HomeMy WebLinkAbout26-46SC'
SBD-6398, Sanitary Permit Application
5/8/2026 2:40:56 PM RECEIVED
Introduction SS-Oo7
MAY 1 1 2026
Planning and Zoning Agency
Wisconsin Department of Safety and Professional
Services
In accordance with Wis. Admin. Code sec. SPS 383.21(2), submission of this form to the appropriate
governmental unit is required prior to obtaining a sanitary permit. Upon completion, you will be
emailed a copy of the completed form for submittal. Include a complete plan on paper not less
than 8 1/2 x 11 inches. Check with your local POWTS authority about additional requirements and
fees.
Note that applications for state-owned POWTS are submitted to the Department via esla.wi.gov.
(Rev. 02/26/2026)
General
Information
Applicant
Name: Robert Hansen
Email: bobplb@cheqnet.net
Owner
Name: Mike & Kim Sherry
Email: campsherry@gmail.com
Phone Number: (715) 209-3944
Mailing Address
Address Line 1: 3113 Golf Course Rd
Address Line 2:
City: Ashland
State: Wisconsin
Zip: 54806
Project and Site
Parcel ID: 38
Skh,-ARy Pm� flu►„, a�-fir s
Fitri4ftc 0D
r-s5u-CJ May H l 10 2b
Scz a)cf Q �ed Ca�ro1
"1
)31
mbL
State Transaction Number: PWTS-
RECEIVED
Project Address
Address Line 1: 74500 Lake Shore Dr
Address Line 2:
City: Wahburn
State: Wisconsin
Zip: 54891
CSM and Lot Number:
Subdivision:
Block and/or Lot:
Legal Description:
X Government Lot
PLSS
Gov. Lot: 3
Section: S07
Township: T48N
Range (E or W): R04
Municipality Type:
City
X Town
Village
Municpality Name: Barkdale
County: Bayfield
Building
Type:
X 1- or 2 -Family Dwelling
Public/Commercial
State -Owned
Number of Bedrooms: 3
POWTS Permit
MAY 1 12026
Bay field co.
Planning and Zoning Agency
Permit Type:
New System
X Replacement System
Other Modification to Existing System
Additional Pretreatment Unit
POWTS Type:
X Holding Tank
In -Ground (conventional) RECEIVED
At -Grade MAY 112026
Mound Bayfieid co.
Planning and Zoning Agency
Individual Site Design
Other
Is there a previously issued permit?:
Yes
X No
Dispersal/Treatment Area and Tank
Estimated Flow: 300 GPD
Tank Information
Type:
Septic
X Holding
Dosing
New or Existing:
X New
Existing
Material:
X Prefab Concrete
Site Constructed
Steel
Fiberglass
Plastic
Manufacturer: Wieser
Holding Tank Capacity: 3000 Gallons
Total Capacity of Septic Tanks: 0 Gallons
Total Capacity of Holding Tanks: 3000 Gallons
Total Capacity of Dosing Tanks: 0 Gallons RECEIVED
Total Capacity of All Tanks: 3000 Gallons MAY 1 1 2026
Total Number of Tanks: 1 Bayfield co.
Planning and Zoning Agency
Responsibility Statement
Signature
Plumber Name: Robert Hansen
Plumber Email: bobplb@cheqnet.net
Phone Number: (715) 209-0708
Plumber Credential Type:
X Master Plumber
Master Plumber Restricted Service
Credential Number: 226148 - PM
Address
Address Line 1: 25370 US Highway 2
Address Line 2:
City: Mason
State: Wisconsin
Zip: 54856
By inserting my typed signature below, I attest that the information provided is complete and
accurate to the best of my knowledge and belief. I, as the licensed plumber, assume responsibility
for installation of the POWTS shown on the submitted plans.
Electronic Signature of Plumber: Robert Hansen
Date: 5/8/2026
• RECEIVED EHTEAED
SIZ_oa396 APR 172026 yn�
Wisconsin Department of Safety 8 Professional Servic PayR6ld Co. Page 1 of 3
fanning and Zoning Agency — —
z'�SP$ Division ofIndustry Services
SOIL EVALUATION REPORT SOIL TEST # at
" In accordance with SPS 385, Wis. Adm. Code County
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, Bayfield
but not limited to vertical and horizontal reference point (BM), direction and percent slope. Parcel I.D.
scale or dimensions, north an -ow, and location and distance to nearest road. 39845
Please print all information. e Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)).
