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HomeMy WebLinkAbout024-841-11-4305-SAN-2023-170 � SAWYER COUNTY ZONING & CONSERVATION ADMINISTRATION � 10610 Main Street, Suite 49 � Hayward, Wisconsin 54843 � (715) 634-8288 � � san�tarian(a�sawvercountveov.ore � O COUNTY SANITARY PERMIT APPLICATION In accord with Chaptcr DSPS 383, Wis. Adm. Code and Sawyer County Private Sewage System Ordinance APPLICATION INFORMATION—TYPE OR PRiNT Propert Ow�e�'s Name Property Legal Description � '� C' � GL�� '/4 ��%,, Sec.�,Twp.�N, Range �W Property Owner's Mailing Address I.ot Number Block Number l � ���,��, �—� L� c� S City,State • Zip Codc Phonc Number Subdivision Name or CSM Number i r�.> � � s � � �1� SS ,3s�� TYPE OF BUiLDiNG: (Check one) ❑ State Owned ❑C;iy N arest Road , ❑ Public � 1 oi•2 Fan�ily Dwelling—No. of bedrooms ❑�'���'�e ,+ v ' g'� Town of Q�t�✓�� G�(f� Fir � i� PUBLIC BUILDWG/LAND USE: [Explain the use/pwpose for d�is Parcel Taa Number: (12 digit legacy number) pennit,(i.e.,campground,festival,recreation/entertainment event etc.)] �-�- �-� � �-.L �-�3 C1 .S� TYPE OF PERMiT: Additional Information: ❑POWTS Recoiv�ection(SAN# - ) POWTS Connection (SAN# �� - (�� ���,) *Attach a Plot Plan with all required information per SPS 383.21 POWTS Revision(SAN# - ) ❑ POWTS Repair(SAN#_- ) '''Soil'I'est Information (CST# q'8- 3gp) ❑ Other: � r Gallons per day� RESPONSIBILITY STATEMENT: I,tlie undersigned, assume responsibility for thc installation of the POWTS activity for which this permit is issued. Plumber's Name:(Print) Plin Signahire MP/MPRSW No: Business Phone Number: l��( ��l (� (71 �.� Plum er's Address(Street,City State,Zip Code): � �� l✓ � �G� � � I^��Lt' ���'� /��1s1 � ��C.�'C!'� �l � OFFICE USE ONLY: ❑Disapproved Review ate: Pemiit Fee: Datc Tssucd: Issuing Agent Signature [�Ap roved ❑O�vner Given Reason for ne,,;�, �(� �.3 �oo.�' � j, �a� -'�1-����� COMMENTS: x*Expires 2 years from date of issue*''� Expirltion date: ��I ( 1�S CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: � u � �ate � � .�3 - �.r� D � � n�� IN��Y � cas� J111. 31 2023 C S � l�— 3��� �='C�lt#�.�5�.__,___._ _ SAWYER COUNTY � Z�NI.NG ADMlN;�TR��IOF�4 Rev. 04/21/15 �� S�S NO REFJNa,�',q�'T�R �SSUE OF PEF�If .� — - --- County �J' � Sa(ety and Buildings Division sawyeC � ���p - 201 1�'. �'a5hington.��°c.. P.O.Rox 7162 Sanitar}�Permit Numbcr(to be filled in I � S . M•dison. �Vi 53707-7162 ���� � ��� __._. L— _ �csT a� - � Sanitary Permit Application StateTransactionNumtx;r In accord-ut�e with s. SPS 383.21(2), Wis. Adm.Code,suhmtssion of this tbrm tn Che apptopriate go��emmental �\.J unit is reGuired prior to obtaining a sanitar��permiL Nut�:Application Yi�rms for�tate-owned POW'IS are submitted Yroject Address(if ditTerent than mailin �- to thc Departrr�ent of Safetv and Pr�Fessiona!Services. f erson�il infnrmation you provide mav L�e used for sce<mdan• � u �ses in accordxnce tiith the Privacv La�.,s. 15.04 1 mj,Stats. SQm� � I. Application Infor,mation-Please Print.411 I�formation Pr�perty(hvner's Name --� --- E'arcel H � William Chepa 024841 I 14305 � _---- --_ ----- — --- -- — Property Owner's Mailing Address Property Location 1277 5 W Galdfinch Ln Govt.Loc City,State 7_ip Code Pltonc Number $W 'l,.SE';,, Section 1 1 Hayward,WI 5�843 tL Type of Building(check all that applv) � Lot#� r 41 N; rz 8 W � I or 2 Pamily[�wclling- Numbcr o1�Redrex�ms J Subdivisicm Namc 4�,5 Rlock 7t � -- � PubGc;Commerci�l-Describe Use ❑ ��t>•�t� ❑ State Owned-Describe Use CSM Number ❑ Villare of � To�j�n of Round [.,ake --- ----- ----- - ___ _.__----- II[.Type of Perrrcit: (Check only one box on line A. Complete line B if applicable) --- .._ `-- - --- -- _ _ `; � Nc���System � Keplau;ment ❑ TreatmenVHoldin� I'ank Kcplacement Onit � Other Modification tn Eristing System lexplain) syst«, ` _ _ __ ____ � _. B. ❑ Pcrmit � PeRnit Rcvisiun � Chan�e of � Permit 7'ranstcr to List Previous Permit lvumber and Dale Issued }tenewat[3elc�re Nlumbcr Nrw Owner — Er iratiqn __ _._.__ ._--_..........._ ._.__---- -- -� - IV.Tv e of POWTS SvstemlCom onentlDevice: (Check all that a�plv�___ � Non-Pressuriu�d In-Ciround ❑ Pressurizrd►n-(�roicnd ❑ At-Grade ❑ biound>24 in.of�suitahlc sail ❑ Mound=24 ia<>f suitablc soil ❑ Holding'I'ank �O[her Dispersal Com�meni{ckplain) ❑ t'retreatment llevice(e,rplain) V.Dispersal/Treatment Area Information: Quick 4 Plus [ksign Flou(gpd) f�sign S�i]Applicxtinn Ratc(gpdst) �Dispersal Area Rcquircd(st) T�ispenal Arca Ptoposed(s� System Elevation 450 .5 90� 9 I 5.3 92.O' -r -- __. � -- - -�__ — V[.Tank Info Capacity in — Tutal �nf Manufacturcr Uallons (_,allons f;niLs � ° L � � � U :.l n I�iew Tanks Laistic�g Tariks � � y � s> i, ;� �: ;_' ^ � -c - `� a. �i ✓: s :i; i.= :� n. — -- -- —_. _-- s��7f10°�t�°�d;"���� 1000 I 000 1 �vieser � � �� � [x�s�a�c�,�,nt,« -- - --- - ---- - —. ❑ ❑ ❑ ❑ ❑ Vll.Responsibility Statement- 1,the undersigned,a�.�ume responsibilitv tor installation of thc PO�►'7'S shown on the attached pl�ns. Ylumbcr's Name{Print) Plumber�s Si�na'e . _ _.J.;� � MP/MPRS Number Qusiness Phone Numbcr Gerald Froemel �%� ""���_.�� 950111 715-558-1138 . _- — �_ ---.. _.__-- — - - Plumtx.rs Addrexs(Street,City.State,7.ip Code) 1;S02W I�roemel Rd Havward,Wl 54843 - __ _-- -_-- _..�_ _ __ VIII. 'oantvlDcpartment Use Only (S�o�� Pemut T�ee Dat Issu�d lss ng A ent 'ignature . � �.Approved ❑ Disappro�ed - C/ � '?