HomeMy WebLinkAbout040-1289-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safetlf and Building Division
INSPECTION REPORT Sanitary Permit No: 483973 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Bond Ventures LLP Tro , Town of 040 - 1289 -10 -000
CST BM Elev: Insp. BM E ev: BM Description: nn Section/Town /Range /Map No:
/D p M 1 18.28.19.1645
TANK INFORMATION A ^ ELEVATION DATA
TYPE MANUFACTURER S� �,S CAPACITY STATION BS HI FS ELEV.
+
Septic Benchmark 5
/ ' /S
A 52 Alt. F 1 (-004 2.3 163 , t
Aeration U Bldg. Sewer
Holding Ht Inlet N
6.(,o 1 SZ.
TANK SETBACK INFORMATION St/Ht Outlet y. $ C 7- �Z
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD DtInlet \
Septic 3Z �� 0 / N � Dt Bottom %--1 \
Dosing O`7 Header /Man. rg C 7 - 7 z�
,
Aeration Dist. Pipe & 9� Z
.07
Holding Bot. System 7
l6�
PUMP /SIPHON INFORMATION Final P\ nn (,P- �9� 3
Manufacturer Demand St Cover� /
GPM �� CEO Z,3 �d 3•
Model Nu
h�,' 7.3 98 , l
TDH ift Friction Loss Syst d Ft $ $ 9/
Forcemain Length Dia. 77to ell /
SOIL ABSORPTION SYSTEM � /a, SZ
BEDITRENCH Width ILengthrg/t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR �✓tt'1 1
Type Of System: '5 /QZ 1 -4 , 1 UNIT
Model Number
r.
DISTRIBUTION SYSTEM 00 C� �S �' Co ��•
Header /Manifold 7/ Distribution ` x Hole Size x Hole Spacing Vent to Air Intake
Length /7 Dia r Length Dia ` Spacing \
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only e,1
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center �, / Bed/Trench Edges Topsoil es � No 0 No
T I
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /y/ �d Inspection #2:
Location: 389 County Road ' F Hudson, WI 54016 (NW 1/4 NE 1/4 18 T28N R19W) En lish Estates Lot 1 �y Parcel No: 18.28.19.1645
1.) Alt BM Description= F�l JV � 5 �-
2J Bldg sewer length = /(�J� ,p) J � I b war r
- amount of cover
Plan revision Required? ❑ Yes 0 No
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
I
P AID
commerce.wi.gov Safety and Buildings Divisig ty
201 W. Washingto S '" C /Zip sc O n S i n Madison, 5370 Sam ry Permit Number (to be filled in by Co.)
Department of Commerce iV 3 / 7
Sanitary Permit Applicatio A State ransaction 1?u t�r
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to e app /n-
unit is required prior to obtaining a sanitary permit. Note: Application forms f t ' /.ddress (if different than ma" 'n dres submitted to the Department of Commerce.
Personal information you provide
p urposes in accordance with the Privacy Law, s. 15.04 1 (m), Slats. 385
I. Application Information - Please Print All Information I
Property Owner's Name Parcel #
ov() Ugh u&6 6 4 - P 4ZAAl�s .D OyD-
Property Owner's Mailing Address Property Location / /(QT�
GT� /L Govt. Lot
Zip City, State Code Phone Number �! �
) , Section
WDSO 1 S / !a� 3� (circleo
T_N; R _L_q_ Eo W
II. Type of Building (check all that apply) Lot #
1W 1 or 2 Family Dwelling - Number of Bedrorroms Subdivision Name
1� L
164 4 � Block Gj� ! t 5N
El Public /Commercial - Describe Use t G
,J.� I
El city of
El State Owned - Describe Use V v ` CSM Number El Village of
Town of
t 21 72a
III. Type of Permit: (Check finly one box on line A. Complete line B if applicable)
A. V New System ❑ Replacement System Y p y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain)
B List Previous Permit Number and Date Issued
❑ Permit Renewal ❑Permit Revision ❑Change of Plumber El Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that apply)
t
N on - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rate pdsf) Dispersal Area Required (sf�/ Dispersal Area Proposed (sf System Elevation
d G /asd ✓/ �a7 ✓ 9C.0 9 7. 0 95.
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units 2 o 'g 2
New Tanks Existing Tanks w c
$ 0 2
a. v ;5 N V) iL c7 a
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement I , the undersigned, assume responsibility for installation of„the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
t�► L ► .a,") t,42��, cJ o, / 33 90 7)S x/97 7C(G
Plumber's Address (Street, City, State, Zip Code)
o� P )VG S i P26sco Cdll, S y�
VIII. County /De artment Use Onl
proved Isapprove Permit Fee Date Is ued Issuing A Signature
rven Reason for Denial
$ 7jl '51M /V
IX. Conditisgwc4X N"p asons for Disapproval O / •G 4
I. Septic tank, effluent filter and [ °
dispersal cell must all be services / maintained
as per management plan provided by plumber.