Property Owner Property Location O
Micheal R. & Kimberly M. Sherry Govt. Lot 3 y. ¼S 7 T 48 N a 4 E (or) W
Property (Tuner's Mailing Address Site Address or CSM and Lot a:
3313 Golf Course Rd 74500 Lake Shore Dr. Washburn, WI 54891
City, State, Zip Phone Number City village X Town NearestRoad
Ashland,W154855 / .20 - Barksdae Lake Shore Dr.
New Construction Use: % Residential/Number of bedrooms 3 Code derived deslgnflow rate 450 GPD
% Replacement Public or commercial' Describe: Flood Plan elevation If applicable ft.
IGenerat comments and recommendations: Holding tank do to soil and limited space on site withn setbacks and boundaries.
Boring ft XPoring
1 X Pit Ground surface elev. It. Depth to limiting factor in./elev. It.
SnitSnit Annil
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description Qu.
Az.ConLCotor
Texture
Structure
Gr.Sz.Sh.
Consistence
Boundary
Roots
GPD/Ft
'Effa1
-Effd2
1
0-4
5yr4/2
_
sit
lmsbk
mvfr
cw
31
.4
.6
2
4-11
5yr3/4
fif5yr5/6
sic(
2abk
mfr
cw
2f
.2
.3
3
11-30
5yr4/4
C
3 ,BDk
mfi
190
Boring N �Boring
2 Pit Ground surface elcv. ft. Depth to timitingfattor in.7clev. ft.
Sail Annll� ra
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description Qu.
Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft
•Effe1
•EIfe2
CST Name Please Print)
Signature
CST Number
Ryan Van Ornum
V —
11011
Address
Date Evaluation Conducted
Telephone Number
65907 Jotma Rd Marengo, WI
4/13/2026
(715) 413-0074
Effluent #1-800>30s 220 mg/L and TSS >30s 150 mg/L - Effluent 02- DOD. s 30 mg/L and TSS s 30 mg/L
SBO-8330 (R03122)
i
I
lik
--
! i. _
.iIIH
1
Z
=
PThE1T71�
-
-�.
LLI.
1±1111
t
t
1k
I
1N1T2H4T
_
I'_
-
1
L
--
-H_r_-[-H--,
Soil Test #
Bayfield County
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1 -1 0(d))
I V N ar v"4"n a certified soil tester determine that in my professional
jud ment the following site (see below) is unsuitable for any treatment component other than holding
tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a
determination. RECEIVED
Property Owner f e1 hestl R +! k„„ 5 r,l y k1_? r� Contractor MAY 1 1 2026
t3ayfield Co.
Property Address ?9cvo_h�t 5 '° t l7 r• Authorized Agent Planning and Zoning Agency
IalasutMti WZ S9t1 1 Agent's Telephone
Telephone �'3 ) 2o9 39 Y`/ Written Authorization Attached: Y or N
Accurate Legal Description is requested:
1/4 of 114 Section -2 —Township qq N. RangeI_W. Town of
Govt.
Lot 3 Lot Block Subdivision CSM#
Volume Page of Deeds Parcel I.D# Acreage
Additional Legal Description:
Indicate reasoning for your determination: -_ 5oi I / o 1j11- _J k'
S' nature of Certified Soil Tester
9/13/ ?o
Date
1l C) 1/
Certification #
Signature of County Official
Date
(Submit a Plot Plan & Fee)
utforms/soiltestwalver(KLK)
February 2005
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet
Component Manual Design References:
Holding Tank Version 2.1 (May 2022-2027)
Rt CEIVED
Pg 1 of 4 Index & Cover Sheet MY 1 1202b
Pg 2 of 4 Plot Plan
Bayfield Co.
Pg 3 of 4 Holding Tank Specificationsrlanningand Zoning Agency
Pg 4 of 4 Management Plan
Attachments:
Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map (if ap
Holding Tank Pumping Contract (if appl
Holding Tank Agreement (if applicable)
Project Name / Description
Sherry
plicable)
cable)
Owner Name(s): Michael & Kimberly M Sherry Phone: 715 209 1646
Owner Address: 3113 Golf Course RD Zip: 54806
Project Address:
/U/.fo
C=ic •3 k rc IOncatL3
&1ac , ,ti Li
Govt. Lot: 3
1/4 of
1/4, Section 07 ,
T48 N -R 04
E
❑
or W
❑✓
Township: Barksdale County: Bayfield
Project Parcel ID #: 3T
Designer Information
Designer Name: Robert W Hansen
Designer Address: 25370 US Highway 2
E-mail:
License Number: 226148
Remarks:
Phone:715 209 0708
Zip: 54856
This space reserved for approval stamp.
