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Parcel 018-1055-10-000 03/21/2007 09:13 AM
PAGE 1 OF 1
Alt. Parcel 24.29.17.381 B1 018 - TOWN OF HAMMOND
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 - FAITH BAPTIST CHURCH INC
FAITH BAPTIST CHURCH INC
2072 HWY 12
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 7.590 Plat: N/A-NOT AVAILABLE
SEC 24 T29N R1 7W 7.59 AC IN SW SE LOT 1 Block/Condo Bldg:
OF CERT SURVEY MAP IN VOL III PAGE 854
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/10/2006
Description Class Acres Land Improve Total State Reason
OTHER X4 7.590 0 0 0 NO
Totals for 2007:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 0 0 0
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
d
TIE' GIRT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PRIMFRY TREpT1VIEENT consists of Septic Tank: Other (Describe)
SEPTIC TANK: Distance from: Well (eft, , Lot Line ft., Build ng1~2_ft,
Highwater Mark ft. 1270 or reater slope ft. V etland ft.
Cistern It. No. compartments_,g_. Liquid capacity, gal.
_EFFLUENT DISPOSAL SYST V1 consists of Tile field dSeepage Pit
Seepage it or Tile F`ield: 10istance from: VveI1 / 0 ft. Building '/o ft.
Lot Line ft. Ci stern it. Highwater Mark.;zf water course ft.
lope 12% or greater ft. etl and ft.
Total length of t it e 1 i nes~Zj~ft. Num er of 1 ines~7 Length of ea h
-7 line_ ft. Distance between lines~ft. S7 idth oft reach,'
Total effective absorption area of trench bottom / s feet.
~ j Depth of filter material below ti? a / ~2-- in. th of f' r mrterial over
tile_.,~in. Cover over filter material
Depth of tile below finished grade _qLin. Slope f tren h bottom
per 100 ft. Depth of bedrock - ff. Depth to ground water F0 ft.
Number of Pits Outside diameter__~_ft. Depth below inlet
Lining material Gravel around pit: -4-yes,
No. Total absorption area esq. feet.
Square feet of seepa "',trench bottom area required
Sgc.are feet of seepa a pit area required ,
Inspected by:
it1e:
I pproved Date 19 ,
rejected ate 197
County, Town of.y~
Owner
Sanitary PermI No. Property t ddress
Septic Tank Permit No. Subdivision j) k %~,K=11-1
k ~
ti
t
August 11, 1972
Pastor Denning
Baptist Church
Baldwin, Wisconsin 54002
Dear Pastor Denning.
This is to inform you that there shall be no furthj
the new church until your plumber has obtained your s«m~tartioer ~
from 1,1
this office. y pmit
If any further construction is shown after Monday.
it may result in prosecution in conformity with the t. Croix Count
Zoning Ordinances, County
If you have any question on this matter, please feel free to contact
this office.
Sincerely,
.fiAROLD C. BARBER
Zoning Administrator
BCB/jh
r
Plb #67 7/71
Wisconsin Department of Health and Social Services
Division of Health
SEPTIC TANK PERMIT APPLICATION
TYPE OR USE BLACK INK - PLEASE PRINT
A. OWNER 0 PROPERTY
Name Address (Street, City, Zip Code)
J~
B. LOCATION OF PROPERTY WHERE SYST-24 WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY
Check Ones
CITY VI GE LEGAL DESCRIPTION
TOWNSHIP (Block, Lo)` Seo.)
-7- 1 C, d
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES No `y PERMIT NUMBER
D. SEPTIC TANK CAPACITY ajL? GALLONS NEW INSTALLATION REPLACEMENT ADDITION
MATERIALSs PREFAB CONCRETE POURED IN PLACE STEEL OTHER
NUMBER OF TANKS TO BE INSTALLED: t
E.. TYPE OF OCCUPANCY Get" V(y
Check Ones One or Two Family Residence Commercial Industrial Other (Speoify)
Number of persons to be Accommodated Number of Bedrooms
F. APPLICANCES, ETC: Food Waste Grinder YES NO Automatic Clother Washer YES -1~140
Dishwasher YES Automatic Potato Peeler YES ~NO
OTHER (specify) YES JNO
10
G. MASTER PLUMBER KING INSTALLATION
Names,' C Lu. u - < Address:
SIGNATURE OF APPLICANTS
License Numbers MP
ADDRESS: MP RSW
H. (TO BE COMPLETED BY ISSUING AGENT)
Date of Application Fee Paid
Permit Issued (date) Permit Number
Agent (name) For: II
tam, village, city, county, etc, (specify)
NOTES The Application cannot be considered for filing until all of the above questions are answered
and the fee paid. Agents will forward application, the fee of $1.00 for each septic tank and
the third copy of the permit (canary) to the Division of Health. Checks and money orders should
be made payable to the Division of Health.
