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HomeMy WebLinkAbout002-939-02-5105-SAN-2024-070 . �' Z SAWYER COUNTY ZONING & CONSERVATION A.DMINISTRATION 5�..> 10610 Main Street, Suite 49 � Hayward, Wisconsin 54843 a J (715) 634-8288 � sanitariannu,sawyercounty�ov.or� 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 PropeRy Owner's Name Property Legal Description Q n ��_����� G �_`X��lli, Sec. � ,Twp.3 t N,Range '1 W Prope Owner's Mailing Address Lot Number� Block Num er I�o 1 �,��k l�, City,State Zip Code Phone Number Subdivision Name or CSM Number 1 Y, �„�� Sy�6R �%5�67z�938 �- 0�5� s TYPE OF BUILDING: (Check one) ❑ State Owned ❑��ty n �� G Nearest Road .�` � ❑Public � 1 or 2 Family Dwelling—No. of bedrooms� �Village ap�, �Tawn of Fire Number Z`�� PUBLIC BUILDING/LAND USE: [Explain the use/purpose for this Parcel Tax Number: (12 digit legacy number) permi[,(i.e.,campground,festival,recrea[ion/entertainment event etc.)] 00 .�-3 ��-o �- 5so � Tl'PE OF PERMIT: ? Additional Information: onne-`c�on(S - �POWTS Connection (SAN#� H:t. *Attach a Plot Plan with all required infor a6on per SPS 3 .21 PO WTS Revision(SAN#_-� N�� �C,51 2�-�Z y� ❑POWTS Repair(SAN#_-_� *Soil Test Information(CST# �� ❑Other: -S��e...a�y�v�/�� G��;�� _ �-��'� � It,�'�v�y * Gallons per day �;� ��� . RESPONSIBILITY STATEMENT: I,the undersigned,assume responsibility for the installation of the POWTS activity for which this permit is issued. Pl ber's Name:(Print) Plumber's Signa e MP/MPRSW No: Business Phone Number: �ti.J`��� �l�Uf:-� �� ��--�G � �`I ��LS)�;��a-�C�.�`I Plumber's Add,,ess(Street,City State,Zip Code): �� �L`��-3 �C�4'U�'��,1� '�����\ �Q4� � ��v�G��� ��,�.�. � `���y-, OFFICE USE ONLY: ❑Disapproved Review Date: Permit Fee: Date Issued: Issuing Agent Signature �Ap rp oved ❑Owner Given Reason for u�4�.�� �n� �O y r I � I�� -�,�1 ' l�ti✓ Denial � o w ' � � COMMENTS: Y I� r2� **Egpires 2 years from date of issue** / Expiration date: � � �- �'� �4' ( ,,.,,t��,°°c�j+��•J C���*S � conr e ��:r. -� �.� ��d . s�s 3ga-�3 CONDITIONS OF APPROVAL/REASONS FOR DISA OVAL: � �� ►� �r r��' �IW rr"�i � J � Rev.04/21/15 ,.,� ' I ,� �� =1� ------' �� 3�,s � AP� 0 5 2024 NO RCFUNDS AFT'ER 'e1`. ---��s�� ISSUE OF PERMIT � O�S� --.- . SAWYEr� CaI�NT'Y ZONiNG ADMiNISTRATION ��""s""°"' APPLICATION FOR SANITARY PERMIT � . , W � D 1 L H R SAWYER rOUNTY � (PLB 67) r ocnavmmnror UNIfORMSANITARY PERR7IT# �D �'�"�T�""�'"""'"����°"` CST 82- 224 45451 - ` �' �.Zo5u A�v�cas�,,kd —Attach complete plans in accord with s. H 63.05,Wis.Adm.Code for the system,on paper not less than 8%,x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT p PROPERTV OWNER MAILING ADDRESS �N�S`�e Bowal.&i2 9r�• Po, �o a �so 1.u1. '7 PROPERTV LOCATION �r � S�1/4gE 1/4,S 3 ,T39 N. R q E (or W row�'oF: .o-S� LA �CG � LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST HOAD, LAKE OR LANDMARK STATE PLAN I.D.NUMBER � 3 � '��" osv�6 s TYPE OF BUILDING OR USE SERVED � �Q 7 or 2 Family Number of Bedrooms: '� [] Public(Specify�: THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement U Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy �Alternate System o L p 1 N N k C1 Reconnection ❑ Petition for Modifieation IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench U Seepa�e Pit ❑ Holdiny Tank ❑ System-In•Fi�l ❑ 