Signature: Ac 7[ a.rt-- Date: sla I
Original signature required on each submitted copy.
CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE.
fl SOIL EVALUATION Scale: V =40 fl SYSTEM PAGE 2 OF
SITE MAP 0 40 60 BD PLOT PLAN
PROJECT NAME: (10 ft grid) , DESIGN FLOW: 450 GPO
1p
Sherry Attach design flow calculations for commercial plans.
PROJECT ADDRESS: 74500 Lake Shore Dr N Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5)
Sanitary Sewer: Sch 40 PVC /
BM Symbol: BM Elevation: 100 FT Force Main: )
BM Description. Top of Well Casing
% Indicate north by IMPORTANT:
Slope Gradient
(°') 2 Well Symbol (if applicable): $ drawing an arms Show ground elevation contours at suitable intervals.
of Tested Area: an the approprite line.
!sp vT, L.oT 3
n& 4, %At_ OF
RECEIVED
MAY 1 1 2026
8ylield Co.
Planningaand Zoning Agency
J
37b
ap
U i�
P p
o''�
t 1t -
r n;�1
�, �`� 171
j, tI
t �-t r
M
0
Is)
fn
Q0
15'-4
4" CAST —A —SEAL 4" CAST —A —SEAL
I I
1 �
i � I
FILTER OR
BAFFLE
----------- --------------
1
TOP VIEW RECEIVED
MAY 1 1 2026
Bayfield Co.
Planning and Zoning Agency
1
io
I
I r U
N R 0.
I V
TLNVC ADC \I Akl11CArn 1001 Tn IICCT fl Cvnton A111 n ♦Onl n,'n, Onrl,ru>•e
WLP3000
TANK SPECIFICATIONS
DIMENSIONS:
WALL: 3"
BOTTOM: 5"
COVER: 6"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 62 3/4"
LENGTH: 15'-4"
WIDTH: 8'-6"
BELOW INLET: 50"
LIQUID LEVEL 43"
WEIGHT: BOTTOM 15,980 LBS.
COVER 9,300 LBS.
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL GASKET
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 69.77 GAL/IN
HOLDING TANK:
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 3,140 GALLONS
LOADING DESIGN: 8'-O" UNSATURATED SOIL
TANK CAN BE USED AS:
SEPTIC / HOLDING / PUMP OR SIPHON
COVER: MIX DESIGN #8 (NO FIBER)
TANK: MIX DESIGN #9 (SMALL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
KEY NOTES:
O1 CONCRETE OR EZ-SNAP RISERS
O(2 EA.) MANHOLE EACH END OR
(1 EA.) MANHOLE & (1 EA.) 4" COUPLER
OPPOSITE ENDS
REVIEWED BY
REVIEW DATE
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
J
o0
0
Z
0
M
d U
3 F
i Z
OF
71
PAGE 3 OF 4
HOLDING TANK SPECIFICATIONS
(No Scale) RECEIVED
MAY 1 1 2026
Bayfield Co.
Weatherproof 12" Min. or 2.0 ft above Planning and Zoning Agency
Junction and Approved Established Flood Elevation
Vent
Alarm Box Cap (typical)
Electrical must comply with Approved Locking Manhole
SPS 316 and NEC 300 4"0 Vent Pipe with Warning Label Attached
Conduit >10 ft from (typical) 4" Min. or 2.0 ft above
Building I — Establishe(�P�d) Elevation
18" Min.