2 A# seftAck reglA(*Ments must be maintained S ,,u,� ,— 1
Attach to complete plans for the system and submit t the County only on p er not less than 81 inches in size
/*
r'
SBD -6398 (R. 02/09) Valid thru 02/11
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PAG E o� 3
Early Plumbing & Heating Inc.
1608 Pine Street
Prescott, WI 54201
PLC 11 R -A tJ
N1 C.Tk " A -
gEp Qao rn S A T ISO &P GEhp-06M - - 75 0
7 S 6 P D t ®• C, G ,P D 1 5 0 fT. = 0 Sd 01►� R-M,D
0 R 70 44
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jvJ �- 12-4Tt`0-Sp 0 0 'A
wATS +
i
Sall Abwn3don Svdm QM Section
r i d 1 %41 /of ft
,62Agc lol n
- S AO FL1a) Glade
VM Vent CW C.O ft
Leaching
S vs It . 7 ft ,Y-Sr ft
Soil AbsoUNO Srs W Plan WWW
ft
ft
I
_ ft Leaching Trench 1
Chambers
4' Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
LsachMa Chamber 8oacQi= ns
Manufacturer And Model r iv F) C 7 - /2,4 ► 6 /Z-. 00 1 Ct y'
EISA Rating OQ sq ft per chamber Sol♦ Appiication Rate • (-- gpd/sq ft
gpd Design Flow + - 1 (0 Soil Application Rate t EISA = Chambers
3 rows of Q chambers each.
Page J of
RECEIVED
PAID
Wisconsin Department of Com erne AUG 19 2010 SOI EVALUATION REPORT ry Page�of .3
Division of Safety and Buildings
ST 6�� Shn Ee 85, Wis. Adm. Code Coun
PLANNI 6 ty S t C t✓/`O 7
Attach complete site plan on a es in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road..
Please print all information. eviewed by Date J
Personal information you provide may be used for secondary purposes (Privacy I Law, s. 15.04 (1) (m)). C��` ! O
Property Owner Property Location
Gov. Lot A/ 1/4 /{/W14 S T gN R � 9.&{qr) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
3 r:Y C r C R F -./- I -- I t k� h 6;4 `Sulam(.
City State Zip Code Phone Number ❑ City E] Village ZTown Nearest Road
j u ds 8
❑ New Construction Use:1KResidential /Number of bedrooms Code derived desigg flow rate ,.G� PrD
eplacement C] Public or commercial - Describe: 6 1 ST7 ( 5 01
Parent material c- c / et. / �� / Flood Plain elevation if applicable Ald ft.
General comments l� e eo•-n ry a it o� Ca I1 jib f p), . f' (i S`fC'!�7 �vF, sr S��
and recommendations: CL
e wet / v vu-S >� ! e a, c�, h c 4 „ e <S --s, CL O _
'Q.pp / % cqT /0" 1-a.f'e Y�i^ dam' j �' , h-rf I. �'e »cles
Boring #
Boring 0 ew/fnel' O 8 7 W I FH / Dr pleo PLZ (,ii1�i�
C� r C
Pit Ground surface elev. / � J ft. Depth to limiting factor e � in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. �1 *Eff#1 *Eff#2
1
C;,:20 05 bs 7 9�'i C W T 1�
w �y.
7- SYRS – Jr a s — y 0. /-
Illy
Boring # Boring
Pit Ground surface elev. / / ft. Depth to limiting factor D in,
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *Eff#2
le R-M6 - s
Effluent #1 = BOD > 30 < 220 mg/L Ed T S >30 5 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
CXq,- I We k7 X 0 6 . 7.
Address Date Efaluation Conduded Telephone Number
N 3 SI.� 70 s' �'�Is�,o -7)'6 GvS 3 4 01 8117110 7J5 -x,73 3 +-3a
Property Owner �v" C y 7`e �"� ��ye S Parcel ID # t3 � U ^ / j ' � � /0000 ge � of
Boring # F1 Boring p
M �A Pit Ground surface elev. / 6• � ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2
rti'-a �a R3/ - s �,>, •�6� .� r' c
C Jr C? S' N7 f D
Boring # E] Boring
J q
❑ ul Pit Ground surface elev. / ft. Depth to limiting factor �- in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
3 2J a vR 4/+ s r ! .Z �, 46x ' c / 4 � !�
s - 7rrxj s C's .� — — 0.7 ! >S
— 7r —
Boring
(�, Boring # Ground surface el Depth to limiting factor > in.