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. Totel ifol Prolab. Sitt Steel Fiberglass Plastic Gallons Tanks Concrete Consvuned Septic Tank Capecity Lil�Pump TanklSiphon Chembar Holding Tenk capecily �Q Manufxturer: C� IF THIS IS AN ALTERNATIVE SVSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In•Ground Pressure Total #o� Prafah. Site Steel Fiberglass Plastic Gallons Tenks ConCrele ConavuCted SeVtic Tank Capaclty Lift PumO/Siphon Chembar Manu/acmrer. PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA yyqTER SUPPLY: (Minuroi per inch): REQUIRED (Squoro Foatl: PROPOSED ISquora Faoq: �.Private ❑ Joint ❑ Public I,the undersigned,hereby assume responsibility for installation of the priv sewage system shown on the attached plans. a of Plumher(P int�: ign MP/ o.: Phone Number: 2 .4• ��. �7� ?15 � 6�s���/u P 6er' Address: am esi ��(o ' w �. 5���'3 COUNTY/DEPARTMENT USE ONLY Signatu flssuing Agent: Fee: Dete: ❑Disappravad � ��. Q� ],0-4- 8 3 � AOV�ored ❑Ownar Given Initial Adversa Daterminetion Reeson for isappr I: Altemate rnurse�s)of Aetion Awileble: �ILMRSB0�5J98(R.5/B3) DISTRIBUTION: Orlginal to County. Ona Copy To; Bureau of PlumbinB.Owner,Plumber � f / , . INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67• SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, {whether this is in a city,village or town�; 2. Indicate specifically what type of use is served, if public is checked indicate type of use(i.e. 10 unit apartment, 30 seat restaurant, etc.1; 3. Complete the block for conventional or alternate system depending an system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rete listed on the 115 soil test report,the number of square feet required by code and the number of square teet to he installed; 5. Complete the section on warer supp�y; 6. PRINT the name of the master plumber or master plumber resnicted who will install the system,circle the appropriate license classi- fication,place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone num6er in the blank provided, if there iz a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form(67•T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm.Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.l, location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drewn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that ere permanent and clearly shown. 14. Piping detail including pipe size,separating distances,distances butween beds if appropriate,tank locatfons,effluent line from tank�s) _. to system, building sewer and vent observation pipe�s). 15. The permit issuing agent_may require a cross section drawing of the effluent disposal system. TO THE OWNEH: This is velid for two yaero.Chongoe In Your 6uiltling plons or lowtlons may raquira yau io obtain a new permit.Private sewage systemf muR 6e properly maintained.Hare a lieensed pumper elaan your septie tank whenever naeauary uwally every 2 to 3 years.�f you have questions eoneerning yout syrtam,cantaet your loeal code adminirtretor or the Bureau of Plumhing.DILHA,Stote of Wiseonsin. isnt.nivc 1�n�:n caoss-st•:�•�i�« r.iai; s :����.�, n�r � � �,1c.:. 83 - 05426 nppr.oved -----> - I � "� {!':�.�t.hoY I'r�.:ur - � v,. , , . , Vent Cnp . Ju;�,r�..i�.n .,,x ! {,I ' I,i /y,i,t..•r� . I.:,.:ki:r•i .•,�.cih�,i�.t •C,.`vt': � � ,� i��� .