(typical)
Inlet
Approved Joints with
Approved Pipe 3 ft onto
Solid Ground
3ht Seal
art
Max. 12" or 90% of total volume
if more than one tank
HOLDING TANK
VOLUME = 3000
gal
°
3" Approved Bedding Material Beneath Tank
TANK MANUFACTURER:
Weiser
e
Finished Grade
Plug
Anchor tank as necessary
pursuant to SPS 383.43(8)(g)
Ballast Weight = [(cu.ft.tank.vol x 62.4 Ibs/cu.ft) - lbs.tank.wt] x 1.5
Ballast Weight = [( 535 cu.ft. x 62.4 lbs/cu.ft) - 33384 Ibs] x 1.5 = 50076 lbs
PAGE 4 OF 4
Holding Tank Management Plan
IMPORTANT:
The owner of this holding tank(s) shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this holding tank(s)
shall be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Estimated Daily Wastewater Flow = 300 gpd
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (Le. odors, user complaints, etc.)
o mechanical malfunction (Le., pumps, valves, switches, floats, etc.)
o material fatigue (Le., leaks, breaks, corrosion, etc.)
o neglect or improper use (Le., exceeding design capacities, prohibited activities, etc.)
o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o surface discharge of effluent or sewage back-up into structure served
SERVICING FREQUENCY
RECEIVED
MAY 1 1 Z026
Bayfield Co.
Planning and Zoning Agency
o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats.
when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s).
Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
Tank pumping reports shall be submitted to the proper local government unit In accordance with SPS 383.55 Wis.
Admin. Code. Report any component failure or malfunction to:
Septic Name of individual or company: # 2 Phone: 715-682-2222
Local government unit: Bayfield County Zoning
Local government unit address:
117E 5th Washburn WI
Phone: 715-373-6138
ZIP: 54891
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
In the event that any failed component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a
plan submitted to the appropriate agecy for review and approval.
System Abandonment
If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
HOLDING TANK — MANAGEMENT PLAN
The Private Onsite Waste Treatment System (POWTS) has been designed and is to be
installed and maintained according to SPS 383, Wisconsin Administrative Code,
Holding Tank Component Manual for Private Onsite Waste Treatment Systems
(SBD-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private
Sewage Ordinance.
1. This POWTS has been designed to accommodate a maximum daily flow of
om gallons of domestic wastewater per day.
2. The owner of this POWTS is responsible for system operation �T1����Eb
maintenance, locking device, alarm and access. MAY 1 1 2076
3. The owner or owner's agent is required to submit reports as regSredl by SPS
383.55(1), Wis. Adm. Code, to the Bayfield County Zoning"'NO f} Pit?Agency
4. Design approval and site inspections before, during and after the construction
are accomplished by the county or other appropriate jurisdictions in
accordance with SPS 383 of the Wis. Adm. Code.
5. Maintenance Cycle. The holding tank must be serviced by licensed pumpers.
An alarm system is to be installed to activate when the tank is < 90% full.
6. Performance monitoring. At the time of servicing, the service provider files a
report with the department of designated agent.
7. A User's Manual will accompany the component. It will include the names
and phone numbers of local health authorities, component manufacturer or
POWTS service provider to be contacted in the event of component
malfunction or failure.
In the event that this POWTS or a component of this POWTS fails and cannot
be repaired the owner will find in the User's Manual the names and telephone
numbers of property licensed individuals to contact for such repairs.
This agreement shall be binding on all assignees and heirs
1/4 of 1/4 SectionO'1 Township4}� N. RangeOj_W. Town of_______________
Govt.
Lot 3 Lot Block Subdivision CSM#
Additional Legal Description _2L.- W P i.C 3
Property Owners S' ature (� Date
u/forms/managementplan
Revised: July 2013
HOLDING TANK SERVICING CONTRACT
Contract ate
5 � �abab
Holding Tank Owner(s) Name(s)
K4 111.E V \6 ti -t
This contract is made between the
Pumper's Name (Print)
Pum er's i ture
Pumpers' Registration #
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions)
PROJECT
Legal Description:
Tax IDk
1/4, 1/4,
LOCATION
(Use Tax Statement(
�-t
Section /
,{
'�2 N, Range £Dw
Town of:
Lot Size
Acreage
,Township
�DY
GoVt Lot
I
I Lot k
CM N
I Vol. Page
I CM Dock I
Lot(s) No.
I Block(s) No.
Subdivision:
3
1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code.
2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have
access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain
the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner
further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by
the owner and pumper.
3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS
383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The
pumper further agrees to include the following in the semiannual report:
a. The name and address of the person responsible for servicing the holding tank; RECEIVED
b. The name of the owner of the holding tank;
c. The location of the property on which the holding tank is installed; MAY 112026
d. The sanitary permit number issued for the holding tank;
e. The dates on which the holding tank was serviced; 6ayrxald Co.
f. The volumes in gallons of the contents pumped from the holding tank for each servicing, Planning and Zoning Agency
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this
contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract
with the local government unit and the County named above within (10) business days from the date of change to this
service contract.