COMPLETE OTHER SIDE
II
J
NAMES
COUNTYt
SEPTIC TANK PERMIT NUMBERt
REPORT ON SOIL PERCOLATION TEST
AND SOIL BORINGS
TO
DIVISION OF HEALTH - PLUMBING SECTION
P.O.BOX 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administravive Code
P E R C O L A T I O N T E S T
TEST DEPTH CHARACTER OF SOIL HOURS `MATER TEST TIME DROP IN WATER LEVEL INCHES MINUTES
NUMBER INCHES THICKNESS IN INCHES SINCE HOLE IN HOLE INTERVAL SECOND TO EXT TO LAST TO FALL
1st WETTED OVERNIGHT IN MINUTES LAST PERIOD LAST PERIOD PERIOD ONE INCH
EXAMPLE
P - 0 3611 TOP SOIL 1011 CLAY 2611 25 YES OR NO 30 60
A 5
r
2
3
RECORD DATA FROM MINIMUM OF 3 TEST HOLES
COMPUTE SIZE OF ABSORPTION AREA IN ACCORD WITH H 62.20 WIS., ADMINISTRATION CODE.
S O I L B 0 R I N G S- MINIMUM 36" BELOW PROPOSED ABSORPTION SYSTEM
BORING TOTAL DEPTH DEPTH TO GROUND WATER DEPTH TO BEDROCK I
NUMBER INCHES OBSERVED ESTIMATED OBSERVED ESTIMATED CHARACTER OF SOIL WITH THICKNESS IN INCHES
EXAMPLE
B - 0 11 7211 BLACK 0 OI 11C' A- I Ott SAS 10", GRknk 24t'
1 Zy /p
t
2
3 7 7/
G~
REC 0 ATA FROM MINIMUM OF, 3_jiORK_EQ1ZS_
TYPE OF OCCUPANCY: 61
RESIDENCE: NUMBER OF BEDROOMS OTHERS (SPECIFY) . NUMBER OF PERSONS /
FOOD WASTE GRINDER: YES NO_4 DISHWASHER: YES N0 AUTOMATIC CLOTHES WASHER: YES NO
EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION: REPLACEMENT
TILE SIZE NO. LIN. FEET TRENCH WIDTH DEPTH NUMBER OF LINES
SEEPAGE BED: LENGTH Fly WIDTH DEPTH TILE SIZE NO. LINES
SEEPAGE PITt INSIDE DIAMTER LIQUID DEPTH
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super-
vision in accord with the procedures and method specified in Chapter H 62.20 (3 Wisconsin Administrative Code, and
that the data recorded and location of test holes are correct to the best of my tuiowledge and belief.
NAME TITLE
TYPE or PRINT
REGISTRATION NO. OR MASTER PLUMBER LICENSE NO.
ADDRESS
DATE SIGNATURE
DO NOT WRITE IN SPACE BE14W - FOR DEPARTMENT USE ONLY
DATE RECEIVED ACCEPTED BY RETURNED
FEE RECEIVED VALID NO. PERMIT NO.
REVIEWED BY APPROVED DATE
INITIALS YES OR NO
4 r
PI-b. kO _
3/7O - PROJECT DETAIL DATA SHEET
t
NAME OF BUSINESS
LOCATION
- _ -
street or h i ghway city or townsh i p -
LEGAL DESCRIPTION
OWNER Mai 1 ing address
ZIP
ARCHITECT OR ENGINEER Address
PLUMBER Address
ZIP
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed:
Existing building _ New building Addition
If addition to existing building attach detailed memo for each.
( ) Drive in restaurant Car spaces
( ) Restaurant Seating capacity (10 sq. ft./person)
( ) Dining hall Per meal served Toilet waste Yes No
( ) Motel ( ) Hotel ( ) Cottages Number of units: 2 persons/unit
Churches 4 persons/unit TOTAL NUMBER OF UNITS _
Number of persons Kitchen Yes No
( ) Bar or cocktail lounge Seating capacity (10 sq. ft./person)
( ) Nursing or rest home Number of beds
( ) Mobile home park Number of units - dependent (camper trailer) _
- nondependent (mobile home) _
( ) Retail store Number of employees
Number of customers Tiff -s-q. ft./person)
( ) Service station Number of cars served (daily)
( ) School Number of classrooms Meals served Yes
No
Showers provided Yes No _
( ) Factory or office building Number of persons (total all shifts
( ) Apartments Number of bedrooms
( ) Other Specify
2. Indicate whether or not the following facilities are connected:
Food waste grinder Yes No Dishwasher Yes _ No
Automatic clothes washer- Yes No Automatic potato peeler Yes
Other . . . (Specify)
3. Fill in the appropriate information for the following as indicated:
Septic tank capacity planned
Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPORT SHEET
COMPLETE OTHER SIDE ,
Seepage trench bottom area planned width
linear feet depth t'
Seepage bed area, planned width
linear feet depth
Seepage pit planned outside diameter
depth below inlet depth
4. See approved plan for specifications and details.
Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION
P. 0. Box 309, Madison, Wisconsin 53701
5
Approved: P
Address: Date.
ZIP_ THIS APPROVAL IS BASED ON STATE PLUMBING
CODE REQUIREMENTS AND DOES NOT EXEMPT THE
Date: INSTALLATION FROM CITY, VILLAGE, TOWNSHIP
OR COUNTY REGULATIONS OR PERMIT REQUIRE-
MENTS AND SHALL BE VOID IF REVISED WITHOUT
THE WRITTEN APPROVAL OF THE DIVISION OF
HEALTH.
ha J ( iNSTALLE'D
VJ} iJ T' d Yc ~,M,S
DEPARTMENTAL USE ONLY FrC,,,, r
_ VAI
Parcel 018-1055-20-000 10/12/2006 04:47 PM
PAGE 1 OF 1
Alt. Parcel 24.29.17.381 B2 018 - TOWN OF HAMMOND
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 - FAITH BAPTIST CHURCH INC
FAITH BAPTIST CHURCH INC
2072 HWY 12
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 1.660 Plat: N/A-NOT AVAILABLE
SEC 24 T29N R17W 1.66 AC IN SW SE LOT 2 Block/Condo Bldg:
OF CERT SURVEY MAP IN VOL III PAGE 854
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 792/227
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/10/2006
Description Class Acres Land Improve Total State Reason
OTHER X4 1.660 0 0 0 NO
Totals for 2006:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2005:
General Property 0.000 0 0 0
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
Parcel 018-1055-10-000 10/12/2006 04:47 PM
PAGE 1 OF 1
Alt. Parcel 24.29.17.381 B1 018 - TOWN OF HAMMOND
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 - FAITH BAPTIST CHURCH INC
FAITH BAPTIST CHURCH INC
2072 HWY 12
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 7.590 Plat: N/A-NOT AVAILABLE
SEC 24 T29N R17W 7.59 AC IN SW SE LOT 1 Block/Condo Bldg:
OF CERT SURVEY MAP IN VOL III PAGE 854
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/10/2006
Description Class Acres Land Improve Total State Reason
OTHER X4 7.590 0 0 0 NO
Totals for 2006:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2005:
General Property 0.000 0 0 0
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
• AS BUILT SANITARY SYSTEM REPORT
WriER TOUTNSHIP SEC. T N, R W
0. ADDRESS ST. CROIX COUNTY, WISCONSIN.
-BDIVISION LOT 9~s LOT SIZE 4J
PLAN VIEW
-Distances b dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~ M
71 1
' -
}
Indicate North Arrow i
r--
:SCALE:
tPTIC TANK(S) MFGR. CONCRETE STEEL
NO. of rings on cover Depth DRY WELL
i NCHES NO. of width length area
i no. of lines width,' r length area L_.
depth to top of pipe
aGREGATE
?a: RATE_ AREA REQUIRED AREA AS BUILT
lisclaimer: The inspection of this system by St. Croix County does not imply complete
,00liance with State Administrative Codes. There are other areas that it is not possible
to inspect at this point of construction. St. Croix County assumes no liability for
IStem operation. However, if failure is noted the County will make every effort to
ijterm_ine cause of failure.
JEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
`'INSPECTOR
DATED PLUAKBER ON JOB ;
LICENSE NUMBER
Z
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
• San.i.taxy Penm.it
State Septic
NAME rownbh.ip St. Cxo.ix County
L o c at.i o m Section
SEPTIC TANK
Size - gattonb. Numbers of Compaxtmen.tb 1
Distance Fxom: Wett 12% on gxeatex e.2ope 6-t
Bu.i.2d.ing it. Wet.bands 6t•
N.ighwaten it.
