deraune ai¢nlne in �ny capecity nhould be tyVeJ or pdnteJ below lheir ei¢neNree��4 0 � � • O
' WAnnnNTY m+.RD eTATF. IIAR OR WISCONSIN \Visninsi�� Lc�.-ul ➢luuk Co. inc.
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CITY OF HAYWARD
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SURVEY OF PARCELS IN THE S.E. I/4 OF THE S.E. I/4 OF SECTION 22 ,
T. 41 N., R. 9 W., TOWN OF HAYWARD , SAWYER COUNTY , WISCONSIN .
N S. 8° 52 42� E. 235.81
35.75 200.06 ' 33.03
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SCALE � I�� = 100 FEET I
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o I�� I.D. X 30�� IRON PIPE PLACED N � �
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X P.K. SPIKE PLACED ?
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• I�� I.D. IRON PIPE IN PLACE :
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Page 1 0� 2 pages z
22 23
�Pf7e��y$�' S.E. COR. SEC. 22 - 41 - 9—
�� 2.s' s.e.c. 27 26 �D
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I , Robert R. Swanson, Wisconsin Registered Land Surveyor,
do hereby certify under the provisions of Chapter 236. 34 of the
Wisconsin Statutes and under the direction of Kennedy Investment,
owner of said land, I have surveyed and mapped the parcel herein
described and that said parcel lies in the Southeast �tuarter of
i the Southeast @uarter (S.E.4 of S.E.4) of Section 22 , Township 41
North, Range 9 West , Town of Hayward, Sawyer County, Wisconsin
described as follows�
Com�encing at the southeast corner of Section 22-41-9; thence
North 00 51 � 24" West , along the east line of said section, 674. 95
feet to a point;
Thence South 68°29 ' 19�� West 36. 29 feet to an iron pipe which
is the point-of-beginningt
Thence continuing South 68°29'19�� West 102. 56 feet to an iron
pipe which is on the northeasterly right-of-way line of New S.T.H.
��77��
rThence North 47°34' 36" West , along said R.O.W. line , 189. 82
feet to an iron pipe;
Thence North O1°00`'S1 �� West 208. 25 feet to an iron pipe;
Thence South 88°$2 '42" East 235•81 feet to an iron pipe on
the westerly R.O.W. line of Ranch Road;
Thence South 1�C7°18 '26" East, along said R.O.W . line 128.6�
feet to an iron pipe;
Thence South 00�57 ' 26" East , along the westerly R.O.W. line
of Ranch Road, 165.40 feet to the point-of-beginning.
Said parcel contains 1 .56 acres more-or-less and is subject
to easements and reservations of record.
176364
�e�e om� ' �,
Sa�ryet Couaty
Received Eor recotd�he_�_daY oL ��..��������r���.
NOV_ AD18�at�38clock �'� �;��,�N����'�.
�, ...... �2,
�,PA md recorded(a vol. � � 3,.+"' w..
W�y_'on Daae_�� _ . �'ROPERT R�'•.
, S4VAI:riON � '
Reyi ter = ,1 "�10-:� �
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Page 2 //-/d-90
31
Application for Land Use Permit 4
County oP Saveyer �
The undereigned hereby makes application for a Land Use Permit and o, �
agrees that all xork ahall be done in accordance with the require-
ments of the 5axyer County Zoning Ordinance and the laws and reg-
ulations oP the State of iiisconsin.