Owner(s) Name(s) (Print) I Owners Signature(s) Subscribed and Sworn to me:
// / �[! / �j yJ on this day of rvL�� ,
N'c e l rl 5i le 7 ifP GtY!1 i by: t/ O ET,
/ Nota ublic
My commission expires on: 'J_yl
Revised: May 2016 (®May 2018) - - Drafted by
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)]
ier Name (s
AGREEMENT
311 D CC�C4 Cai.4L
RD Ate`.'D, WI
Anreement Date (same as Notary D
on the following property or that continued use of the existing premises requires that a
holding tank be installed on the property for the purpose of proper containment of
sewage. Also, the property cannot now be served by a municipal sewer, or any other
type of private onsite wastewater treatment system as permitted under Ch. SPS 383,
Wis, Adm. Code or Ch. 145, Wis Stats,
1/4 of 1/4 Section Cs -I Township 4S N. Range _____W
Town of �141RICaC�'9i.IS
Additional Legal Description: f5le.P.r P Pw+ 317
Gov't Lot 3 Lot_ Block_ Subdivision Lot
CSM # Vol Page CSM Doc#
Return To
DOCUMENT NUMBER
2026R-61 2095
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
05/1 1/2026 AT 9:13 AM
RECORDING FEE: $30.00
PAGES: 2
RECEIVED
MAY 12 2026
Bayfield Co.
Planting and Zoning Agency
Lct,v..�j
zTh
As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above -described property, N�grg�;ta do the
following:
1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and
maintenance. If the owner fails to have the holding tank properly serviced in response to orders issued by Bayfield County or the
Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., Bayfield County may enter upon
the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a
special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats.
2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and
maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield
County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days of the date of notice. In the event the
owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax
roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law.
3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to
have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County.
The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within
30 days of the date of change to the service contract.
4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Stats., and Ch. NR 114, WI's Adm. Code who shall
submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to
investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being
properly maintained.
5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private
onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by
executing and recording said certification with reference to this agreement in such manner which will permit the existence of the
certification to be determined by reference to the property.
6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this
agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the
existence of the agreement to be determined by reference to the property where the holding tank is installed.
Owner(sj Name(s) — Please Print
f?9.c�,gel R. St!te✓iy
K tryl b4yn
Subscribed and sworn to before me on this da P , .
M-&.1 4, zoz�,
Notar'z d caner ) SI t7r)C�
Nota 'c _ ....
' L._.L1JLt
My Commission Expir
Drafted by: /<tn. 5Acrr.y Date: ^11 )2L
Personal information you provide maybe used for secondary purposes IPnvacy Law, 5.15.04 (0(m)] u/fonnsrsanitary/HoldingTankAgreemeol 4.2026
RECEIVED
MAY 112026
EXHIBIT "A"
Bayfield Co.
Planning and Zoning Agency
A parcel of land in Government Lot Three (3), Section Seven (7), Township Forty-eight (48) North,
Range Four (4) West, Bayfield County, Wisconsin described as follows: Starting at the '/+ post of the
West line of Section 7-48-4 West; thence N. 86°16' E., 2475 feet along the East-West ''/, section line
to the East Boundary line of the Chicago, St. Paul, Minneapolis & Omaha Railroad right of way, the
point of beginning; thence S. 04°10' E., 200 feet along the railroad right of way; thence N. 86°16' E.,
168 feet to the shore of Lake Superior; thence Northerly along the lake shore approximately 218
feet; thence S. 86°16' W., 110 feet to the point of beginning.
AND
A parcel of land in Lot Three (3), Section Seven (7), Township Forty-eight (48) North, Range Four (4)
West, Bayfield County, Wisconsin, described as follows: Commence at the West''/a section comer;
thence N. 86°16' E., along the'/s line a distance of 2375 feet to the point of beginning; thence
continuing N. 86°16' E., 100 feet; thence S. 04°10' E., 200 feet; thence S. 86°16' W., 100 feet;
thence N. 04°10'W, a distance of 200 feet to the point of beginning.
