HomeMy WebLinkAbout26-110SSS -0o 03
Industry Services Division County
4822 Madison Yards Way Bayfield
Madison, WI 53705 Sanitary Permit Number (to be filled in by Co.)
P.O. Box 7302
— 0 0 8 �3 Madison, WI 53707 '— fl I �5
Sanitary Permit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary 48525 S Lake Owen Dr. Cable, WI
purposes in accordance with the Privacy Law, s. 1 S.04(1)(m), Srats. RECEIVED
I. Application Information — Please Print All In formation
Property Owner's Name Parcel #
Windmark North LLC JUL 152026 13931
Property Owner's Mailing Address Bayfield Co. Property Location
555 Main St. STE 450 Planning and Zoning Agenq
Govt. Lot
City, State Zip Code Phone Number
Racine, WI 53403 414-331-7856 % %, Section 22
II. Type of Building (check all that apply) Lot # T44 N R 07 E or W
❑✓ I or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name
Block #
❑Public/Commercial — DescribeUse
Cityof
State Owned— Describe Use CSM Number Village of
Town of Drummond
III. Type of POWTS Permit: (Check either "New" or"Replacement" and other applicable on line A. Check one box on line B. Complete line Cif
applicable.)
A. IZINew System ❑Replacement System lllOther Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain)
B. Holding Tank jIn-Ground fAAt-Grade Mound Individual Site Design Other Type (explain)
(conventional)
C. ❑ Renewal Before ❑Revision Change of Plumber Transfer to New Owner List Previous Permit Number and Date Issued
Expiration NA
IV. Dispersal/I'reatment Area and Tank Information:
Design Flow (gpd) Design Soil Application Rate(gpd/st) I Dispersal Area Required (so I Dispersal Area Proposed (st) I System Elevation
300 NA NA NA NA
Capacity in Total # of Manufacturer
Tank Information Gallons Gallons Units
V
New Tanks Existing Tanks o "+ y ' `"
O r ,°a a.
1 CJ VI v. VI [t t.i L
Septic or Holding Tank 3000 3100 1 Superior Precast ✓
Dosing Chamber
V. Responsibility Statement- I, tire undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) I Plumber's Signatur MP/MPRS Number Business Phone Number
Jason Kuettel 675751 715-798-3355
Plumber's Address (Street, City, State, Zip Code)
PO Box 66 Cable, WI 54821
VI. County/Department Use Only II
Approved ❑ Disapproved Permit Fee I Date Issued Issuin ge Signature
I ❑ Owner Given Reason for Denial S 24 2b "ZO
Conditions of Approval/Reasons for Disapproval
Cc wed
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2,x II inches in size
SBD-6398 (R. 02/22)
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet
Component Manual Design References:
Holding Tank Version 2.1 (May 2022-2027) RECEIVED
Pg 1 of 4 Index & Cover Sheet JUL 15 2026
Pg 2 of 4 Plot Plan Bayfield Co.
Planning and Zoning Agency
Pg 3 of 4 Holding Tank Specifications
Pg 4 of 4 Management Plan
Attachments:
Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map (if ap
Holding Tank Pumping Contract (if appt
Holding Tank Agreement (if applicable)
Project Name I Description
Windmark North LLC Holding Tank
Owner Name(s): Windmark North LLC
Owner Address: 555 Main St. STE 450 Racine, WI
Phone:414 _331
Zip: 53403
Project Address: 48525 S Lake Owen Dr. Cable, WI 54821
Govt. Lot:
Township: Drummond
Project Parcel ID #: 13931
ilLl.31
Designer Name: Jason Kuettel
Designer Address: 42940 US I
E-mail: tim@andryras.com
License Number: 675751
Remarks:
plicable)
cable)
7856
1/4, Section 22 , T 44 N -R 07 E❑or w1
County: Bayfield
Designer Information
63 S. Cable, WI
Phone: 715 _798 _3355
Zip: 54821
iii,, space rc.crvcd hi apps'cal e[,ury..
Signature: ; Date: 7Jt f/zG
Original g ature required on each submitted copy.
OUN'ES : w1Nt�M+i�'L NQC-T h C-LC-
CCGa-c Szz TlYN (Z o71J
LAKE OWEN
S0
_--
BSVEOETATNE
BUFFER ZONE
WETLAND
TS
$HORELANO --_-
SETBACK y.�
------------------ ----
____ _
L
(iJEV¢JT
01 SITE LAYOUT PLAN
Pzo us6
G�tT— ,
tl'ORNE
RELANO /'
rmcN
RECEIVED
JUL 15 2026
Hayfield Co.