PLEA$E PRIAT - tTSS BIACK INR OR PffiYCIL �
��
Smittv ' s Inc . Dalc Jo�� �cnscn - �
rnmer -- er �
P. O. Box 513 Rotite 7 � �
ma a ress ma a resa µ
Havwaru . 1Visconsin 54843 [lavward , 6VI
Building Land Use Zone District c:- 1 �
h Nex Filling i�
Addition Dredging Lot size '�
Alteration Mining
Moving on Grading Acres . 86 �n
�
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New Construction (year round) or (seasonal) -conatructed _
Size 5o Pt xide ft wide
l00 Pt long Pt long �
cr
Floor area 5 , 00a sq ft sq ft
�
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Total height Zp � to peak to peak '''
Stories 1 N
Ao. of bedrooma rear lot line or waterline
�
e of structure �'
IAvellin8 � s�
Garage (1} �2) car
Storage buil ing
Boathouse m
Livingroom
Bedroom �
Utility room �
Kitchen-dining
Porch - enclosed a i�
Deck - open C �
X Liquor Store � �"
m
µ n�
e oP construction � N
x Frame Slock
Log Concrete
Po2e Steel �
Metal
Estimated coat � 45 , 000 . 00 �
CST 81- 285 �
Vol 334 Pg 523 of deed Sd
CS 90l g Pg 30 �je� Q��4C��� �
Sanitax-y Permit : 81- 265 �
-------CL road ------------ cyi �
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Isaued Denied
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DEPARTMENT OF �' APPLICATION �� � SAFETY&BUILDING$a
INDUSTRY, FOR SANITARY DIV�SIOIrI���'
LABOR AND - PERMIT P.O. BOX 79g9;n;
HUMAN RELATIONS , (PLB 67) MAD�SON,WI 597071°u,
Attach plans for the system on paper not less than 8K x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical charec[eristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed,sealed and dated by the designer. If designed by a Master
Plumber,the date,signature and license number must be shown. The ownero copy or a legible reproduction of the soil test report must be
included.
— 2Z
Property Owner: !7 � � Mailing Addresa:
� � C .Q, 0 W ft � cS 8
Property Location: Bif�YiNega or Townahio: ounty:
Ya,�� YaS � �T N�R (or) W � vy ..S
Lot Number: BIk No.: Subdivision Name: � Nearest Road, Lake or Lendmark: Stata Plen I.D.Number:
(lf assigned)8�•0 b���
TYPE OF BUILDING
Number of
�Public' ❑ Variance~ ❑ O[her (specifyl" Bedrooms:
Q 1 or 2 Family 'State Approval Required. ly'�-yLQ�
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITV �-U
HOLDING TANK CAPACITV
IIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SVSTEM
PERCOLATION RA7E ABSORPTION AREA
(Minutes per inchl: PROPOSED (Square feet): � NCW ❑ Replacement ❑ Experimental � Seepage Bed ❑ Seepage Pit
1 /_ �� ❑ Alternative (specify) ❑ Seepage T�ench
��
Water Supply: Owner's Name as Listed on Soil Test Report (lf other than present ownerl;
�Private ❑ Joint ❑ Public
I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: � � MP/MPRSW No.: Phone Number:
�:/�t-P -N c� /�''1 Q�c L � ,��;, �, � �� ' .. __.__ l �l 9 S �)/sG,s'y�i 3
Plumber's Address: , ' Name of Designar:
� V /`}- : , � � � �.0 � �
COUNTY/DEPARTMENT USE ONLY CS'r 81- 2s5
Signa r f Issuing ge . Fee: Date: � qppROVED Sanitary Permit Number
5� . �� lZ- 'J- $1 ❑ DISAPPHOVED 23616
fieason for Disapp al;
Alternate coursels)of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
JTION: White�County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DE398 IN.03/81)
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PROJECT DETAIL DATA SHEET
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NAME OF BUSINESS �SM I TT Y S L I �L.�n R fdRYGu�+an Tu,asNP�.Saruv�2Ca
LEGAL DESCRIPTION SE%y S�%Y S 7�-T4lN-R9ul I_oT � oF C,SM"/582
OWNER ��ANI( A. SM17H _ MAILING ADDRESS P Q ,I��X ,51.3
��Y.i ,L�L2�11ZIR cS�Sy.�
ARCHITECT, ENGINEER, (;LRRENCE M�TCAL� ADDRESS /�FD 6
PLUMBER OR DESIGNER M p �y 9 g
AY�iARD�/Ul ZIP �t[BH.4
TELEPHONE NUMBER ���, ��{-� �y�3
l. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed. Please consult Section H 62.20.
