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Home My WebLink About010-841-14-5119-LUP-1992-389 Application for Land Use Permit � County of Sawyer o� The undersigned hereby makes application for a Land Use Permit and � � agrees that all work sha11 be done in compliance with the require- o ments of the Sawyer County Zoning Ordinance and the laws and regu- M lations of the State of Wisconsin. , m `� J � PRINT - USE BLACR INK: OR PENCIL � �2��-834i) � C_7�c'-�l(�LL7 �.. -r i�. . : `�' /}'l4� u� so,.� SuNdper� �o-�S7'. Owner � Builder -1 �s w�o� I,�,� C��c�.(� c��3si C�,�,.«�-��o �c> � Mailing Address Mailing Address � �4��v/� �/✓ SSy�`7`_ (�J(�✓Tt,� L✓.2 _�`fS�`7.6 City, State, Zip City, State, Zip Building Land Use Zone District _��-I r o ( ) New ( ) Filling �* � ( '� Addition O Dredging Lot size m rt ( ) Alteration ( ) Grading ( ) Moving On ( ) Acres •�j J ( ) ( ) � :J New Construction ��` � � �c�OtT�oa �; Size 7?, ft wide (�� 2� ft wide ��0 � '�/'(� ft long ��p g ft long T Floor area ��{D sq ft -rjZ4- sq ft I•� � � Tota1 htg /3 to peak �� t�-.pe�ak o�r ' I?�i7F � r Stories � _ _� Stories �} No. of Bedrooms rear lot line or wat:erl�, o (year round or (seasonal) 12o„r� (�` m rt Type of Bidg or Addition ,s I 4-4,I S� a o ( ) Dwelling .�f, � e. � ( ) Garage (1) (2) car i,Z�' r• O Storage Building .��,<��„ s ae � N ( ) Boathouse �; `�`�e• y._77�,� o� ( ) Livingroom �Sp'i-�� U � •(ac1 Bedroom �a; � w"`'"� O ( ) Kitchen-Dining N�____ '�� ( ) Porch - enclosed/roofed r aQ - �'f--(^ O (�Q Deck - open — ,�. " � ( ) � a � � F ( ) {� I -' � O Type of Construction � U`�� Q. 8f� sT 77 � � f.� Frame ( ) Block � �� r� ( ) Log ( ) Concrete ( ) Pole ( ) Steel � � ( ) Meta1 ( ) _ � � � Construction Cost $ (oa, pfl0. � -� —r ~ T Vo133�0 Pg 52(p of deed CS Vo1 � Pg �F2(-�F2.7j I ro � w Cer. Soil Test 4a - �sa 1 �`i .a � � C Road ~ — Sanitary Permit ��- 14� -----""' L ---"--�� z �4AF�CY��'E VO��--�� P�k y-�lU ��✓," L�/��4' � z .� � Issued �(°�tz,{� (q�'1Z_ Denied i - �i � � �,,��'�.� ��.�� r,�od�� £ g�e:r Zoning Admin�_strator PARTMENT-0F � APPLICATION � �� SAFETY&BUI!DIN6S fNDUSTRY, FOR SANITARY DIVISION co LABOR AND PERMIT P.O.BOX 7969�;' HUMAN RELATIONS (PLB 67) MADISON,WI 53707� V Attach plans for the system on paper not less than 8%x 11 inches in size.Include a plot plan that is diinensioned or drawn to scale.Horizontal and vertical elevation reference points must be shown.All appropriate separating distances and physic:al characteristics 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.A legible reproduction of the soil test report or the owner's copy must be included. ' - M la J. �Property Owner. /` . Mailing Address: . / L'�• .S ; .) .f _Q:.L�9. 7//.fi� .sS�!'�.Z Property Location: C�iE1y,iJie�ror Township: County: '/ Y4S/� iT 5�-�NiR � E(or '� - D�,S ' � e i-, Lot Number: Blk No.: Subdivision Name: Nearest Road,Lake or Landmark: State Plan I.D.Numbec `, „fo / r� ` / C (lfassigned) ✓ L TVPE OP BUILDING� Number o" ❑ Public" ❑�Variance" ❑ Other(specify)* sedroomr Q 1 or 2 Family "State Approval Required. � � TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY ',y-(� � HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: �, EFFLUENT DISPOSAL SVSTEM PERCOLATION RATE ABSORPTION AREA IMinuces per inchl: PROPOSED(Square feed: � New ❑ Replacement ❑ Experimental �Seepage Bed ❑ Seepage Pit 6 �//� M ❑ Altemative(specify) ❑ Seepage Trench T' Water Supply: _ Ow er's Name as Li/sted on Soil Test Report(lf other than present ownerl: � � Private ❑Joint ❑ Public ,�K }U��+ �/(U�'/�/L (ni/ I,the undersigned,hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signat e MP/MPRSW No.: Phone Number: + '� �/� ' :� -�7 (n � �v`��'S' P umber's Address: Name o esignEr: �j • � � l.a.j' a COUNTY/DEPARTMENT USE ONLY CST 82-15z Signat Issuing en. � Fee: Date: �qpppOVECI Sanitary Permit Numbec �60.�� $-Z�-$2 ❑DISAPPROVED Z9Q99 Reason for Disappr I: 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. DISTRIBUTION:White-County,Canary-Bureau of Plumbing,Pink-Owner,Goldenrod-Plumber DILHR-SBD$398(R.07/81) . DEPARTMENT^OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS I.ABOR & HUMAN RELATIONf� pRIVATE SEWAGE SYSTEMS �ivisioN P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 � CONVENTIONAL ❑ ALTERNATIVE S1atePlan I.D Number: (17 assiqned� ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: AODRESS OF PERMIT HOLDER: INSPECT�ON DATE: � ERALD MRCx �uu3�/�l ,Ep� Nr� MN, I QGT $2 BENCH MARK (Permanent reference pointl DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF, PT, ELEV.� /�LU Co�:.u�2 of ,G�cv �o'�onn a F �ioiN G �� 0 O Name of Plumber�. MP/MPRSW No. Counry. Sanrtary Permrt Number. Cb� -r��„p�o � � �Ww�- a4 � 9 SEPTIC TANK/HOLDIMG TANK: MANUFACTURER�. LIOUID CAPACITY�. TANK INLET ELEV.�. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER �� PfiOVIDED� PROVIDED: � U QC� + � IRJYES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF � ROAD: PROPERTV WELL: BUILDING: VENT TO FRESH ALARM� FEET FROM� � LWEj' � •/Ot � AIR INLET: ❑YES ❑NO ❑YES ❑ NO NEAREST , O� ��N �S r"— DOSING CHAMBER: MANUFACTURF.R BEDDING�. �IOUID CAPl�CI7V PUMP MODEL PUMPiSIVHON MANUF�CTUqER WARNING LABEL LOCKING COVER . PROVIDED�. PROVIDED: ❑YES ❑ NO ❑ YES ❑NO ❑YES ❑ NO GALLONS PER CYCLE: Punnvnrvocorvrao�soPEanriorvn� NUMBER OF PHrir�eNTv WELL BUILDWG IVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM ��"� "�R i"�Er PUMP ON AND OFF) ❑YES ❑ NO NEAREST ` SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing �ENcrt� oinh�FrE�� h�aTEr�in� allo nnnr�Kiruc or excavation. (lf soil can be rolled into a wire, construction shall cease until � FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: � �� IVI�TH LENGTH NO. OF DISTR. PIPE SVACING COVER INSIUE UTA. rP1T5 LIQUID �BED/TRENCH� �� rr�Ervcr+es� � ro�nreRin��. � PIT oePTN: ==DIMENSIONS �' � Io2 �L^ � ,Sl�i2A(,tJ FAVEL (>EPTH FILI DEPTH UISTH. PIPF DISTH PIPE DISTR. PIPF. MATERIAL�. NO. DISTR. ,NUMBER OF � PROPERTV WELL�. BUILOING: VENT TO FRESH � BEIOW GIPES ABOVE COVER ELEV iN�E � ELE�/. END� �PIPES � � �.� LINE� �O� AIRL INLET: � / �N �$�2 P�C� .� NEARESTO--s I� r l/�F �� V� MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fili material for PROVIDE A DIAGRAM OFSYSTEM I and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER. TEXTURE PFHMANFNT MAHKERS. OHSEHVl1LION WELLS ❑YES ❑NO ❑YES ❑NO UEPTH OVER TqENCN:BFD DEPTII pVFH �HENCi�,tlEU U[PTH OF TOPSUIL ti(IUUf I) SEEDED MULCHED. CENTEH EDGES ❑ YES ❑NO ❑YES ❑ NO ❑YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACING. (3HAVEL DEPTH HELOW PIPF. FILL DEPTH ABOVE COVER�. .. BEDJTRENCH raENct+Es: DIMENSIONS - MANIFOLD �UN1P MAMFOLD OISTR PIPE MAMFOLD MATEFIAL�. NO DISTR. DISTR. PIPE � DISTRIBUTION PIPE MATERIAL & MARKING. � �. ELEV.. ELEV. DIA. ELEV. P�PES DIA.: �LEVATtON AND 1STRIBUTION - NFORMATION HOL[ SIZE HOLE SPACING DRILLED CORRECTL� COVER MATERIA� VERTICAL UFT CORRESPONDS TO APPROVED PLANS i "�•�;'� � ❑YES ❑NO ❑YES ❑NO COMMENTS: � PERMANENTMARKERS: OBSERVATIONWELLS�. NUMBEROF . PROEERTV WELI: BUILDING: FEET FROM ❑YES ❑NO ❑YES ❑ NO NEAREST _ Sketch System on Retain in county file for audit. Reverse Side. s�cn,n�aE _ T'T�E v� �ti�m.�1� i4 ��+ DI LHR SBD 6710 (R. 01 /82) �'�� I 1 � ,.,S.o � 5G�, TMC I , s / 15t,t. f�N�• �U�LL NoT � !r / ,—J ia� Io Pv� �----- I NST'HLLCC� � Y�NT 3G' �D i � / ' �K D�' / ' '---- E f / / __ ---- ----- �-- --- R�� ,� k� DOCUMENT NUMBER AFFIDAVIT � 2 3 1 5 3 8 EXISTING SEPTIC SYSTEM ONE AND TWO FAMILY .e ay� i' If the existing septic system does meet the minimum re- ecr��.-�^t�—�'4,Ty`x ��hB �� quirements for groundwater and bedrock depths and if it nCXt��-AD13�nt�Le�� is functioning, an addition to or replacement of a hab- _�T__��-��'�°t-"O1�'�"'°Ol'� itable structure can be made in most instances without a :?•*:x�1E °R �""�° y7--�'— updating the existing system. If the existing system ��—� is utilized for the addition, every attempt should be made to locate and reserve an area which is suitable �.....�..------- � for a code complying replacement system for when the system fails. If the addition will substantially in- crease the wastewater discharge, the existing system RL7'URN TO � � �/�g will be replaced with a code complying private sewage Sauyer County Zoning Admin system. P.O. Box 668 �ward WI 54843 owner(s) Myla J. and Gerald E. Magnuson Maiiing aaaress 65 Woodland Circle Edina Minnesota 55402 Property description Lot 6 being a part of Govt Lot 1 S 14, T 41N. R SW Parcel :1.19. Vo1 336 Records Pg 526 and CS Vol 8 Pg 421. .80 acres. Town of Hayward. 010-841-14-5119 (� (we) Myla J. and Gerald E. Magnuson plan to {� Add onto existing dwelling ( ) Add onto existing mobile home ( ) Replace existing dwelling ( ) Replace existing mobile home The nresent orivate sewaae system has been working satisfactori.ly as far as disposi�ig of wastes. If the present private sewage system does fail, it will be replaced witti one that is code complying. � �� My1a J. M gnuson d te: � �. .�� ,�'\�-�,_ _ _ �� , - ; z- Gerald�,E. Magnuson date Personally came before IDe this �� day of �//�./i`-_�ii 19 , �� / _ /� � �1� �//� �.. BETTY E.SJOVALL /�//// � f�/� ,C�` �.e,�t . "'OT: 1.7.r �nc.1 . `�� Notary Publi�c '�� / '�.c. County, Sek�ar�s� Minnesota �� My Commission is expires Existing septic system - Sanitary Permit 82-14� Date system installed �1 OCtobOY 1992 � ��y� ZA or AZA David Heath /G ^ /� --- 9� date This instrument was drafted by � Gerald E. Magnuson ^�f� � �[� � 4�O 0/ Sawyer County Zoning Administration 0 Inspection Report � � K Owner Myla J . and Gerald E. Magnuson � � r• W r oa Address 65 1Noodland Circle Edina Minnesota SSd02 � G o m 0 0 Name of business N�A p. � rV Builder William D. Musser � � am oa � Address Route 1 Box 166 Loretta 1UI 54852 � w _ � a Plumber ponald Thompson m Address Route 1 Winter Wisconsin 54896 Inspection (vY Private ( ) Public ( 1 Property ( �etback-lake Violation � `�Dwelling ( ) S<:tback-road o ( ) Mobile Hm ( ) Setback-lot line � ( ) Sanitary ( ) Zoning ( ) Garage ( ) ( ) Privy C � -- o ~' rr x w � w Onsite inspection conducted on September 16 , 1981 . ¢. Average setback for new construction and the relocation of existing dwellings established at �5 feet � 4s ~ � I � 0 < ' rt cn r p o v' r+ a (� I ' � � �� I � �,� � I� � �f b w H Y3iscussed with oi+ner ( ) � A biscussed with builder ( ) � Discussed with plumber ( ) .. c Discussed with � � � q�� 7 � � � Date 25 August 1982 , Signature of Officer ,2��j��.�,,) VVltiCin.�J ` William F. Milner , AZA �