Planning and Zoning Agency
77 WETLAND
35WETlAND
SETBACK
715 �2 F
PAGE 3 OF 4
HOLDING TANK SPECIFICATIONS
;EIVED
(No Scale)
JUL 152026
Bayfield Co.
Planning
and Zoning Agency
Weatherproof 12" Min. or 2.0 ft above
Junction and Approved Established Flood Elevation
Alarm Box Vent Cap (typical)
Electrical must comply with
Approved Locking Manhole
SPS and NEC 300 SPS 316
40 Vent Pipe
with Warning Label Attached
Conduit >10 ftfrom
(typical)
4" Mn. or 2.0 ft above
Building
Established Flood Elevation
(typical)
\
\J/
Airtight Seal
{j
.
Finished Grade
18" Min.
(typical)
.: a:
"
.
..
e
4
Inlet
Inlet Invert
Approved Joints with
—Watertight
Plug
Approved Pipe 3 ft onto
Max. 12" or of total volume
than one tank
"
Alarm -On
e
HOLDING TANK
VOLUME = 3100 gal
3" Approved Bedding Material Beneath Tank
TANK MANUFACTURER: Superior Precast
Anchor tank as necessary
pursuant to SPS 383.43(8)(g)
Ballast Weight = [(cu.ft.tank.vol x 62.4 lbs/cu.ft) - lbs.tank.wt] x 1.5
Ballast Weight = [( cuff. x 62.4 lbs/cu.ft) - Ibs] x 1.5 = Ibs
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
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o electrical components (to., wiring, connections, switches, controls, timers, alarms, etc.)
o surface discharge of effluent or sewage back-up into structure served
SERVICING FREQUENCY
RECEIVED;
JUL 15 2026
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:
Name of individual or company: Andry Rasmussen & Sons Phone: 715-798-3355
Local government unit: Bayfield Co. Zoning Phone:
Local government unit address: 117 E 5th St. Washburn, WI
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.
[5' SUPERIOR LP30001-Compartment Tank SUPERIOR
PRECAST CONCRETE
PRECAST CONCRETE
Weisht (in lbs)
Tank: 19.127
Lid: 9,77:
Total: 24,902
Volume of Concrete
Total : 6.: Yd'
Gallons Per Inch: 70.9
Lid
TOP VIEW
184"
178'
i LCCt:1VED
JUL 15 2026
Bayfield Co.
Planning and Zoning Agenri
3029 Gallons
-L1-- \ SIDE VIEW
Enlarged Detail L— ____��
Conditionally
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
50"
SEE CORRESPONDENCE
9" Air Space
• 33" uid
Depth
De
96" 102"
---------------------
J ____ ] Thor
Ti'ck's"
Manhole Opening- _ _
I -12 ? Taper
/ Produced by Superior Precast Concrete, LLC
( PO Box 1390
^ Hayward, WI 54843
C)
Polyethylene
Baffle
Mastic
Rope
S
SUPERIOR
PRECAST CONCRETE
Design conforms to ASTM C1227, Specification for Precast
Concrete Septic Tanks and WI SPS 384.25, POWTS Holding
Components or Treatment Components.
The information provided on any Superior Precast
Concrete (SPC) drawing or document shall be verified by
the purchasers licensed professional engineerfor
suitability of use.
Configuration may change from drawing, consult with SPC.
Product File No: I This is proprietary lnrounatIon, and remain[he propnry of Superior Precast Concrete, LLC. I 0. 3 0519.20 241
HOLDING TANK SERVICING CONTRAC≤p"oTARrA"�'o'
*„ j••. SEAL.
Contract Dates.�Pf
i Jis%�6 This contract is made between the
Windmark North LLC
Pumper's Name (Print) Pumper's Signature Pumpers' Regi:
Cri i*JM.. ($ESP `. CcC �O1 Q.'�� L qc' •r— .-t.. CSo4,��4�/._1. ^JQ
JACOB ELLIOTTCRIDER
Notary Public
for the State of Montana
Residing at:
Bozeman, Montana
My Commission Expires:
June 4, 2029
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions)
PROJECT
Legal Description•
Tax ION
3 9 3
LOCATION
jUse Tax statement), - --
-- 1 • 1
1/6• 1/4,
Section LZ N, Range D Z
Town of:
i Lot Size
I Acreage
,Township w
t _v MA -01
3S- 2.1
GoVt Lot
Lot N
CShM N
Vol. Page
CSM Doc N
Lots) No.
Block(s) No.