DISPOSAL SYSTEM
Distance F,%om: Wett ~Z. 12% on gxea,tex stope it.
Bu.itd.ing it. W ettands Ft.
• H ighwatex it.
FIELD DIMENSIONS:
Width oj' txench it. Depth o6 xock below t.ite in.
Length o6 each tine it. Depth o6 xock oven t.i.2e .in.
Numbex o6 tines Depth of .t.ite below grade .in.
Tota., Zeng,th o6 tines it. Stope o6 ,txeneh in pen 100 it.
Distance between tines fit. Depth to bedxock it.
Totat absoxbt.ion area 6t2 Depth to gxoundwatex it.
Requ.ixed axea it2 Type of Covex: Papers ox Stxaw
PIT DIMENSIONS:
Num+bex o6 pits GxaveZ axound p.itzs yee no
Outside d.iametex it. Depth below .inlet St.
2
Totat absoxbt.ion axea it A
Area %equi,%ed it2
INSPECTED BY TITLE
APPROVED DATE 197.
REJECTED , DATE 197.
f EH 115 Rev: 9178 I VIZ C S .i-1 - fY}~r~17c;~H
REPORT ON SOIL BORINGS AND PERCOLATION TESTS r Z
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
~..'/4 1 L p -11 1-'1 1 1 OA-)
LOCATION IL /4, , Section ,T3_N,R_E-Gera W, Township of-M
Lot No. , Block No. Subdivision Name County c~_- 0 zLj x
& m i /Buyers Name: xn_.N 1 L lys i_'4: H `-f
Mailing Address: Z X42 G-eF-fZii-k>_b AyE
TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW -REPLACEMENT ALTERNATE SYSTEM f y~ Q~HE fib
Tr"
j '
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET -6 NAME OF SOIL MAP UNIT F`-
PERCOLATION TESTS S,
TEST HOURS WATER IN TESTTIME DROP I ~,ER LEVEL; INC
DEPTH CHARACTER OF SOIL ATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 • ~I ;
P-
P- ~ f L_ ► it lti - / `7
P-
P-
SOIL BORING TESTS , ,~~iNG~ vG k+tC-I2 .
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST
IF OBSERVED IN INCHES
B- Z ~7 c~ v 0E_~ 7 ' Ish v S S& 6W
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plane the 19cation and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy -4/9y 17Z-49UCN Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope. C FED
LOT LOT
tZ- .1ft 170 /►l -vi-, CSC
~t 1 [Zl M a 'i ~d~=auR1 AT TWA- V140-
(.,u h , 1V 1'1'f~l.s S Tom. I ! r
J ~F'1 / il! r M uiH~ a N
ILIP&k_T-37111 ~ f`I1.4 .
ScX
P~LACk ')V7
e T -um S.
iC 't3 V4
S ,..,H Vv -kJ
I, the undersigend, 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 location of test holes are correct to the best of my
knowledge and belief.
Name (print) 4y G-G ea t_=_2 Certification No. b
Address
Name of installer if known
Copy A -Local Authority CST Signature l All
PLB 67 State and County State Permit #
a; Permit Application County Perm db~~
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY 1 n~ Mailing Address:
AV-,U AJi /4A),A
B. LOCATION:Section, T N, R J,7 Ij (or) W Lot# -City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
- ~f -/S '7%
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family- Duplex No. of Bedrooms No. of Persons 7
D. SEPTIC TANK CAPACITY Ino Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete- Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area ~T2 sq. ft.
New X Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: ;)e_Length / Width 162 Depth Tile depth (top)- f No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- S Distance from critical slope
WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME ry/~~° C.S.T. # and other information
obtained from (owner/builder). _
Plumber's Signature MP/MPRSW# / Sal _ Phone #C - % 3S
Plumber's Address :4- AL j O
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
ZLL Z2&
.
i
i
A
. y
IN?
9.~
T
14j,
a
a
Da Not Write in Space Below FDR COUNTY AND STATE DEPARTMENT USE LY
Date of Application - C Fees Paid: State -J County ` Date
Permit Issue (date)
r f -7
- ~2 Issuing Agent Name
Inspection YeTecopy) State Valid# Date Recd
1. county (w3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78