� �� ` �`w ❑ OwTu-rC�iven Rcation€or I:)enial � ( ��. �'* �� Z�yI � --- I\.Conditions of ApprovallReasons for Uisapproval ;-�-rti � , Uf `ri rL rr,� �'i��'� 1; ,� � � � n! NO��F T� �% �C'-=—=�`- �r�,j_ � � i a ���4 M ��U��Fp�Afi R �� r _� � "��. RM1T �,{555�,5�it �' ,J1 +i.'€}'� a '.a�'u�?� nW �:s�a .al� ��. �''��i S � n {� �/ � � t.�2� �_. ; Attach to complete plans for the syslcm and sabmit to ihr Countv onH on paper nnt I�ss than 8(�2�cy'���ip�SUC "�'-'' � SI3D-6398(R. 1 l/(1) ZC�NIiLG r ,��.fj�, ��,_,��,.,. iLt'� ��,.P� � ���� , l� I 4c} ` �--�-�� 1 AOOITIONAL COMMENTS ANO SKETCH SANITARY PEAMIT Nl1M6ER___ _ �j�� _ 10 �el�l��c� �tiL / � ,�°`� 117iSti✓ D�.�,;, � _ � •�-� 7 � n'p �,2\1 I � I I Y�`�s,o'^"' ��,.�r J \ \v � � � �C^� �� �c^o�,. � � � � i � ���� �,y5 �,a�- �� ' I ' � I � ��* � �o _ ��_ _ ,��PI' x '�.� '.��� l � W;e� �C �j� �,,00 ,qnd�e ;.>��Ib� .��e�r �aA' � � �D� V ��1 �'F� BI7/23, 9:09 AM Real Property Listing Page Real EStdt2 Sawyer County Property Listing Property5tatus: Current Today's Date: 8/1/2023 Created On: 2/6/2007 7:55:45 AM �Description Updated: 7/1/202D � Ownership Updated: 4/30/2021 . . . . .. _. . . . . . . . . . .... TaxID: 26565 WILLIAM A CHEPA HAYVJARD WI PIN: 57-024-2-41-OB-11-4 03-000-000050 Legacy PIN: 024841114305 Billing Address: Mailing Address: Map ID: .15.5 WILLIAM A CNEPA WILLIAM A CHEPA Municipality: (024)TOWN OF ROUND LAKE 12715W GOLDFINCH LN 12715W GOLDFINCH W STR: Sll T41N ROBW HAYWARD WI 54843 HAYWARD W[54843 Description: PRT SWSE LOT 5 CSM 18/101 #5427 m Remrded Acres: 2J40 r Site Address * indicates Private Road Calculated Acres 2J33 12715W GOLDFINCH LN ' � HAYWARD 54843 Lottery Claims: 0 First Dollar: No � Property Assessment Updated: 7/16/2019 Zoning: (RRI) Residential/Recreational One Z023 Assessment Detail ESN: 461 Code Acres Land Imp. G1-RESIDENTIAL 2.740 17,900 0 � 7ax Districts Updated: 2/6/2007 . _. . .. _. -----.__... .. 1 � � State of Wisconsin 2-Year Comparison 2022 2023 Change 57 Sawyer County Land: 17,900 17,900 0.0°/o 024 Town of Round Lake Improved: 0 0 0.0% 572478 Hayward Community School District Total: 17,900 17,900 0.0°/o O01100 Technical College . Recorded Documents Updated: 9/30/Z021 .�property History TERMINATION OF DECEDENTS INTEREST � N/A Date Recorded: 4/26/2021 431454 TRANSFER ON DEATH DEED Date Recorded: 4/26/2021 431455 WARRANTY DEED Date Recorded: 6/2/2020 424141 LAND CONTRACT Date Recorded: 8/9/2019 419240 TRANSFER ON DEATH DEED Date Recorded: 1/27/2014 389164 WARRANTY DEED Date Recorded: 10/8/2004 325700 CERTIFIED SURVEY MAP Date Recorded: 6/13/1996 254837 https:/Itassawyercountygov.orglsystem/frames.asp?uname=Eric+yyellauer ���