LESS the following described property:
A Permanent Highway Easement in and to the following tract of land in Bayfield County, Wisconsin.
A parcel of land in Government Lot Three (3), Section Seven (7), Township Forty-eight (48) North,
Range Four (4) West, as described as follows: Commence at the West one -quarter (W'/<) corner of
Section Seven (7); thence S. 88°53'59" E., 2336.39 feet along the East-West Quarter line of said
Section Seven (7) to the point of beginning; thence continuing S. 88°53'59" E., 75.46 feet; thence
S.1°33'42" W., 234.78 feet; thence S. 16°28'46" W., 142.60 feet; thence N. 88°26'18" W., 38.75 feet
to the centerline of State Highway 13; thence N. 1°33'42" E., 371.96 feet along said centerline to the
point of beginning.
EXHIBIT "B" RECEIVED
MAY 1 12026
Bayfield Co.
Planning and Zoning Agency
POWER OF ATTORNEY
and severally
appoint r'Pll .of 15i1 12)V
to act on my behalf, or on behalf of rr�/each of us singly, as
(1) To buy, sell, mortgage, or otherwise deal in any real or personal property
whatsoever, or any interest therein, upon such terms as our attorney shall think proper;
(2) to collect, hold, maintain, improve, invest, lease or otherwise manage any or all of our
real or personal property or any interest therein; (3) to transact every kind of business of
any nature or kind; (4) to deposit and withdraw (by checks or withdrawal slips) in or from
any banking institution, any funds, negotiable paper or moneys which may come into our
attorney's hands as such attorney or which we now or hereafter may have on deposit or
be entitled to; (5) to engage in any administrative or legal proceedings or in any litigation
In connection with the premises; (6) to act as my attorney or proxy in respect to any
stocks, bonds, shares or other investments, rights or interest we now or hereinafter hold;
(7)10 engage and dismiss agents, counsel, and employees, and to appoint and remove
at pleasure any substitute for, or agents of our attorney, in respect to all or any of the
matters or things herein mentioned and upon such terms as our attorney shall think fit;
(8) to prepare, execute and file income and other tax returns, and other governmental
reports and documents; (9) to transfer any interest we may have'in property, real or
personal, to the trustee(s) of any trust created by us,. or each of us, for our benefit; (10)
to warrant title, and (11) to borrow money.
I/We grant to my/our attorney full power and authority to deal with my/our estate (our
joint estate as well as our individual estate), property and affairs as fully and effectually
as I/we might or could do if personally present. The above enumerated powers are
Intended to amplify, rather than to limit or restrict the general power of attorney herein
granted.
Any lawful act(s) done hereunder by my/our attorney shall be binding upon ourselves,
jointly and singly, our heirs, legal and personal representatives and assigns whether
done before or after my/our death or other revocation of this instrument, unless and until
reliable intelligence or notice of revocation shall have been received by my attorney;
provided any bank or depositor may rely upon this Power of Attorney until receipt by it of
an executed copy of revocation hereof.
The authority given mylour attorney in fact under this Power of Attorney is limited
to the following property:
SEE ATTACHED LEGAL DESCRIPTION.
CONTINUED
RECEIVED
MAY 1 12026
Plannin Oeld Co.
9 and Zoning Agency
Property Address: 74 G & &c3& c • r `p Ut&Qwn A1!
!
Reproductions of this executed original (with reproduced signatures) shall be deemed to
be original counterparts of this Power of Attorney.
This authority granted under the attorney in fact under this Power of Attorney will expire
and the attorney in facts authority granted herein will terminate and be deemed revoked
as of the sixty first day following the date of execution stated herein.
STOATEOUNTY o&2'4 6'oan
CCr y) 4) C
On this _ day of m6'Ft , 20 job, , before me, a Notary Public in
and for said County, personally appeared dU t*J dears.. I.fA 1 CA- to me
known to be the persons described in and who executed the bove Power of Attorney,
who acknowledged to same to be their free act and deed.
Nota Publi Gene Hydes
y Commission Expires: Notary Public In and for the Caymap Islands
My commission expires Jan.31st, 20_./
Drafted By:
Sut5cin l.J&-+L{
�'e
4
RECEIVED
MAY 1 1 2026
EXHIBIT "A" Bayfield Co.