�::� ' � , 5�� c.i. ,� ��.._..—._,— - VenC Pipc . . . } I � i .. ...'._"' ! � ' � M.iu -.. I'in.;l f tldi�.-_ i I �n , , ,a � f ,— �— , � . , �,— ,_ E .—� _ _ , �,_ -; , ,� , ;�`�� , �; ,- ;-� , I i % � ��� ; �� ,�� , � � ; i � , � � / � i ��� , , i' ; I , , �;� � , � '�PYroved .loint `, ���-_ �.-� I . In:"_ � ^.� � � lt3" M1n �_ — ---- ---- .�..� i ------� - -------� � �.er 1'igFt � --J�_----.}..-� scal -z- I ::iai� :e-;. .�r � -y- " ( Ai.irn� t�-�.:irct�,-'�-J,�� �� I . Ar>provc�9 SPi•:C7;�ICA1'luNS � I Joint 'w/ -- / I � I. F'ipr. :e!.]h: n�,nu� � r� � , :..�5.'�l�:`-..� f -� �f_}£ ��k . �.,,., i t,�te•iding . 1...i: a - _•.. .__. � --..._ 1 �u}. .,..::E --�--- "-----� --. ... ]c�.�:, I � '3 n,��o I Soli.d 5^il i�LAKt? :da:�nl.trCULeL: ' ' � - , ' � I __ __..... _"__.__.__'._ ".'_'l..'.___.-_._____ - _.'. '_'___ M:idel ;4ut�tb;�i: . - . • . . . . i . _.�_._.._—__'__'-..�..______'_'______"_._ ' , � " �i"c�h Typc I .::. �. 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' * � � ; . � �, `��t (�- �D M h r,,; � kp�L � -_.. � . • � t: 4I8/24,8:38 AM Real Property�isting Page R2al EStat2 Sawyer County Property Listing PropertyStatus: Current 7oday's Date:4/8/2024 Created On:2/6/2007 7:55:06 AM �Description Updated:8/11/2021 �Ownership Updated�8/ll/2021 Tax ID: 2532 ]ON D&TRACEY C SEIFERT PEPIN WI PIN: 57-002-2-39-09-02-5 OS-001-000050 Legacy PIN: 002939025105 Billing Address: Mailing Address: Map ID: :1.5 ]ON D&TRACEY C SEIFERT 70N D&TRACEY C SEIFERT Municipality: (002)TOWN OF BA55 LAKE N1501 BUCK LN N1501 BUCK LN STR: 502 T39N R09W PEPIN WI 54759 PEPIN WI 54759 Description: PRT GOVT LOT 1 LOT 3 CSM 9/339 #2018 �Site Address *indicates Private Road Recorded Acres: 0.510 7218N MOCCASIN RD HAYVJARD 54843 Calculated Acres: 0.471 Lottery Claims: 0 -�-�property Assessment Updated:5/31/2022 First Dollar: Yes Waterbody: Lac Courte Oreilles 2024 Assessment Detail Zoning: (RRl)Residential/Recreational One �ode Acres Land Imp. ESN: 407 G1-RESIDENTIAL 0.510 283,500 43,700 2-Vear Comparison 2023 2024 Change �Tax Districts Updated:2/6/2007 Land: 283,500 283,500 0.0% 1 State of Wismnsin Improved: 43,700 43,700 0.0% 57 Sawyer County Total: 327,200 327,200 0.0% 002 Town of Bass Lake 572478 Hayward Community Sthool District 001700 Technical College �,�, L"1 Property History N/A +� Recorded Documents Updated:3/18/2024 WARRANTY DEED Date Recorded:8/10/2021 433875 BUNKHOUSEAGREEMENT Date Recorded:3/5/2024 448839 WARRANTY DEED Date Recorded:8/10/2021 433674 LAND CONTRACT Date Recorded:5/15/2020 423854 CERTIFICATE OFTRUST Date Re�orded:5/15/2020 423853 QUIT CLAIM DEED Date Remrded:10/7/2013 387626 TERMINATION OF DECEDENTSINTEREST Date Recorded:4/21/1995 247404 WARRANTY DEED Date Recorded:1/13/1994 239880 CERTIFIED SURVEY MAP Date Recorded:8/3/1983 187871 CERTIFIED SURVEY MAP Date Remrded:8/3/1983 187871 https:lltas.sawyercountygov.orglsystemlframes.asp?u name=Eric+W ellauer ��� �1����c1�'�i���i "�j�,' J��' ; �r' •tf'.++ '�� '� " `'.� :!°!',1� -'�� a ,� ' �� ��' . resses , .h � ��� t � � � " � � ���7/�',y�t� r..�.. �'A�"`�' �'�+,"�► � �r,�`�'� ,7 '� Add "ti #yl _ �^ `��"p 1 � �� � sr -.I . ��� � y . �y ���r` .�F���, � F � � .����,� � � � �.�� y' � �€(� �'� � . � , ,.� +'� _�F, t � 6� � `� _ *�����.������ �.��� �.. 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