5 ;Z Pit - -,,. _ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz: Sh. 'Eff#1 'E1W
3 /6 oYR/' S .Z Q
o - �'YR S o s ,�, - - d..7 l {
' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg1L ' Effluent #2 = BOD, < 30 mglL and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (R.07 /00) -
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1
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
1 Owner LL J 41MngS_ Septic Tank Capacity ga l ❑ NA
9 Permit # Septic Tank Manufacturer /&_ ��c ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 1 064y& o C 1G ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units J VNA Pump Tank Capacity ga l M
Estimated flow (average) gal /day Pump Tank Manufacturer jYNA
Design flow (peak), (Estimated x 1.5) gal /day Pump. Manufacturer JZ NA
Soil Application Rate 0. gal/day/ft' Pump Model 9NA
Standard Influent / Effluent Quality Monthly average* Pretreatment Unit '10 NA
Fats, Oil & Grease (FOG) <_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD <_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD <_30 mg /L V In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) <_10 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
A/ L 7b t
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: �3; )(s) (Maximum 3 years) ❑ NA
,3 Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ yeast j(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA
❑ year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
year(s)
Flush laterals and pressure test At least once every: ❑ ye a ar((ss) ❑ m r ) ❑ NA
)
Other. ❑ month(s) ❑ NA
At least once every: ❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one - third (Y) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
f
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
• A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
• A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
• Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name gg 4 Name
Phone 7� _ z i •. ALG Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name Z.6 n it
Phone Phone 7 �J �..
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
START. UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged 'to the dispersal cell(s)'in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to 'assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, tot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name 7 Name
Phone 7�_ xi , Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name , 4 ZO A-t
Phone Phone 715• %.. 4 S 'A ��]
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer _ go L j () N i L4 /1 4 e j e� S p rd C S bat
Mailing Address IRS Q D
Property Address W U ►.LSD J 0/- S C/o,/
(Verification required from Planning & Zoning Department for new construction.)
City /State M14 O S6IU Parcel Identification Number 0 6 — 1,2Rq 10, cab 0
LEGAL DESCRIPTION
Property Location '/4 , A) 1 /4 , Sec. � , T N R /q W, Town of - Zee6
i
Subdivision ,Lot #_.
Certified Survey Map # )y Volume , Page #
Warranty Deed # I 1 7 L � CO , Volume , Page #
Spec house yes ' no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedr s
IGNATURE OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
August 30, 2010
St. Croix County Zoning Department
RE: Bond Ventures LLP /James Bond
389 Cty Road F, Hudson, Wisconsin
Dear Sirs:
We are including this letter along with the sanitary permit application. We are applying
for a sanitary permit for an in- ground non - pressure system - which is a permit for a five
bedroom system.
At this time our house plans have not been finalized. But, we realize we will be limited
to five bedrooms or less.
Z re ,
James Bond
Bond Ventures LLP
111111111111111111111111111 lllil 1111 111111 1111 1111
State Bar of Wisconsin Form 1 -2003 * 9 1 7 4 0 0 1
WARRANTY DEED 917400
Document Number Document Name BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
THIS DEED, made between Thomas J. O'Leary, Sr., and Kathleen E. O'Leary, 06/11/2010 10:50AM WARRANTY DEED
husband and wife EXEMPT s
("Grantor," whether one or more), REC FEE: 11.00
and Bond Ventures, LLP TRANS FEE: 324.00
( "Grantee," whether one or more). PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in St.
Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach Name and Return Address
addendum) KRISTINA OGLAND
Lot 1, English Estates, St. Croix County, Wisconsin ESTREEN & OGLAND
304 Locust
Hudson, WI 54016
040- 1289 - 10-000
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: easements, restrictions and restrictions, if any, of record.
Dated
(SEAL) / (SEAL)
* *Tho as J. O'Leary, S .
(SEAL) X (SEAL)
* * hleen E. O'Leary
AUTHENTICATION ACKNOWLEDGME
Signature(s) Thomas J. O'Leary. Sr.. and Kathleen E.
O'LeaM husband and wife STATE OF )
authenticated on U ) ss.
0 �� COUNTY )
*Kristina O land Personally came before me on ,
TITLE: MEMBER STA E BAR OF WISCONSIN the above -named
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
*
Kristina Ogland. Estreen & Oaland Notary Public, State of
304 Locust Street, Hudson, WI 54016 My Commission (is permanent) (expires: 1
(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. INFO-PRO" Legal Forms 800 -855 -2021 www.Infopmfomu.com
1 of 1
Parcel #: 040 - 1289 -10 -000 08/19/2010 E 1 F PM
PAGE 1 1
OF 1
Alt. Parcel #: 18.28.19.1645 040 - TOWN OF TROY
Current EX ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
0 - BOND VENTURES LLP
BOND VENTURES LLP
PO BOX 701
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): "= Primary
Type Dist # Description 389 CTY RD F
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 3.530 Plat: 08- 097 - ENGLISH ESTATES 040 -02
SEC 18 T28N R19W PT NW NE LOT 1 ENGLISH Block/Condo Bldg: LOT 1
ESTATES
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
18- 28N -19W NW NE
Notes: Parcel History:
Date Doc # Vol /Page Type
06/11/2010 917400 WD
03/29/2006 821696 QC
03/20/2002 674071 1857/388 WD
2010 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/09/2009
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.530 105,300 45,200 150,500 NO
Totals for 2010:
General Property 3.530 105,300 45,200 150,500
Woodland 0.000 0 0
Totals for 2009:
General Property 3.530 105,300 45,200 150,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00