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Parcel #: 182 - 1028 -20 -000 06/19/2007 02:57 PM
PAGE 1 OF 1
Alt. Parcel #: 311706- 31- 50 -01 -02 -000 182 - VILLAGE OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - HEISS, THOMAS
THOMAS HEISS
110 SARATOGA AVE
STAR PRAIRIE WI 54026
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE
LOT 2 BLK A & ADJ S 33' LIN- COLN AVE Block/Condo Bldg:
NEW SARATOGA SPRING ADD VIL STAR PRAIRIE
FKA PARCEL 229 ALSO LOTS 4 & 5 BLOCK B Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
06-31N-17W
Notes: Parcel History:
Date Doc # Vol /Page Type
07/28/2000 627174 1530/32 WD
07/28/2000 627173 1530/31 WD
07/28/2000 627172 1530/27 TI
05/16/2000 623044 1510/632 PR
more
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Changed: 09/08/2003
Last Chan
Valuations: g
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 8,500 50,700 59,200 NO
Totals for 2007:
General Property 0.000 8,500 50,700 59,200
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 8,500 50,700 59,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 521
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel #: 182- 1028 -10 -000 06/19/2007 02:56 PM
PAGE 1 OF 1
Alt. Parcel #: 311706- 31- 50 -01 -01 -000 182 - VILLAGE OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - HEISS, THOMAS
THOMAS HEISS
110 SARATOGA AVE
STAR PRAIRIE WI 54026
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE
LOT 1 BLK A & ADJ E 33' ABD SPRING ST & Block /Condo Bldg:
ADJ S 33' ABD LINCOLN AVE NEW SARATOGA
SPRINGS ADD VIL STAR PARIRIE FKA PARCEL Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
228 06-31N-17W
Notes: Parcel History:
Date Doc # Vol /Page Type
07/28/2000 627174 1530/32 WD
07/28/2000 627173 1530/31 WD
07/28/2000 627172 1530/27 TI
05/16/2000 623044 1510/632 PR
more
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/08/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 4,000 0 4,000 NO
Totals for 2007:
General Property 0.000 4,000 0 4,000
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 4,000 0 4,000
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
/* ..
Wisconsin Department of Commerce y
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryNr�jtNo.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3GG44
Permit Holder's Name: ❑ City ❑ Village g Tot(vp of: State Plan ID No.:
Heiss, Thomas Villa e o2 tar Prairi
CST BM Elev.:. Insp. BM Elev.: BM Description: I Parcel Tax No.:
I �. 1 182 - 1028 -10 -000
oZ
TANK INFORMATION ELEVATION DATA 1 7 0& - I '5 — Dl O/ 006
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark I -
Dosing Alt. BM WA
Aeration Bldg. Sewer 0 , tn 4 )
Holding St /Ht Inlet (c -2-° 91.7-V
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic , �� 9 S� --� NA Dt Bottom ._
Dosing NA Header/ Man. ca
Aeration NA Dist. Pipe g ; j 13.29 f
1
Holdin Bot. System Ct '`-3 9b •03 ,0o
PUMP/ SIPHON INFORMATION Final Grade S' q•SS.- qS, /'
Manufac r Demand
St cover 2,$ Z 02.6' (
Model Number GPM
TDH Lift Lriction stem TDH Ft
For ain I Length Dia. Dist.To
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length �1 No- f T enches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 fob �' DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufa ure : `
SETBACK CHAMBER r
INFORMATION Type of .,. (/ M el Num e :
30
System: w" -3 OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Le
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: (o /1 l /Ub Inspection #2•
Location: 110 Saratoga, Star Prairie, WI 54026 (NW 1/4 SW 1/4 6 T3 IN R17W) - Saratoga Springs -Lot 1
1.) Alt BM Description = /01 3
2.) Bldg sewer length = Z (' K 29
- amount of cover = It3 ��
Plan revision required? Yes ja No
Use other side for additional information. to 11 � ti Z
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
_., ®m. m
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.�m.�... fw m-- _ .... ..»
E
E I }
ILA
I S CALE10 ,,
Safety & Buildings Division
Sanitary Permit Application 201 W. Washington Ave.
In accord with Comm 83.21, Wis. Adm. Code PO Box 7302
r See reverse side for instructions for completing this application Madison, WI 53707 -7302
1 %,s on . l n Personal information you provide may be used for secondary purposes (Submit completed form to county if not
oeptirYmont:of<Cammerce (Privacy Law, s. 15.04(l)(m)J state owned.
Att ach comp letc plans to the county co onl for the system, on paper not less than 8 -1/2 x I 1 inches in size.
State Sanitary Permit N ber ❑ Check if revision to previous application State Plan 1. D. Number
0 2
Location:
I. AnliiI c ation - Please Print all Information Property Location
Property Owner Name
c N W /4`�ta%1 /4 S T I N, R1 W
Lot Number Block Number
Property Owner's Mailing Ad ress
Sa r Q Subdivision Name or CS
Number
Zip Code i)onp • .ber
Cit stat� .,
UD
❑ city
rOaStatc-Owned e of Building: (check one) it ; rfyhC� Village
r 2 Family Dwelling - No. of Bedrooms : '' `" �- Town of
ic/Commercial (describe use):_ P t ` •Q
- t E
n c ' i— a
Nearest oad
S7 SO[ i^0.
T mbe s
T N
P ccl )
- t� ,
x 68
III. T 3 e of Permit: Check only one box online `A".. k box on line. - licable
Addition to
A) 1. ❑New 2. Replacement 3. ❑ lactsrrltt�tgt -', 4. Existin S stem
System System Tank Date Issued
Permit Number
B)
❑ A Sanitary Permit was previously issued
. Type of POWT System: (Check all that apply) ❑ Sand Filter ❑ Constructed Wetland
Non - pressurized In- ground ❑ Mound
Pressurized In -ground ❑ Holding Tank ❑Single Pass ❑Drip Line
❑ At- de ❑ Aerobic Treatment Unit ❑ Recirculating r:
❑ Other
Area Information: vation 7. Final Grade
V. Dis crsal/Trcatm
ent Arc System Elc
2. Dispersal Area J. Dispersal Area 4. Soil Application 5. Percolation Rate 6. Sys Ir Elevation
I. Design Flow (gpd) P ( y q ) mJinch ,
Required Proposed Rate GalsJda /s . ft.) (M� )
i 9�. � fOD � b
375 � 3 � - 7 N ft' 7
VII; 'lank Capacity in Total # of Manufacturer Prefab Site F l Fr ass Plastic ;�� r`
Gallons Gallons Tanks Con - Con- g /
Information crete structed ✓
New Existing
Tanks Tanks �, ❑ ❑ ❑ Zee 1
Se I� I "�lsi`
❑. ❑ ❑ °
VIII. Responsibility Statement
I the undersigned, assume res onsibili for installation of the POWTS shown on the attached plans. Business Phone Number
umber's i ture ( o stamps): PRS No. N
Plumbers Name (pri 53 l V
C a l v
Plumber's Address (Street, City, State, Zip Code)
IX. County /Department Use Only issui A gent (Nostamps)
El Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 6 g
® Approved ❑ Owner Given Initial Adverse Su ++ harge Fee)
Determination GD - iCao�J 0
X. Conditions of Approval /Re ons `
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
In accordance with Comm 85, Wis. Adm. Code County
Attach complete site plan on paper not less than 81/2 x 11 inches 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. fS a — to d lk - -a O
Please print all Information. Reviewed by Date �
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property 5rer Property Location
b Govt. Lot IV iA) 1/4J(„ 1/4 S T31 N R 1 9 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
Ilp s cf)' C'
Cit -- Sta zip Code Phone Number [I city village ❑ Town Ne rest - d
�ICR. r • t -�
() - 9 S r. r � SCL chGL t o
❑ New Construction User Residential /Number of bedrooms Code derived design flow rate
J GPD
Replacement ❑ Public or commercial - Describe: _ ft.
anent material Flood Plain elevation if applicable --
General comments '7
and recommendations:
F-/1 Boring # I Boring
Pit
Ground surface elev. tt. Depth to limiting factor � In. Soil Application Rate
Horizon D th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF •Eff #1 'Eff#2
Munseil Qu. Sz. Cont. Color Gr. Sz. Sh.
sbk s �5
t 17
r
1 g' c 33• b ff o
.z gs z
FA-1 Boring # El Boring
pit Ground surface elev. -- ft. Depth to limiting factor tBoundjary • Soil Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Ro ots E tf#1 Eff#2 GPD/f1?
17 G Munseil Qu. Sz. Cont. Color Gr. Sz. Sh.
a fsbit 4A
� N
'L Zo
* Effluent #1 = BOD ;0 < 220 mg/L and TSS >30 150 mgA. ' Effluent #2 = BOD <_ 30 mg/L and TSS <_ 30
ame (Plea nt) sign, CST Number
'
Address 4 . Date Eva uation Conducted Telephone Number
° cti Il p — — 71 S - -.y(,- S
dd �
(� z
Property Owner - 7 - �c vVnoas ►'t k-'-Is Parcel ID # 1 Q - / O A t -26 Page _I-of
[37 El Boring
Boring #
Pit Ground surface elev. . -Qn ft. Depth to limiting factor, 9 �o in.
- - Soil Application Rate
Horizon -Depth . Dominant Color. Redox Description Texture Structure Consistence Boundary Roots GPD/fF
Z.(in2 Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
; s bk 0r k . 5
All 9
►n � 1 -- � I7 i, a
F-1 Boring # E] Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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
Boring # Boring
Ground surface elev. ft. Depth to limiting factor in.
F-1 Pit
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
Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 mgll_ - Effluent #2 = BOD 5 30 mg/L and TSS 5 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 (8.6100)
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal)
Soil Absorption Component Size (ft')
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) av 3 z — ao
Maximum Influent Particle Size (in) U 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. The utlet filt shall be cleaned as necessary to ensm
. proper en. The filter cartridge should not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, es, and a visual inspection for any evidence of surface seepage or discharge
e
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
3
Aw
r
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer h m (� p S s
Mailing Address r S
Property Address _ S a vr_ ��
(Verification required from Planning Department for new construction)
_io
City /State %c, a Pc&A r ; Parcel Identification Number z _ 1 a
S'c{ o col 10
LEGAL DESCRIPTION
�y \�&r
Property Location W ' /4, St ' /o, Sec. (-O , T 3 _ N -R�W, T&wn of
Subdivision µ S , Lot # � a
Certified Survey Map # , Volume , Page #
Warranty Deed # (p,;; - 7 Ty , Volume /S 3 ZC , Page # -
Spec house ❑ yes P no Lot lines identifiable ;6 yes ❑ no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, 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 Zoning Office within 30
days of a three year exp n date.
/ p / 3 / 0
SIGNATURE OF APPLIC NT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of .
the prop descri d a ove, by virtue of a warranty deed recorded in Register of Deeds Office.
/0
SIG A OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.******
Aqj
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
Toi 1530PAGE 32
62717.4
STATE BAR OF WISCONSIN FORM 2 - 1999 Y.AIHLEEN H. WRLSR
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Michael Payson RECEIVED FOR RECORD
07- 28-2000 9:00 AN
WARRANTY DEED
Grantor, and Thomas Heiss, a single person EXEMPT N
CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 150.00
RECORDING FEE: 10.00
GAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Name and Return Address
Lots l & 2, Block "A ", also Lots 4 and 5, Block "B ", Plat of New First National Bank of New Richmond
SaratogaSprings, now part of the Village of Star Prairie. TOGETHER PO Box C
WITH vacated portions of Lincoln Avenue and Spring Street located within New xChtnorid, WI 54017
the above described Plat pursuant to the Resolution of the Village Board of
the Village of Star Prairie, recorded October 9, 1940 in Vol. 259, Page 84.
182 - 1028 -10 & 182 - 1028 -20
Parcel Identification Number (PIN)
This is not homestead property.
04) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this [ 17 day of July 2000
• MichaelPayson �Ly
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AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF W*eON$ttd n1 r1- )
) ss.
County )
authenticated this day of
Personally came before me this !J day of
July 2000 the above named
Michael Payson
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
authorized by § 706.06, W is. Stats.)
THIS INSTRUMENT WAS DRAFTED BY + L c.,. L •r N ARY PIIR�I IA-MINN—MINN OTA
Attorney Kristina Ogland Notary ublic, State of -eae
Hudson, WI 54016 y ssimExprasJAN.31. -'
My Commission is permanent. — °<
(Signatures may be authenticated or acknowledged. Both are not necessary.) •)
+ Names of persons signing in any capacity must be typed or printed below their signature. hrormanan Prdssai. — I. C—p.y. F-d du Lac. wt
WARRANTY DEED STATE BAR OF WISCONSIN 8001.55-2021
FORM No. 2- 1999
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