Subdivision:
1. The owner agrees to file a copy of this contract with Barfield 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 axe ' n ypJ xis. The
pumper further agrees to include the following in the semiannual report: flttatl V CL)
a. The name and address of the person responsible for servicing the holding tank; JUL 152026
b. The name of the owner of the holding tank;
c. The location of the property on which the holding tank is installed; sayeeld Co.
d. The sanitary permit number issued for the holding tank; Planning and Zoning Agency
e. The dates on which the holding tank was serviced;
f. The volumes in gallons of the contents pumped from the holding tank for each servicing;
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.
Owners) Name(s) (Print) Owner's Signature(s) =y:
rn to me:
i
Windmark North LLC Authorized Represetative
Notary Public
Scott Weas
I es on: ZLfkt. Ll 7,029/
Revised: May _016 (: ),day 201E) use,t„
Personal inrorrnalion you provide may 1', d for Sc,,,, ,n, la Drafted by
ry Purposes IPm•aey Law, x.15.0.1 P),^t)I
lffnlHlmRir_nIItKt17TL tjfl1
DOCUMENT NUMBER
2026R-6 12947
Document Number
WINDMARK NORTH LLC
Document Title
JUL 16 2026
gayfield Co.
A9e.�
planning and Zoning
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
07/15/2026 AT 1:44 PM
RECORDING FEE: $30.00
PAGES: 3
Recording Area
Name and Return Address
ZONING
Parcel Identification Number (PIN)
THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE.
This information must be completed by submitter: document title, name & return address, and PIN (if required). Other information such as
the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the
document.
WRDA Rev. 12/22/2010
""""^• JACOB ELLIOTT•CRIDER
� 4 EWoT?c`'• Notary Public
,o. 2a,
Document Number/Plan I.D. No.
HOLDING TANK
AGREEMENT
v Tna1 a
X0_._44
for the State of Montana
-'�: :
* •, SEAL r z
Residing at:
Bozeman, Montana
Owner Name(s)
Owner(s) Mailing Address
Winorrerk Nat LLC
1345 N Jefferson St
P.O. Box 387
` iA•• ••'•c °`
My commission 4,2 Expires:
4, 2029
'�•,,,,°'
June
Milwauke, W153202-2657
Parcel Identifier Number (PIN)
Agreement Date (same as Notary Date)
We acknowledge that application is being made for the installation of (a) holding tank(s)
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, Ws Stats.
114 of 1/4 Section i? Township ______N. Range 6) W.
Town of ' MZIA A,_4n
Return To:
Additional Legal Description: f& 4 T77C .'-
RECEIVED
G
ZON 1N G RECEIVED
Gov't Lot - Lot_ Block_ Subdivision Lot
CSM # Vol
JUL 16 2026
Page CSM Doo#
As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above -described proper,�°��}@r?0RPrdo 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 property 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, Scats., 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, Scats.
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. Stab., 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. Scats., 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(s) Name(s) — Please Print
Subscribed and sworn to before me on this date:
Windmark North LLC
-7 /10/oz Co
Notarized Owner(s) - Signature(s)
�VD
Notary Publ-
lJ�
Scott Weas
My C mission Expires:
Authorized Representative
7u n c.. y t" Z.c 29
Drafted by: 7TA" CJL_14 __ Date: 7J/0/24,
Personal information you provide may be used for secondary purposes IFiuery Law, s.15.04 (fi(m)] Wb,ms/aauta Modi TenkA ry ng greemant 4.2026
Oct 22 2008 7:39 JOE ZIRN SOIL TESTING 715 765 4608 p_1
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Divisi not Safetyand Buildings
In accordance wan Comm 85. was. Adm Code
County &, Fwd
Incl dr, big note site plan ci,verticall and horizontal efeenoe point (BM), direction and Parcel I.D. D - 0IQ- 2- YY- o'%- a-
peril slope, scab or dlmenalona. north arrow, and location end distance to nearest road. Of 0c7- 20oo0
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Mann SfMraIbn you premed may be used ter woondary purposes (Pxsucy Low. x 1 S.os (1) mm.
Propwty0vsI& Tl ProperryLocallon
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need material in an alternate format. please contact the department at 608-266.3151 e( TCY.608-264-8777.
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State Bar of Wisconsin Form 1-2003
WARRANTY DEED
Document Number II Document Name
THIS DEED, made between Lake Owen Shores L.L.C., a Delaware limited
liability company
("Grantor," whether one or more),
and Windmark North, LLC, a Delaware limited liability company
("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):
A parcel of land located in Government Lot Seven (7), Section Twenty-two (22),
Township Forty-four (44) North, Range Seven (7) West, in the Town of Drummond,
Bayfield County, Wisconsin, described as follows: Beginning at a 2 inch brass capped
itnn pipe at the East 1/4 corner of Section 22, thence N. 01° 3700W. along the East
line of said Section 22, 1124,83 feet to a 1 1/4 inch iron pipe; Thence N. 80° 44' 00"
W. 434.97 feet to a I inch iron pipe near the Westerly shore of Lake Owen; Thence
along a meander line near said Westerly shore of Lake Owen, S. 58° 03' 24" W,
1649.97 feet to a 5/8 inch iron rod; Thence leaving said meander line, S. 780 25' 41"
E., 1901.49 feet to the Point of Beginning.
