HomeMy WebLinkAbout014-842-16-3215-LUP-1992-195 _ Application for Land Use-Permit �
, � County of Sawyer x o
'Lhe undersigned hereby makes application for a Land Use Permit and �
agrees that all work shall 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. '
PRINT - USE BLACIC INK OR PENCIL
t
Dawn T. Sahs Tart (��� S�'��I N=�J4 ^y
Owner Builder �
�i-
Route 3_ Bo.: 3321-A
R�. � (�o ;� e s5o
Mailing Address Mailing Address
/�il i���) �,ti i - /�� �� �r,��� L� ,�s�43
City, tate, Zip City, State, Zip
Building Land Use Zone District �-� o �
( ) New ( ) Filling �*
(�Addition ( ) Dredging Lot size N n
( ) Alteration ( ) Grading v �
( ) Moving On ( ) Acres �•(nQ y
( ) ( ) �
F��7 ��� �y
New Construction p��' ���k l�
Size ?;7 ft wide ft wide `� �
��- ft long ft long � � y
�
Floor area q-,� sq ft sq ft �
m y
Tota1 htg /` to peak to peak �
Stories �i .�. � s�L�T l�x� Stories
No. of Bedrooms rear lot line or waterline c�
0
(year round) or (seasonal) � rt
Type of Bldg or Addition � t-�
( ) Dwelling a o
( ) Garage (1) (2) car <
( ) Storage Building m� l
( ) Boathouse o
(�'j,Livingroom �
(� Bedroom �1��
( ) Kitchen-Dining Z
( ) Porch - enclosed/roofed C
(✓f Deck - open ��
{ �_ rv-
( ) � U
Type of Construction .� I�
('T rrame ( ) Block
�
( ) Log ( ) Concrete � `�
( ) Pole ( ) Steel
( ) Metal ( ) N �
Construction Cost $ �,,����`1�g°J�
Vol c�k� Pg 3�0 of deed N �
CS Vol _� Pg 7S� � E
rwt p
Cer. Soil Test �-Z�3 - � ��� _ �
p' � �
Sanitary Permit c�-�9 ----------C Road ~
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TOWN OF LENROOT
S EC. 16 T W P. 42 N . R . f
8 9 PETERSON R0. �
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DOCUh�NT NUMBER APPIDAVIT
� N � � J � EXISTING SEPTIC SYSTEM
ONE AND TWO FAh1ILY `. "
nc�eo'�rr�r� om� � >
.+,,.��JT Ct%tCPy
If the existing septic system does meet the minimum re- o„�; �o� r�,,Jr� t;,t, o!
quiremeats for groundwater and bedrock depths and if it nPAq �a� �
is f�nctioi�ing, an addition to or replacement of a hab- t„ ,��; �„`Q�e� �� �,
itable structure can be made in most instances without � �� ��, �Kw _-1�i!�
updating the existing system. If the existing system
is utilized foi the addition, every attempt should be ((�� —' g
made to locata and reserve an area which is suitable ,;�3t,� ;
c__�_.
for a code complqing replacement system for when the
system fails . If the addition will substantially in- �J
crease the wastewater discharge , the existing system RL•TURN TO i�,�,,,�:
will be ra.placed with a code complying private sewage Sawyer County Zoning Admiii
system. P.O. Box 668 �Ij
Ha ard WI 54843 x•
owner (s) Dawn T. Sahs Tart
Mailing address Route 3 Box 3321-A
Hayward WI 54843
Property description Lot 14 in part NW4 of the SW4 S 16 , T 42N , R 8W. .
Vo1 395 Records Pg 345 and Vol 443 Records Pg 330 . CS Vol 9 Pg 253 .
1 . 68 acres . Parcel . 10 . 15 014-842- 16-3215 . Town of Lenroot
(r) (1�) Dawn T . Sahs Tart plan to
(1.� �dd onto existing dwelling
( ) Acd onto existing mobile home
( ) Replace existing dwelling .
( ) Replace existing mobile home
The present private sewage system has been caorking satisfactorily as far as disposing
of wastes . I�? tne present privace sewage system does fail , it will be replaced with
one that is code co lying.
�ao�a� �LS� (wtzG � - 9 - 9�
Dawn T . Sahs Tart date
date
Personally ;:ame before me this
�day of �� , 19�_ �A�,E�{� Q ��
� �J �,� �,w•,�,,,,r D
- SI "ri-�-�-Cu� � �'J.( �r7C�(/� �2�:1� �?���J' s���:
Notary Public � . � = _
�,�/�(�4� County, Wisconsin 3� t � t ��
� � : ����.�C�
My Commission is expires � �j ��f••-.••••'�����
� G/ 1���
�wsmn r -
Existing sentic system - Sanitary Permit 83-229
Date system installed 14 November 1983
�''�-..'�a. l.�.r . F-�l�&:. .�h m-�..
FIerton W. Ma i qssT Snu
�e J �,rt� 1�t`l2
date
Tnis inst,:umcnt was drafted bp
Dawn T . Sahs Tart
- A�. �_ � �� � 1 � �
,
`�_ �
� wisconsn ApPUCATION FOR SANITARY PfRMIT .
� DILHR SAWYER COIiNTY �
(PLB 67) UNIFORM SANITARY PERMtT # N
- OEPfiRTTT1EflT OF �
- IfIIXJSTRV,IGiBOR 6 MUTPfI RELG7TIOflS � C S T 8 3- 2 6 3 4 5 4 8 2
N
�
—Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/Zx 11 inches in size.
—See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
� Jack S ' ostrom & Susan K . S ' ostrom f 3 u ��� '
PROPERTY LOCATION CITY:
�1��4 5��4, S VILLAGE: L2Ylt"OOt
►u 1, (, , T42, N, R 8 �(or) W TOWN OF:
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
Larson rd .
TYPE OF BUILDING OR USE SERVED
� 1 or 2 Family Number of Bedro�ms: � PuL;lic (Specify) :
THIS PERMIT IS FOR A:
Q New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Aiternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
� Seepaye Bed ❑ Seepage Trench � Seepage Pit ❑ Holdiny Tank
� System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity X
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: e . Rasmussen and COI'1S � Tf'1C .
IF THIS IS AN ALTERNATIVE SYSTEfJI COAIIPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #'of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA 1�/ATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feetl:
— �:0 �05 250 �] Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number:
A �dry Rasmussen 3938 � 71,5� 798- 3355
Plumber's Address: Name of Designer:
p . � . Rox 66 , � able , ��� isconsin 54821, nennis Rasmussen
COUNTY/DEPARTMENT USE ONLY
Sig a e f Issuing Agent: Fee: Date:
0 Disapproved
� 7 � . � � 11 - 8- 8 3 '� Approved � �"+�ner Given Initial
A�verse Determination
eason for Disa val:
Alternate coursels) of Action Available:
DILHR-SBD�6398 (R. 5/82) DISTRIBUTION: Original ro County, One Copy To; Bureau of Plumbing, Owner, Plumbcr
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDIN
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS �ivisi
P.O.BOX 7969 BUREAU OF PLUMBi
MADISON,WI 53707
L�CONVENTIONAL ❑ALTERNATIVE StatePlanl.D.Number:
Uf assigned)
❑Holding Tank ❑ In-Ground Pressure ❑Mound
NAME OF PERMIT HOLDER; ADDRESS OF PERMIT HOLDER: WSPECTION DATE:
W ►Z �o• Li I 1^0 ��.T 3 •J io rcJ � �— /`l'� 3
BENCH MAfiK(Permaneot reference po�nt)DESCRIBE IF DIPFERENT FROM GLAN: - REF.PT.ELEV.: CST REF.PT.ELEV.�.
Name ol Plumber: MP/MPRSW No.�. County: Sanitary Permn Number:
/ , 393� C�� ,e/d ��- z
SEPTIC TA K/HOLDING TANK:
MANUFACTURER: �I�UID CA7ACITV: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
/�' G PROVIDED: PROVIDED:
k�S�?UfSeh., (BJLt've'-� C' � [� �i /� � (�YES ❑NO ❑YES ❑NC
BEDDING: VENT DIA.: VENT MAT�. HIGH WATER NUMBER OF ROAD: PROPERTV WELL BUILDING: VENTTO FRE
�� A�ARM FEET FROM LWE: AIR INLET�.
❑YES ❑NO � � � ❑YES ❑NO NEAREST �Z�
DOSING CHAMBER:
MANUFACTURER. BEDCING�. LI()Uln CAPACITV PUMP M()DEL PUMP/SIPHpN MANUFAC7l1RER. WARNING LABEL LOCKINGCOVER
Pi70VIDED�. PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP nNo coNrao�s oPeanTiorvn� NUMBER OF PROPERTv WELL BUILDING I VENT TO FRE
(DIFFERENCE BETWEEN FEET FROM ��"E AIR INIET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing �ENcrH oinnneTEH MnTEaiA�nrvo nnaRKwa
or excavation. (If soil c:3n be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to r_ontinue.) MAIN
CONVENTIONAL SYSTEM:
WID1N�. LENGTH NO.OF DISTR.PIPE SPACING COVER INSIUE DIA. #PITS�. LI�U�D
BED/TRENCH � � � � TRENCHES � MATE(71A� P�T DEPTH.
DIMENSIONS Y
GRAVEL DEPT11 FILL DEPTH DISTH.PIPF DISTR PIPE OISTR.PIPE MATERIAL� N .DI rN. NUMBER OF PfiOPERT�' WELL�. BUILDING�. VENT TO FRI
BELOW PIPES ABOVE COVER ELEV.iNLFi ELEV.END PIPES FEET FROM LINE�. AIR INLET:
�Z << � �' `� .Z �i/��'. �63 y Z NEAREST---► 7`�
MOUND SYSTEM:
Mound site plowed perpendicular to slope �heck the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
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� PERMANENT MARKEHS. OE35EHVATION WELL$
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH:BED DEPTH OVERTRENCM;BED pEPTH OFTOPSOIL SODDED SEEDED MULCNED�
CENTER- � EDGES.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WI�TH- LENC;T11 NO.OF LATEfiAL SPACIN(i (;HAVEL DEPTH fiELOW PIPF FILL DEPTk1 1180VE COVEH�.
BED/TRENCH raErvcHes
DIMENSIONS
� � MANIFOLD PUMP MANIPOLO DISTR.PIPE MANIFOLD MATEFIAL. NO DISTR. OISTR.PIPE DISTHIBUTION PIPE MATERIAL&MARKING.
ELEV.�. ELEV.. DIA. ELEV.� PIPES DIA.:
EIEVATION AND
DISTRIBUTION
INFORMATION HOLE S12E HOLE SPACING DFILLE�CORRECTLV COVER MATEFiIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ❑NO ❑YES ❑NO
COMMENTS: 7ERMANENTMARKERS: OBSERVATIONWELLS�. NUMBEROF LRnOEERTY WELL: BUILDING:
FEET FROM
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side. si�rvAru riT�E
DILHRSBD67701R.01/82) '� ` «� � �`�' ��
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Stock No. 25457 ��w��.,�«�..,
STATE OF WISCONSIN, CIRCUIT COUHT, SAWYER COUNTY IN PflOBATE
� 1 � 817
AMENDED "���•a���� �,
4N THE MATTER OF THE ESTATE OF Sewyae County
DAV I D A. SAIIS ABflIDGMENT OF Aa a�,.dd�or record Ihe a v der��
oeceased FINAL JUDGMENT ��� A D 19��a� Lo4�cJoo1
�M ond remrded Iu vol,�3
ol rHec-o(rda on pe • � '
�� �.��. 4 4�n ;�r`. +I• y _G �Ct� �1pI�IN
�
� , DEC 1&1989 � �
t.. �lA. ,.
NEGISTER IN PROBATE
Sawyer Counry WI Fue No. 86 E S 1 1
The flnal Judgment entered In lhe above enUlled eslale,on �al�o�d�� ,
conlalns the following flndings of fact and decislons,Ihat:
1.Thedecedentdledon September 16, 1986
2.Inherltance and Income taxes liave been delermined and pald and all clalms and charges have been pald.
3.Real properly and secured Interesls In real property were asslgned or terminated as lollows:
The joint tenancy of the decedent in the followin9 property was
terminated as of Lhe date oF death, and Dawn T. Sahs, aka Dawn Sahs, is the
surviving joint tenant:
��
Part of the Northwest Quarter of the Southwest Quarter (NWY�SWY�), Section
Sixteen (16), Township Forty-two (42) North , Range Eight (8) West,
described as Lot Fourteen (14), recorded in Volume Nine (9) of Certified
Survey Maps, pages 253-254, as Survey No. 1967.
1 hereby certify that the foregoing abridpment of final�udgment In the above enlilled eslale is lrue and accurate.
Deted _ December (� , 1989
By the c/ourl,
� �-Clrcult Judge or Reqister In Probaie
—"��i�^'^ i:,Z�y
Flon. �
Ward Wm.Winton, attorney at law G ,. .;L���T "���"�cSCONSIH j SS.
�� -- � .•' �'��Ok.Al�i'YEf. f
Allorne,� �, h�irl�„���j� ���,��thi dnr.ument Is a full,
°� - �. � 'linc a,�,o a ��.� ol iht-on�i�il._n r,fa
i�' P.O. BoX 796, HdyWard, WI 54II43 •' � , ���, , i y�r i� i,^i��:ui;.;ourt�oi Sai��9er
Address .� � r" ^ C��inl� ns�has hr.en comcared by me ar.d
�;,' . is in lull ty�rc�aud effeci.
. AttesL• 1�. �� ,19��
V�I�� 4 3 �G 3 3 0 , �c� � �
Re�ister in Pr— o— bajN '
,_ — _ , So ti��r Cou��YJ�6. -==----- ;
No.30�A(1980)ABRtDGMENT OF FINAL JUDGMENT s.063.29(2)