Existing building New building Y E'S Addition
( ) Apartments and condominiums . . . . Number of bedrooms _
( ) Assembly hall . . . . . . . . . . . Seating capacity _
( ) Bar . . . . . . . . . . . . . . Seating capacity _ # of ineals served
( ) Bowling alley . . . . . . . . . Num6er of lanes ( ) With bar
( ) Campground and camping resorts . . . Number of sewered sites
Number of unsewered sites
Total number of sites
( ) Camps • • • • • • • • • • • • • • • ( ) Day use only Number of persons _
( ) Day and night Number of persons _
( ) Catchbasin . . . . . . . . . . . . . Number
( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of persons _
( ) With kitchen Number of persons _
( ) Dance hall . . . . . . . . . . . . . Number of persons
( ) Dining hall . . . . . . . . . . . . P�umber of ineals served daily _
( ) Doq kennels . . . . . . . . . . . . Number of enclosures
( ) Drive-in restaurant . . . . . . . . Inside seating capacity _
Car-service -- Number of car spaces
( ) Dump station . . . . . . . . . . Number of dump stations
(� Employees ( total of all shifts) . . Number of employees �
O Hotel O Motel O Cottages . . . . Number of units with 2 persons per unit _
Number of units with 4 persons per unit
( ) Medical and dental office bldas. • • Number of doctors, nurses, medical staff _
Number of office personnel _
Number of patients _
( ) Mobile home parks . . . . . . . . . Number of sites _
( ) Nursing homes . . . . . . . . . . . Number of beds
( ) Parks . . . . . . . . . . . . . . . Number of persons ( ) Toilets ( ) Showers
( ) Restaurant . . . . . . . . . . . . . Seating capacity _
( ) Dishwasher and/or disposal?
( ) 24-Hour service
(X) Retail store . . . . . . . . . . . . Total number of customers
( ) Schools . . . . . . . . . . . Number of classrooms Meals ( ) Showers
( ) Self service laundry . . . . . . . . Total number of machines
( J Service station . . . . . . . . . . Number of cars served daily _
( ) Swimming pool bathhouse . . . . . . Number of persons _
( ) OTHER . . . (Specify) . . . . . . .
COMPLETE OTHER SIDE
v
2. Indicate whether the following facilities are present.
Floor drain yes _ no �j _ Number of drains _
Food waste grinder yes _ no X
Dishwasher yes _ no _� -
Automatic clothes washer yes _ no �_ Number of clothes washers
3. Septic tank capacity �pn�
Holding tank capacity
Septic or holding tank manufacturer 7'M C', Po S k 1 hl
4. SEEPAGE TRENCHES: total square feet width of trenches
length of trenches depth
number of trenches
SEEPAGE BEDS: total square feet ��� width �� �
length of bed 3 7 ' depth 3� "
SEEPAGE PITS : total square feet outside diameter
depth below inlet
total depth from top to bottom of pit
Signature of person completing form: FOR DEPARTMENTAL USE ONLY
�//_I� �F
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Address �� �4��r«r��T�ti,�c�'
r/� � Z i p
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Tel ephone Number �f`j�5=/,��/� �,�y.�
Da te /�G' ��/
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Department of Zoning and Sanitation �- •
Sawyer County
0
Inapection Report �
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Owner Smitty ' s Inc.
�
Addrese P. O. Box 513 Hayward, WI �.
rr
Name of businesa `�
ti
Builder
�,
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Address "
Plumber Clarence Metcalf
Address Route 6 Hayward, WI
Inapection
( � Yrivate (7(� Public Property Sanitary-instal r o
Dwellin� Setback - lake h �
Violation Mobile HM Setback -•road o
Gara�e Setback lot lin "'
( ) Sanitary ( � Zonin� Privy
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Discussed with owner yes no �y
Diacus�ed wi.tti Uui.lder yes no
P:i_ncuuscci with plumber X yes no �
Di3cussed with ye3 no
v�te �7 �(' f�1
Signature of Of£icer ���(� - �-j ,� �
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INDEX � ��
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Soil Test Data Sheet
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Owner Smitty ' s Inc
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Address, c/o Smith Realty P. O. Box 513 �
�
Hayward, Wisconsin 54843 '�
Certified Soil Tester Clarence Metcalf �
Date Soil Test Received 05 November 1981 �
0
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Land Use Permit No. 81-277 �
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Date Issued 09 December 1981
�
�
Sanitary Permit No. 81- 265 r N
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Date Issued 07 December 1981 �;
Plumber Clarence Metcalf �
�
Tank Size 1000 No . of Bedrooms �'
Zone District �- 1 Acres • 86
Volume 334 Records Page 5z3 � Icn
z• M
Certified Survey Volume 8 Page 3� a
NEW OWNER: I�
Hayward Family Dentistry S.C.
Patrick Duffy � a�
P.O. Box 1220 °'
K
Hayward, WI 54843 � �'
Vol 540 Pg 470 �
LUP 94-515 issued 12 December 1994 for medical clnc denti t y N
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUI �.DINGS
INDUSTRY, DIVISI'JN
LABOR AND PERCOLATION TESTS (11J) MADISON WI 53707
HUMAN� RELAT O
' a,� �- ��— � .
LO AT10 • ECTION:T TOWNSHIP/ LOT`NO.: BLK. NO.: SUBDIVISION NAME:
� �/ � /1 N/R � (orl n �� �,
COUNTY: OWNE 'S B ER'S NAME: AILING ADDRESS:
s �v -��t' ,' � /-i�.s, . ,� ✓.� �
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USE � � DATES OBSERVATIONS MADE
NO. BEDRMS. : COMMEF3..IALDESCRIPTION: I R S: LA ON ESTS:
❑Residence ' "' �New ❑Replace i
�'`�-1 - y�-� � _
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUNaPRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
s ❑u os ou os ❑u os au ❑ s ❑u
If Percolation Tests are NOT re uired DESIGN RATE: S STEM L
4 If any portion of the lot is in the
under s.H63.09(51(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPrH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.1
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PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. pERIOD 1 PERIOD 2 p RIo PER IN�H
P_ � �p �9 � � �— �
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PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slop.
SYSTEM ELEVATION � �> „�,� �,�, �
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print : TESTS WERE COMPLETED ON:
�� �� �.� , � / �/
ADDI� , CE IFI ATION NUMBER: PHONE NUMBER optional):
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CST� TURE:
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DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. `!'�
.
DILHR-SBD-6395 (N. 03/81)
P5/03/1999 08:56 608-765-9330 PAGE 01
Safety 8 Buildiog5 Division ,
2226 Rose St
La Crosse,wlsconsin 53603
- (808J 785-9334
� 7DD#�(60B)264-8777 �
www.commerce.sfete.wi.us
` ,�7'{��nsl� � Tanmy G.Thompson.Go�remor
De artmentofCommerce erendaJ.B�anchard,secreta�
FAX COVER SHEET
Date June 3,1999 No.of Pages EXCLUDMG cover Z
Sant: sheet
To: Cindy Kuczenski From: John Spalding
Deputy Zoning Administrator Sectio�Chief
RecipienYs Fax#: 7'15-638-3277 Sender's Fax#: 608-785-8330
RecipienYs Phone 715-634-8288 Sender's Phone 608-789-4693
Number. Number:
Special I nstructions:
Cindy:
Thank you for the info you sent down yeSterday. That helped quite a bit. Attached is a copy of the
Site Plan for the Duffy Dental Clinic on the corner of Hwy 77 and Ranch Rd.showing the existing
building and the proposed addition that we are looking at. If I understand the setback requirements,
there is a 730'setback from the centerline of Hwy 77. If so,that would put most of our addition
within the setback area. If this is correct,is there a zoning variance process that we could appiy to
in order to look at building this addition.
Could you give me a call at your convenience so I can go over this with you and see what our next
step would be?
Thanks again for your assistance,
John Spalding
If there were any problems with the transmission or not all pages were received, please contact
sender immediately at sender's telephone number above.
ADM tO5B5(R.<198)
Efi/03/1999 08: 56 608-785-9330 PAGE 02
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