For Informational Purposes Only
Address: 48525 South Lake Owen Drive, Cable, WI 54821
DOCUMENT NUMBER
2026R-613247
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY, WI
RECORDED
O8/O7/2O26 AT 8:OO AM
RECORDING FEE: $30.00
TRANSFER FEE: $22500.00
PAGES:1
ELECTRONICALLY RECORDED
Recording Area
Name and Re urn Address
I lostak, Henzl & Dickler S.C.
Attn: Jessica Grandberg
840 Lake Avenue, Suite 300
Racine, WI 53403
04-018.2.44.07.22.1 05.007-20000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
municipal and zoning ordinances and agreements entered tinder them, recorded easements for the distribution of utility and
municipal services, recorded building and use restrictions and covenants, and general taxes levied in the year of closing. RECEIVED
CE _
IVED
Dated
February 12, 2026
Lake Owen Shores L.L.C.Is AUG 202026
MACKENZIE TENUTA. Bayfield Co.
Notary Public Planning and Zoning Agency
(SEAL) in
• Robert Kirby. riz Signer State of Wisconsi
AUTHENTICATION
ACKNOWLEDGMENT
atgnamrcts) STATE OF WISCONSIN )
ss.
authenticated on RACINE COUNTY )
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
Jessica Grundberg
Hostak Henzl & Bichler S.C.
Personally came before me on j (ar[
the above -named Qo1Oe€# IGrbj
to me known to be the person(s) who executed the foregoing
instrument �,r/r'/Iand acknowled ed the same.
fr1t1ckA4c TG.. -4s
Notary Public, State of Wisconsin
My Commission (is permanent) (expires:_____________________
(Signnmres nay be authentlented or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TOTHIS FORM SHOULD DE CLEARLY IDENTIFIED.
WAltRAN'rY DEED 4) 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
• Type name below signatures.
Bayfield County Register of Deeds Document #2026R-613247 Page 1 of 1
EXHIBIT "A"
LEGAL DESCRIPTION
A Parcel of land located in Government Lot Seven (7), Section Twenty-two (22), Township Forty-
four (44) North, Range Seven (7) West, in the Town of Drummond, Bayfield County, Wisconsin,
described as follows:
Beginning at a 2 inch brass capped iron pipe at the East 1/4 comer of Section 22,
thence N. 01' 37' 00" W. along the East line of said Section 22, 1184.83 feet to a 1
1/4 inch iron pipe;
Thence N. 80' 44' 00" W. 434.97 feet to a 1 inch iron pipe near the Westerly shore
of Lake Owen;
Thence along a meander line near said Westerly shore of Lake Owen, S. 58' 03' 24"
W, 1649.97 feet to a 5/8 inch iron rod;
Thence leaving said meander line, S. 78 25' 41" E., 1901.49 feet to the Point of
Beginning. Tax Key No.: 018-1023-05
RECEIVED
Address: Town of Drummond
Bayfield County, Wisconsin JUL 16 2026
Bayfield Co.
planning and zoning Ag8110Y
Tax Key No. 018-1023-05
V1057 P608
ONUS 5230618-1.022358.0010
I3 1YFIELD 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: Submission Number:
LAKE OWEN SHORES LLC SS -00803
555 MAIN ST
RACINE, WI 53403 Transaction Number:
SS-00803-4C94F
Description
Private Sewage System (Holding Tanks)
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 15114
Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821
Payment Type: Check
Transaction Date: 8/ 20/ 2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
HAYFIELD COUNTY
SANITARY PERMIT (#04)-26-11 OS
STATE SANITARY PERMIT
OWNER: WINDMARK NORTH LLC
G OV'T LOT: LOT: B L K:
1/4 1/4 SEC: 22, T 44 N, R 7
TOWNSHIP: Drummond
SOIL TEST:
NEW SYSTEM
SYSTEM TYPE: Holding Tank
PLUMBER: JASON KUETTEL
SCOTT ROUSH
Authorized Issuing Officer
DATE: 8/21/2026
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: 1977 c. 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: # MP 675751
Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-
weather road.
THIS PERMIT EXPIRES 8/21/2028
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION