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WHtOntrn DeOa'ir^+rl of Industry. WIL UtbI-t%lr I out ii rtLI Un I
Labor and human Relation{
(Attach Soil Profile Location Map • To Scale • On A Separate, Signed Sheet) Faadnon, :.t S!
Page
tuirttaearrwe eoL ev►l. oxi cu►ral "Umveocam ►y1a♦fr4Mtn rev PLO= JAM a.e
Gary Pj cotte 2-27-9~ `grass, outwal re W n/a
DORM . 15350 Xenon St., Ramsey, Mn 55303 a►~.e `c"nt. Croix 1 t 450 eeo~e
SW t 1I~ SE 114 0 u/n 19 tSt.~ Jos pn 1"'►'""`wa"
CSMI
lot n/a McK n/a SUBDIVISION n/a Yk.._ aeW aeet.aQe
B- 1 honton Death DomtnantColor Mottles structure Limiting Facamr LwanOGPD,ta. N.
In Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence R0011 Boundar Depth trench Bed
1 -8 10yr4/ none 1. 2/f/sb mfi 2/f C none .3 .2
Elcv = 2 -20 10yr4/4 none sit /f/gr mvfi 1/f G none .0 .0
103.0 3` 0-91 10yr5/4 none co.s. 0/co/s ml 1/f n/a none .7
MofNOn Depth Dominant color Mottlet Structure
13 .'2 In. Munsell u St. Cont. Color Texture Gr. St. Sh. Consistence Roots boundary Ls~DepthFaatorr trench aF9 d it
1 -9 10yr4/2 none 1. /f/sbk mfi 2/f C none .3 .2
Elev 2 -17 10yr4/4 none s.l. 1/f/sb mfr 2/f C none .5 .4
101. 3' 7-87 10yr5/4 none co.s. 0/co/s ml 1/f n/a none .7
Monson Depth Dominant Color Mottles Structure limiting Factor/ LoadtngGPDe4 h.
In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Con Isten a Roots Bounds Dept Trench {sad
1 -9 1 r4/3 none 1. 2/f/sbl mvfi. 2/f C none .3 .2
Elev = 2 -15 10yr4/4 none I.S. o/f/sg mvfr 1/f G none .8 .7
02.E 3 5-91 10yr5/4 none co.s. -
o/co/sjr 1/f n/a none .8 .7
0. 4 (Mq22-23 Depth Dominant ne Color Mottlts 'Structure Unsung Factor/ LaaangApDact.h.
u. St. Cont. Color Texture Gr. St Sh. Consistence Roost Bounds Depth trench Bed
Etev = -12 10yr4/2 none 1. 2/f/sbl mfi 2/f C none .3 .2
10yr4/4 none sil 1/f/gr mfr 1/f G none .0 .0
101. 3 3-87 10yr4/3 none co.s. 0/cots ml 1/f n.a none .8 .7
j~. 5 Monson Depth Oomrnant Color Mottles Structure LIMI Factor/ LaengopOHO. h.
In. Munsell u. St. Cant. Color Texture Gr. St. h. Consistence Roots Boundary Depth Trench Bed
1 -10 10yr4/2 none 1 2/f/sb mfi 2/f C none.3 .2
Elev e
2 0-20 1 r4/4 noen sil. 1/f/gr mfr 1/f G noen .0 .0
104. 3 0-10, t 10yr4/3 none co s. 0/co/s~ m 717- n.a none
Additional Remarks: RECOMMENDED SYSTEM TYPE: 11
a e # 42 Soil series BxC2
lot on back FC
lot 20.06 acres ,q,
~kc rory
other Sttt Features.
98.45 zzz 2 92 1715 1246-6200 -2~~2?9~8~..
System Elevation • ' 't"r Datt Signed Telephone No. CSr •
Gary Steel 1554 200th. AVe., New Richmond, Wi. 54017
CST Name (Print) Cily State Zip
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Parcel 030-1079-40-400 02/17/2005 10:18 AM
PAGE 1 OF 1
Alt. Parcel 28.30.19.286D 030 - TOWN OF SAINT JOSEPH
Current X-! ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* DEGREGORIO, ROBERT M & CATHERINE M
ROBERT M & CATHERINE M DEGREGORIO
560 PERCH LAKE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 560 PERCH LAKE RD
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 10.610 Plat: 0622-CSM 12/3394
SEC 28 T30N R19W S1/2 SE1/4 BEING LOT 5 Block/Condo Bldg: LOT 5
CSM 12/3394 ALSO COM S1/4 COR SEC 28;TH
S 89 DEG E 375';TH N 00 DEG E 463.52' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
POB;TH N 00 DEG E 474.86';TH S 89 DEG E 28-30N-19W
329.32 FT;TH S 00 DEG W 474.86';TH N 89
DEG W 329.32' POB
Notes: Parcel History:
Date Doc # Vol/Page Type
05/04/1998 578513 1320/615 WD
07/23/1997 1167/457 QC
07/23/1997 1095/64 WD
07/23/1997 930/636
more...
2004 SUMMARY Bill Fair Market Value: Assessed with:
5426 461,400
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 10.610 123,100 330,800 453,900 NO
Totals for 2004:
General Property 10.610 123,100 330,800 453,900
Woodland 0.000 0 0
Totals for 2003:
General Property 10.610 72,200 258,600 330,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1
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- DEC 1 ~ l99~ 2 5f 97`71
CROIX COUN
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VOLUME 12 PAGE 3394
• FEB 18 1998
SURVEYORS RECORD
C) I<
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VOLUME 12 PAGE 3394
AS BUILT SANITARY SYSTEM REPORT
OWNER (!;'&-r4 1,01e- e:Zf~ TOWNSHIP
SECTION T N-R W
ADDRESSy aLt'o~ ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOTde-(- LOT SIZE y~.L C~Cr
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
z~ G .mod l S ~ ~ f
i
Y
i_
INDICATE NORTH ARROW
BENCHMARK:Elevation and description: 1D2. ck s J l S
Alternate benchmark .e,-
SEPTIC TANK: Manufacturer: Liquid Cap. f4 0 O
Rings used :Manhole cover elev: Final grade elev:
Tank inlet elev. Tank outlet elev.:
No. of feet from nearest road:Front._L,,, Side , Rear Ft.J Gcf-
From nearest prop. line:Front , Side , Rearj(_Ft. f4
No. of feet from: Well Building:_ 20
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: -Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front_, Side_, Rear_Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: _K__Trench: Seepage Pit:
Width: /-2-_Length Gig Number of Lines: Area Built
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe: Fld'`
No. feet from nearest prop. line:Front , Side , Rearp!(_Ft. d'
No. feet from well: Sv-- No. feet from building Ya
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well building , nearest road
Alarm Manufacturer:
INSPECTOR:
DATE: r~2 PLUMBER ON JOB:
lr/
LICENSE NUMBER:
6/90:cj
LOCATION: 560 PERCH LAKE ROAD TSTJ,SW,SE,28,PERCH LAKE RD.
{
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and:4u an Relations INSPECTION REPORT ST. CROIX
Safe$y and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 149279
Permit Holder's Name: ❑ City ❑ Village X] Town of: State Plan ID No.:
PICOTTE, GARY ST.JOSEPH
CST BM Elev.: Insp. BM Elev.: LBIVI Description: Parcel Tax No.:
/07. Z i c-~ etc .''gip-' 030107940200
f1i
TANK INFORMATION ELEVATION DATA A9200126
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic f~' • 4 t -fit A ~ Benchmark /614 Ido,6
Dosing
Aeration Bldg. Sewer
Holding X1 Ht Inlet
TANK SETBACK INFORMATION 616 Ht Outlet /o0/ /1
vent
irIto ntake ROAD Dt Inlet
TANKTO P/L WELL BLDG. A
Septic 4~ S y l /p NA Dt Bottom
Dosing NA Header/Man. Q 91.7r
Aeration NA Dist d_Pi e ~
p ; ~5
Holding Bot. System j ct 1
PUMP/ SIPHON INFORMATION Final Grade 5 p ~f
Manufacturer Demand 5T + 5 3 v
d u~ {
/Z 3
Model Number GPM
TDH Lift Friction System TDH Ft
oss mead
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of T ches PIT No. Of Pits Insid Liquid Depth
DIMENSIONS (C,p DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAMBER G Manufacturer:
SETBACK A
INFORMATION Type O Mode Number:
System:OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of T xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil C] Yes ❑ No E] Yes E] No
COMMENTS: (Ir~c4ude code discrepancies, persons present, etc.)
Plan revision equired? Yes No
Use other side for additional information.` VinLr's SBD-6710 (R 05/91) Date Signature Cert. No.
f
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: `
r
e
E
i
EoD:IL R SANITARY PERMIT APPLICATION mmmmmmmmma In accord with ILHR 83.05, Wis. Adm. Code Cff-
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than I Y5 a 2 9
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
cw G S4tJ'/a /a, S T30, N, R % E (or
PROPER OWNER'S MAILING ADDRESS LOT # BLOCK #
16^^,5-0 e o Si cam- el
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
gy/ 1_5-,J~Lgg OG A- G
e
II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD
) ❑ State Owned VILLAGE
❑ Public ro 1 or 2 Fam. Dwelling of bedroom PAR LTAX MB ( )
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranVBar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. [9 New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.E] Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 [V- Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
y S~ ~Y.3 7 d Gf YSe Feet 41 13" Feet
VII. TANK CAPACITY Site
INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper.
New istin Gallons Tanks Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber, El El El 0
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) P MPRSW No.: 7Business Phone Number:
Plumber's Address (Street, City, State, Zip Code :
O~ 6
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved SaVitary Permit Fee (Includes Groundwater [ate ssue Issuing A ent Sign lure (Nps
Surcharge Feel
Approved ❑ Owner Given Initial
Adverse D rmin tin X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safetys Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A-sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this systEM Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/ water. service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points; '
C) complete specifications for pumps and controls; (Jose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross, section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizi.Ag information`K - - -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
:ri ►
_...STC-100
This application form is to be completed in full and signed
the Ot~~ilC by
r(s) of the
property being developed.
An
will only result in delays of the Y inadequacies
permit issuance. Should this
development be intended for resale by owner/contractor,(spec
house), then a second form should be retained and completed when
the property is sold and submitted to
this office with the
appropriate deed recording.
Owner of property Gary and Jane Picotte
Location of property SE 1/4 1/4, section 28 , T 30 H-R 19 W
Township St. Jose h
Hailing address c/o_ -watson-Scot Cone rurtion
o , 7nr
14191 70th Street South
Hastings, MN 55033
Address of site 560'Perch Lake Road
Subdivision name Lot no.
other homes on property? yes x No
Previous owner of property _ Erickson7STith
Total size of parcel 20.6 acres
Date parcel was created ?
Are all corners and lot lines identifiable? x Yes No
is thia property being developed for (spec house)? Yes x No
volume 899 and Page Number 128 as recorded. with the Register
of Deeds.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARIUUITY DEED which -includes a DOCUMENT NURBER, VOLUME AND PAGE.
NURBER & THE SEAL Or THE REGIS'1'GR OF DEEDS. In addition, a
certified survey, if available; ;would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a certified survey Map, the certified survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I(we) certify that all..statements on this form are true to the
best of ny (our) knowledge that I (we) am (are) the owner(s) of
the property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. and that I (we) presently
own the proposed site -or the sewage disposal system or I (we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has been duly
recorded in the office of county Register of deeds as Document
No.
; 4~7
,f ap 1 cant kPPc a
I ~r
inatuze Da ofSignature
47 805I VOL 930 PAGE O ~ II
THIS INDEN'T'URE, Made this....15th...........day Of.... anuary REGISTERS OFFICE I
A. n., lii..:92 , between ..D.14.0nis R.....E.rick.sQn &?1d.. Cherie. D........... ST. CRQIX CO. W1
Erickson, hussband and., wifg Recd for Retond
"92
AN 174- t
a ,
part.191. of the first part and 3:15 P. M
Jane ...Aeed .P.i.co.tke.e....a..ma.rri.ed..person /VV10 ~A~N
i
start y........ of the second parr,
RETURN TO
W i t it c a a e t It, That the said part igS..uf the first part, for and in consideration
of (flu sun) Of....One Do1Zar and....gther...valuab•le,..considerat .ior . Jane Reed Picotte
15350 Xenon St. NE
-Rant~ _jI 55303 to ...in hand Paid by the. said purl.
....th:Bnl y of the scennd itrt, ttr recci t whereof is hereby
corllcssel and acknowledged, haVIEL..... given, granted, hargained, suld, remised, released, alicucd. ronve)cd and confirmed, and by these presents
do give. grant, bargain, sell, remise, release, alien, convey and confirnl unto the said part,...Y.....of the second p:irr,h~'.r..hvirs and assigns
forever, the following described real estate situated in the County of..St....... Crot .............and Stale of Wiscumin, to-wit:
The South 858.00 feet of the southeast Quarter (SEt-) of
!I Section 281, T30N, R19W, EXCEPT the East 1,217.00 feet
thereof; and also EXCEPT the West 375.00 feet thereof.
Subject to driveway easement over the South 80 feet of
the East 100 feet thereof.
1'►A,,
(IF NECF,S$ARY. CONTINUE DMRIPTION ON RBVt•:R.*w Sim)
Together with all and singular the hereditttuents and appurtenances thereunlu belonging or ill any wise :appertaining: end all tine estate
right, title. rtiterest, claim or demand whatsoever, of the slid part.i.e.suf the first part, either iu law or etlofry, eltller in pn55eSSir,R or expeLtanCy
of, in and to the nbnve bargained prumius, and their hereditament,. and nppurtet►ances.
To Have and To Hold the said prooi4t.r. its above described with the hereditatnlents and alq,uttanomes, unto flit. s:.iaf pan_Y...... of the
i second part, and to her....... heirs and assigns FORFVFR,
And the said.. Dennia.... W......Er.ic.kson...and...Cher.ie....D.... ErA k.oll..........
i
her thems e,l.Y..e .~.....t.heir 11eir5, etecuturs and administrators, do ................cuvenant, grant, bargain, and agree to and
with the said parr y of the second part,... her heirs and assigns, that at the rime of the eoseading and deliver,, of these presents II
t4ey.....4;71-.. , well seized of the preullses abuvL dest-rlhed, as of a good, sure, perfect, absolute and iude(easible estate of inheritance
I ill the late, in fee Mntple, and that the same are free and clear front all incutnbrances whatever
Subj.ect.... property may not be subdi.y.dgd.,i.n any...way prior to September 20,
.9.9.......
and flint the :abr)vc bargainLd premises in the quiet add peaceable po&wmiun of the said part y....... of the second parher . heirs and assigns, i
against all anti every person or persons lawfully claiming the whole or any part thereuf,.theLy. will forever WARRANT A\n DEFE\U.
In Witness Whereof, the mid partilB.B.of the first part ha.Ye. o set..the.ir.h:and...,15 art ral..rg....this 15th.
I d.ty of Januar.y............ I A. D., 19 92 .
SiC.:NED ANU SEALED IN PRESENCE O fSF.r1L)
I
,r Dennis, kson
Cherie ...a-....Erickson
(SEAL)
(REAL)
-tWUJJAOA
STATE AF
y S5
WASPersona lltp:an,c before sue, this l"ntlnty. 15th ~Q
day of. ,......,January........... A. D., 19 2..
rile abuv,named Dennis....K...,.Erickson and. Chex C. Q,,•. Er,~,C.kson,, husband and wife.
.
to n,e known to be the person S..... ..who execut the foreAoin ~idstnunent and acknowledged the samr.
' ~..,...........~...~....~`L..~..
, SANDRA K. KOLAS KI
clk~.4. 1 NOTARY F4JBLIC-MI ESOTA
1 NIASHIN GTTIN C Nfty Y My COMM. Exp. Oct 6. Sand K. o l a s h i n s k i M f~!
r.w
..~..a."&"`h,u-tuy..tirt U)Q.....1.!. y
This instrument drafted b l.F Notary Public. ( ra n .............Cnunt ,u4r.
n Lakeland N J My rntern,;. ln., ,V: C';'-) r.t-•, IC1 „)b- Ct ~
F s.~....l M
WeeuoR 51.51 (1) or the Wisconsin Sntutse otovldes that an Instruments to Ae recorded shall hoe Plainly prinod or typawHEfle fbtfllSE It; elstuii
n • w a.avr H1en M.O4 ono .salary).
WAn RANTV Dwmro-UTATR nR wtscoNallY. FORM NO 1
, n C raise eo rn ....rr
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
Gary and Jane Picotte
ADDRESS: 560 Perch Lake Road FIRE NO:
LOCATION: SE 1/4, 1/41 SEC. 28 T 30 N-R 19 W,
TOWN OF: St. Joseph ST.. CROIX COUNTY
SUBDIVISION: N/A LOT NO. N/A
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 septic tank pumper. What you
put into the system can affect the function of the septic tank as
a treatment stage in the waste disposal system:
St. Croix County residents may be eligible to receive a grant to
help with the cost of the replacement of a failing system, which
was in operation prior to July 1, 1978. St Croix County accepted
this program in August of 1980, with the requirement that owners
of all new systems agree to keep their system properly
maintained.
The property owner agrees to submit to the St. Croix County
Zoning 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 (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification from will be sent approximately
30 days prior to three year expiration.
I/WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system-in accordance with
the standards set forth, herein, as set by the Wisconsin DNR.
Certification form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expiration date.
SIGNED:
DATE: ~
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, s DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/QTY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
SW 14SF1/4 28 /T 30 N/1119 6r)YV St. Joseph n/a n/a n/a
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
St. Croix Gar Picotte 115350 Xenon St., Ramsey, Mn. 55303
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: ( 2PROF-I17LE-D92 DESCRIPTIONS: ER LAT ON TESTS:
Residence 3 n/a New ❑ Replace 3-19-92
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GR~~OIUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
FIC ❑U QS ❑U I S ❑U ❑ S EiU ❑ S EAU conventional
If Percolation Tests are NOT required DESIGN RATE: ( If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: .8 Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS pagwe 42 BxC2
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPrHAK ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-1 91 103.9 none >91 810yr4/21., 8-2010yr4/4sil. 20-9110yr5/4 co.s.
B-2 87 10L.1 none >87 -910yr4/21, 9-1710yr4/4s.1.17-8710yr5/4co.s.
B-3 91 102.65 none >91 -910yr4/31.,9-1510yr4/41.s. 15-9110yr5/4co.s.
B-4 87 101.2 none >87 -1210yr4/21., 12-2310yr4/4sil., 23-8710yr4/3co.s.
B-5 104 104.45 none >104 -1010yr4/21., 10-2010yr4/4sil., 20-10410yr4/3co.s
B-
decimal' PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. -PERIOD 1 PERIOD2 PER PER INCH
P-1 2.65 none 3 6 6 6 <3
P- 2 .75 none 3 6 6 <
P_ none 3 6 6 <
P-_
P
P- ~
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 98.45
~ B
3 s
3 f I F i I(
NF-
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i
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y
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i ~ ~ 11 H( i 1 i
I
i. _I 4~aK(G4..
-1 L
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 3-19-92
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. AVe., New Richmond, Wi. 54017 2298 715-2#6-6200
CST SIGN
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
1
!":'7 RUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a c id accurate soil test, your report must include:
1. Complete ' I '!scription;
2. The use section must clearly indicate whether tis is a residence or commercial project;
1 MAXIMUP' r -,i'>er of bedrooms or eomm use planned;
4. Is this a n " rcernent system;
5. Comr)r v -jility rating boxes. A SITE .3 SUITABLE FOR A HOLDING TANK ONLY IF ALL
FE'',;IS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. Pl-abbreviations shown here for writing profile descriptions and completing the plot plan;
7. M _E diagram accurately locating your test locations. Drawing to scale is preferred, A
- used if desired;
8. IV' imark and vertical elevation reference point are clearly shown, and are permanent;
9. CC T riate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if ap, ,
10. If ° info t rch as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Si, - the form ,'ace your current address and your certification number;
12. legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cols Cobble (3 - 10") SS - Sandstone
ter - Gravel (under 3") LS - Limestone
Xs - Sand HGVV - High Gic
cs - Coarse Sand Perc Percolat;
coed s - Medium Sand W - Well
fs - Fine Sand Bldg - Building
is - Loamy Sand > Greater Than
"sl Sandy Loam < - Less Than
' l - Loam Bn Brown
*sil - Silt Loam BI Black
si - Silt. Gy - Gray
cl - Clay Loam Y Yellow
- Sandy Clay Loam R - Red
Silty Clay Loam mot - Mottles
Sandy Clay w/ --'with
sic - Silty Clay ` fff - few, fine,, faint
*c - Clay cc c~ -non, coarse
pt - Peat min - Mr aeciium
m - Muck d - c i.rt
p _ K- f iinent
HVVL - High water level,
Six general soil textures Surface water
for liquid waste disposal BM - Bench Mark
VRP Vertical Reference Point
TO THE OWNER:
This til test report is the first step in securing a sanitary permit- The county or the Department may recfuest
--;Drr of this soil test in the field prior to permit issuance. A complete set of plans for the private
vstem and a permit application must be submitted to the appropriate local authority in order to
obt a permit. The sanitary permit must be obtained and posted prior to the start of any construction.
1
A
• : ' rFEB 2 9 1992
w'ltonun Dtoa•ir^rr•t of lodullty, bUIL UCJt.i%lr s tye itLove" *0
gnr t••!
Utiot and Ittrtnan Relaponl , fdadelon, :.1
(Attach Soil Profile Location Map To Scale • On A Separate, Signed Sheet)
Page ?1
tuaro>.earwn toaewt.e~t evr+orru+otawvtotwert ►a^wrrtutin rtvweer Raoo at
Gar P~cotte 2-27-9~ 'grass, outwas 1% W n/
errv enae 9,11i, nt. Croix anlrtao•+D0►e.ea
15350 Xenon St., Ramsey, Mn. 55303 450
' loe►tvr raw.rtre iNl►MCRt4►.rtr1
UottWU SW 1 SE 0 u 19 Sti osepn
C9tll
(.DT n/a BLOCK n/a subotvlstoH n/a 7,_ Maw sirlaCl -
B, ~ Norllon --Death DorrtrnlntC0lDr MolNti Struttere llmlllnt Faelarl lets^tt7p0'10 N.
Munilll u. St. Cont. Color Tteturt Gr. St. Sh. Contnlenct aooll Boundary Depth tench odd
1 1 In
1 -8 10yr4/2 none 1. 2/f/sb mfi 2/f C none .3 .2
L•Icv = 2 -20 10yr4/4 none sit /f/gr mvfi 1/f G none .0 .0
103.0 3 0-91 10yr5/4 none' co.s. 0/co/Sj; 1/f n/a none ..8
U. 2 Norrton Depth Dominant Color Mottles Slrutlurt UrM11nor raeted le~►an4.OPOed h.
in. .Mtrnsell a St. Cont. Color Texture Gr St. Sh. Consrftenct doott Boundary Depth trench bad
1 -9 10yr4/2 none 1. /f/sbk mfi 2/f C none .3 .2
Clev a 2 -17 10yr4/4 none s.l. 1/f/sb
101. 3 7-87 10yr5/4 none co.s. 0/co/SjI 1/f n/a none .8
Munstll u mfr 2/f C none .5 .4
(Houton Depth Dominant Color Mottles Structure llrntunB raetaN laaelryalPOkt h.
3 In. . St. Cont. Color t court Gr. St. h. Conililenctl 110011 Boundary Opth frloco bed
1 )-9 10yr4/3 none 1. 2/f/sb mvfi . 2/f C none .3 .2
Clev = 2 -15 10yr4/4 none l.s. o/f/sg mvfr 1/f G none .8 .7
L02.~ 3 5-91 10yr5/4 none co.s. o/co/SjI 1/f n/a none .8 .7
,
4 (NorNOn Ototh Oomtn sell or Motlltl Tlruclu►t U erellat raelarf letantAOdta. rl.
• _ In Mun ill Qu. St. Cons. Color ftrtur Gr. St h Consistent! Rooti Bounds Depth french bad
1 -12 10yr4/2 none 1. 2/f/sb mfi 2/f C none .3 .2
Elev 2 2-23 1 r4/4 none sil 1/f/gr mfr 1/f G none .0 10
101. 3 3-87 10yr4/3 none co.s. 0/co/sj~ 1/f n.a none 68 .7
IJ , 5 Honten Depth Oor►trnant Color Motilts Structure limhint rteleH le/apCpaM. h.
In. Munstll u. St. Cont. Color Ittturt Gr. St. Sh. Conhilence Awl Boundary Depth flinch Btd
1 -10 10yr4/2 none 1 2/f/sb mfi 2/f .C none, .3 -.2
Ciev a 2 0-20 1 r4/4 noen sil. 1/f/gr mfr 1/f G noen .0 10
104. 5`'-"3 .0-10 10y-t4/3 none co.s. 0/co/Sj f n.a none a .
Additionallltmarkl: RECOMMENDED SYSTEM TYPE: .....gn3z -
BxC2
page # 42 Soil series
lot on back 1
lot 20.06 acres
Oihtf Sllt INlurtf:
98.45?~8~~_ 1715 1246-6200 ,2q8
Syslctn Lit vation v 7si- w ► lt r9nt ?lltphontNO.
Gary Steel 1554 200th. AVe., New Richmond, Wi. 54017
Cst Nonce (rrlrtll Cur aisle zip
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LCIN
REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 2
06/09/92 11:59 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 9/92 AREA: MJ
Adtivity: A9200126 6/ 9/92 Type: CONVSEPT Status: PENDING Constr:
Address: 560 PERCH LAKE ROAD TSTJ
Location: 560 PERCH LAKE ROAD TSTJ,SW,SE,28,PERCH LAKE RD.
Parcel: 030-1079-40-200 Occ: Use:
Description: 149279
Applicant: PICOTTE, GARY Phone:
Owner: PICOTTE, GARY Phone:
Contractor: SCHUMACHER WILLIAM C. Phone: 386-3121
Inspection Request Information.....
Requestor: WM. SCHUMAKER Phone:
Req Time: 14:06 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
I