Planning and Zoning Agency
Parcel 1:
A parcel of land in Government Lot Three (3), Section Seven (7), Township Forty-eight (48)
North, Range Four (4) West, Bayfield County, Wisconsin described as follows: Starting at the
1/4 post of the West line of Section 7-48-4 West; thence N. 86°16' E., 2475 feet along the
East-West 1/4 section line to the East Boundary line of the Chicago, St. Paul, Minneapolis &
Omaha Railroad right of way, the point of beginning; thence S. 04°10' E., 200 feet along the
railroad right of way; thence N. 86°16' E., 168 feet to the shore of Lake Superior; thence
Northerly along the lake shore approximately 218 feet; thence S. 86°16' W., 110 feet to the
point of beginning.
AND
A parcel of land in Lot Three (3), Section Seven (7), Township Forty-eight (48) North, Range
Four (4) West, Bayfield County, Wisconsin, described as follows: Commence at the West 1/4
section corner; thence N. 86°16' E., along the 1/4 line a distance of 2375 feet to the point of
beginning; thence continuing N. 86°16' E., 100 feet; thence S. 04°10' E., 200 feet; thence S.
86°16' W., 100 feet; thence N. 04°10'W., a distance of 200 feet to the point of beginning.
LESS the following described property:
A Permanent Highway Easement in and to the following tract of land in Bayfield County,
Wisconsin.
A parcel of land in Government Lot Three (3), Section Seven (7), Township Forty-eight (48)
North, Range Four (4) West, as described as follows: Commence at the West one -quarter
(W1/4) corner of Section Seven (7); thence S. 88°53'59" E., 2336.39 feet along the East-West
Quarter line of said Section Seven (7) to the point of beginning; thence continuing S.
88°53'59" E., 75.46 feet; thence S.1°33'42" W., 234.78 feet; thence S. 16°28'46" W., 142.60
feet; thence N. 88°26'18" W., 38.75 feet to the centerline of State Highway 13; thence N.
1°33'42" E., 371.96 feet along said centerline to the point of beginning.
DENISE TARASEWICZ
HAYFIELD COUNTY, WI
REGISTER OF DEEDS
State Bar of Wisconsin Form 1-2003
WARRANTY DEED
Document Number V Document Name
THIS DEED, made between
" whether one
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real
estate, together with the rents, profits, fixtures and other appurtenant interests, in
BAYFIELD County, State of Wisconsin ("Property") (if more space is
needed, please attach addendum):
See the annexed Exhibit A
2020R-586009
12/14/2020 11:56AM
TF EXEMPT #:
RECORDING FEE: $30.00
TRANSFER FEE: $1,056.00
PAGES: 5
RECEIVED
MAY 112026
Bayfield Co.
Planning and Zoning Agency
Recording Are.
Michael R. Sherry and Kimberly M. Sherry
3113 OolfCourse Road
Ashland, WE 54806
14431-20
04.002-2-48.04-07-3 05-003.10000
Parcel Identification Number (PIN)
This IS NOT homestead property
Grantor warrants that the tide to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
EASEMEN fig, RESERVATIONS �AND RESTRICTIONS OF RECORD.
flee
ee axug't // oa — ..
AUTHENTICATION
Signature(s)
authenticated on
TITLE: MEMBER STAT$rH
(If not, _
authorized by Wis. Stat,
THIS INSTRUMENT DRAFTED BY:
ATTORNEY MAX T. LINDSEY, SB#1112865
Anich. Wickman & Lindsey, S.C.. Ashland, WI 54806
* WILLIAM H. LEAKEY
WATLER
ACKNOWLEDGMENT
STATE OF WISCONSIN
)ss.
1-')L W'q'Cd % OUNTY )
Personally came before me on £_Q O's€&U//f
the above -named WILLIAM H. LEAKEY JR. AND WILLIAM H.
LEAKEY JR., AS POWER OF ATTORNEY FOR SUSAN
LEAKEY WATLER AIK/A SUSAN WATLER
to me known to be the person(s) who executed the foregoing
instrument an ckn d¢ed,Ilie sgpte. �'
Notary Public, State of Wisconsin
My Commission (is permanent) (expires: /I
(Signatures may be authenticated or acknowledged. Both are not necessary.) '
NOTE; THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
* Type name below signatures.
BAYFIELD COUNTY
CHECKLIST FOR SANITARY APPLICATONS
Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e))
Ff Check List
,� Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.)
Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) RECCNEr)
'R Original Plot Plan (383.22(2)2. 3. & 4.a) MAY 1 1
jd Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer 2026
SaYfielCo.
❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) Planning and Zoning Agency
Contingency Plan / Management Plan (383.22-3(2)(b)1.f.)
Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds)
_ Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds)
;' Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5)
❑ ATU Servicing Agreement (Recorded at Reg. of Deeds)
(d Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
,02 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached
to all copies)
2'Soil and Site Evaluation Report (383.22-3(2)(b)1.e.)
❑ State Plan Review (when applicable)
❑ Copy of Warranty/Quit Claim Deed (Optional)
Sanitary Application: (Include the following Information)
j2'I Application Information must include: ❑ 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete)
JQ'Project Address or Road Name where driveway is/will come off of)
22'II Type of Building
VIII Type of Permit
P -'IV Type of POWTS System
❑ V Dispersal / Treatment Area Information
E2 VI Tank Information
_Q -VII Responsibility Statement (Plumber's Information)
❑ *Date Stamp*
Plot Plan: (To Scale or To Dimension)
j2'Signature and Plumber Information
❑ Surface Elevation of Body of Water
J 'Direction and Percent Land Slope
Tank and Filter Information and Location
❑ Wetlands / Navigable Bodies of Water
❑ Absorption Area (Proposed and Existing)
Bench Mark (Location, Elevation and Description)
Fd Component Manual Version
(Owners Phone Number)
'Address Number and Road
2'North Arrow
9 -Contour Lines
i' Structures and Driveways
❑ Boring Locations
"Property Lines
2 -Well Locations
O'Legal Descriptions
Turn Over ►
Cross -Section and Over -Head Profile of the System:
Surface and System Elevation
to Position of Observation and Vent Pipes
Dimensions and Depths ❑ Make, Model & Number of Chamber Units in each Cell RECEIVED
Property Information MAY 1 1 2026
hayfield co.
Planning and Zoning Agency
How many systems will there be on this parcel of land? �
Has this property been split? r'> (Property Statement shows Property History)
Fees:
O Private Sewage System (Septic Tanks)
$ 400.00
IQ'Private Sewage System (Holding Tanks)
$ 400.00
O Mounds or Systems requiring Pre -Treatment
$ 500.00
❑ Sanitary Revisions
$ 25.00
❑ Private Sewage System Reconnection
$ 50.00
and Private Interceptor
❑ Return Inspection
$ 50.00
O Maintenance Agreements +
$ 30.00
(checks made out to Reg of Deeds)
u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by:
]3'�'FIELD Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
SHERRY, MICHAEL R & KIMBERLY M
3113 GOLF COURSE RD
ASHLAND, WI 54806
Description
Private Sewage System (Holding Tanks)
Submission Number:
SS -00745
Transaction Number:
SS-00745-456EB
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 1101
Paid by: Michael R Sherry or Kimberly M Sherry, 3113 Golf Course Rd, Ashland WI
54806
Payment Type: Check
Transaction Date: 5/14/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-46S
STATE SANITARY PERMIT
OWNER: MICHAEL R & KIMBERLY M SHERRY
G OV'T LOT: 3 LOT: BLK:
1/4 1/4 SEC: 7,T48 N, R 4 W
TOWNSHIP: Barksdale
SOIL TEST: 22-26
REPLACEMENT SYSTEM
SYSTEM TYPE: Holding Tank
PLUMBER: ROBERT HANSEN
TRACY POOLER
Authorized Issuing Officer
DATE: 5/14/2026
CHAPTER 145.135(2) WISCONSIN STATUTES
a. The purpose of the sanitary permit is to allow installation of the
private sewage system described in the permit.
b. The approval of the sanitary permit is based on regulations in force on
the date of approval.
c. The sanitary permit is valid and may be renewed for specified period.
d. Changed regulations will not Impair the validity of a sanitary permit.
e. Renewal of the sanitary permit will be based on regulations in force at
the time renewal is sought, and that changed regulations may impede
renewal.
f. The sanitary permit is transferable.
History: 19770.168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of the
permit, please contact the county authority.
PREVIOUS PERMIT #:
LICENSE: # 226148
Condition: Old System needs to be properly abandoned per SPS 383. Properly Maintain System
Per Recorded Agreement. Must be within 25 ft of an all-weather road.
THIS PERMIT EXPIRES 5/14/2028
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION