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W N O W W O O O O N C Sll N ~ A O ^'t 73 Cn (D (D O O O r 1y~. o n D o !i 7 N C = O N d a C N a N D O O CL 7 W _`.e'. CD l'\r jZ A (D O O O !\1 cJn L'I O C O + z 7 'O = v !\I • O O O C Y a (y N (-1J7 N D N c v o fD N N (D A N < N O O fD 3 N z m z Q (T} D a D 20 Z CD (D CD ~r• N N m O N C (D O a m 3 ~m A Z CD `p Z O CL O C W W K m O. z _ A Z7 N O Cl) 3 o u z (D O F N > C X R G ~ O Ut T Q C CD z a a N 6 (D O O 3 4 C a t v N N (D ~ 2 0 N (D O 7 O O ~ A ~ ^b N (D Up O r~ 10 O I S O Parcel 161-1026-50-000 03/21/2007 12:17 PM PAGE 1 OF 1 Alt. Parcel 13.29.20.441A.442A 161 - VILLAGE OF NORTH HUDSON 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 - BIBLE BAPTIST CHURCH BIBLE BAPTIST CHURCH 546 4TH ST N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 0057-VIL OF N H ASSESSORS PLAT 1 ST AMEND LOT 126 & LOT 131 OF 1ST AMENDMENT OF Block/Condo Bldg: ASSESSORS PLAT VIL NH CHURCH 545 6TH ST N PARSONAGE 546 4TH N SCHOOL 540 4TH N Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 13-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/02/1994 Description Class Acres Land Improve Total State Reason OTHER X4 0.001 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 P.TPORT OF INSPECTION--ITITDIVIDUAL SFWAGE-DISPOSAL SYSTEM P':IMIARY TP.EATIMENT consists of Septic Tank: Other (Describe) SEPTIC TANK Distance from: Well - ft., Lot line-zLft., Bui, d~ ing ft. , Highc,7ater ![ark _77f t. , 127 or greater slope - ft. , f eland ft., Cistern ft., No. compartments Liquid capacity gal. EFFLUENT DISPOSAL SYSTETI consists of Tile field Seepage Pzt Seepage Pit or Tile Field: Distance from: Well ft. B1111T!ng ft. Lot Line `''ft. Cistern ft. ;Iighwater dark of water course ft. ope 12% or rrreater ft. <Jetland ft: Total length of-tile lines,' ` ft. I'lurlber of lines Len th of each line v ft. Distance between lines ft T•lidth of trench -inc. Total effective absorption a ea of trench S`bottom sq. ft. -7 Depth of filter material below the in. Depth of filter material over the in. Cover over ilter material Depth of the below-TInished grade _`171 in. :lope of trench bottom in. per 100 ft. Depth of Bedrock, ft. Depth 11. to ground water ft. Number of Pits Outside diameter ft. Depth below inlet ft. Lining material Gravel around pit: yes. No. Total absorption area sq. ft. Square feet of seepage trench bottom area required 16"Y _ Square feet of seepage pit area required << Inspected by: Title: Approved Date 137, Rejected Date 197. C2 County, Town of Owner Sanitary Permit No. Property Address Septic Tank Permit II1o. S Subdivision Plb 67 State and County . State Permit # - Permit Application ~A County Permit # 1 for Private Domestic Sewage Sys't*,ns County _ t •4~t *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: Section T N, R a Z. a (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village i3 Township C. TYPE OF OCCUPANCY: 'Commercial 'Industrial *Other (specify) d►vY 'Variance Single family Duplex No. of Bedrooms No. of Persons o? D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES l NO # of Bathrooms -Q- Automatic Washer YES -NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation X Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area ej~sq. ft. New / Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length _8_~_Width Depth Tile Depth -:2 ~j No. of Lines --2 Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope 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 Ce e fied Soil Tester, NAME C.S.T. # -/-','l ,2nd other information obtained from vg~'4 (owner/builder). Plumber's Signature MP/MPRSW# /SG -s Phone #yc~y PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). SCuc~~ '~J i r z a_ ; w e e E E , e j roc `r W Ilia f Do Not Write in Space Below FOR DEPARTMENT USE ONLY Date of Application Fees Paid: State County % Date Permit Issued/Rejected (date) /i / Issuing Agent Name Inspection Yes_ No Valid# Date Recd 1. county (white copy) 3, owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 3/1/75 P1b. # _50 _ R 3/70 PROJECT DETAIL ..DATA SHEET NAME OF BUSINESS V- C street or hig way city or township county LEGAL DESCRIPTION OWNER ,n.l,J\. Mai 1 i ng address ZIP s' qW(- ARCHITECT OR ENGINEER Address _ ZIP PLUMBER Address (1hsYV~z4Pt1~_G1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building _X _ Addition If addition to existing building attach d4t~iled 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 4 persons/unit _ TOTAL NUMBER OF UNITS ( Churches 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 T10-sq. 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 shif_ts ( ) Apartments Number of bedrooms _ ( ) Other Specify 2. Indicate whether or not the followin facilities are connected: Food waste grinder Yes _ No _ Dishwasher Yes _ _ No _ Automatic clothes washer _Yes No Automatic potato peeler Yes Other (Specify) No -X-- 3. Fill in the appropriate information for the following as indicated: Septic tank capacity planned p'7 5O. Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPORT SHEET COMPLETE OTHER SIDE Seepage trench bottom area planned _ width linear feet" depth Seepage bed area planned LQ oC! f~= 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 30 dison, Wisconsi 701 Approved: - Address: Date: Z I P S YU1 7 THIS APPROVAL IS BASED ON STATE PLUMBING CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date: 7 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. DEPARTMENTAL USE ONLY ;1 Fr) urn) W(`, YEAR.' r vA,F NOTICE '-vl and/or county +sfull,:;Non permits required State of Wisconsin \ DEPART NT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH MAIL ADDRESS: P. O. BOX 309 MADISON, WISCONSIN 53701 ~~CF y IN REPLY PLEASE REFER T0: A(IG 70 ~~(,f SECTION OF PLUMBING 1ND FIRE PROTECTION SYSTEM` IOH~/y~ 19ZS ~ oFFj~~ Identification No. Dear Sir: Re , This is to acknowledge receipt of your plans and specifications for the above- indicated project. When referrin to this plan in the future it will be absolutely necessary to utilize the plan identification number assigned to the project. The spaces below indicate if proper fees have been submitted or if more information is required. Providing plan review is not completed within thirty (30) days, a permit to start construction may be issued if requested. See Section H 62.25, Wisconsin Administrative Code, for limitations in reference to permits to start construction. Preliminary plan review for determination of fees does not hold the department liable in the event additional fees may be required upon complete plan review. Preliminary review indicates the plan review Fee required is $ d o _ Fee received is $ Cad Plan accepted for review. Fee is being returned because of Overpayment El underpayment. Providing one of the two categories above is checked, please remit correct total fee in one payment. Indicate plan identification number on remittance. No fee has been remitted. Plans submitted with no fees will be held in abeyance until remittance is received. Indicate plan identification number on remittance. Additional information required. See attached Plb. 100. The permit to start construction will not be issued until 30 days after requested information is received and accepted. Q Plans being returned. See attached Plb. 100. Sincerely, ames A. Sarg Chief JAS:fjs 1 RFPOrtT OF I ISSPECTIO ?--I:dijIVT!31JAL %'V "E ")ISPOSIV., L `PEI Sanitary Permit J' tate Septic ~ TOWINSIHIP / St. Croix County ~e c allons . "'umber of omoart-gents Distance Prop.: 'till. ft. 12`,% or greater slope t ~ ft. T3etlands ---1 ft >uilding "ij Iiwater_ ft. DISPOSAL S"ccM-4 'pile Field or Seepage Pit(s) DISPOSAL v~sJ 1L'!7. r. 1 1`?tance Prom: '"'ell 1''1; or treater slope ft nuildin~: ft. T-Jetlands ft PI117LI) ,i Fhwater ft. Total length of lines ` ft. unber of lines Lenp;t'-i of 1 ±.-~t } T. L sb,rc ura f ft. ,:lidtii oT- _ the trench Z~f t. Total absorption area sq. ft. Dert': of rock below ti-le Y--in. Depth of rock over tile ~ in. Cover over rock to 41, trenc'. ~ in = er r' t(.. nyl)th to Bedrock ~ft. DeLDt'~ to ,701111d, water ft. Iur-iher of nits 0utsic diameter ft. Dent'? below inlet ft. Gravel ro nd n* eyes no. Total absorption area sq. ft. t square feet of see age trench bot_tonl area required Square feet of s epag ni rea equired _ Inspected by _`y f~'i tle Date 197/ R-c ec t-d III 4 PLB67 State and County State Permit # Permit Applicat?nn County Permit 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 Mailing Address: 461 C- st B. LOCATION: Y4 15GO '/4, Section, T N, R (or) W Lot# _ City _ > Subdivision Name, nearest road, lake or landmark Blk#_ Village _ Township - C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) Variance Single family. Duplex No. of Bedrooms 'a. No. of Persons D. TYPE OF APPLIANCES: Dishwasher _J~ YES NO Food Waste Grinder YES NO # of Bathrooms Automatic Washer YES NO Other (specify) SEPTIC TANK CAPACITY o) G C~ Total gallons No. of tanks "Holding tank capacity Total gallons No. of tanks "'ew Installation J~ Addition Replacement- Prefab Concrete *Poured in Place _ Steel Other (specify) FFLUENT DISPOSAL SYSTEM: Percolation Rate 14 2) ~ 3) _~Total Absorb Area sq. ft. :ew Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches- r ,eepage Bed: Length Width 1 Z Depth Y7 Tile Depth No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, ',%isconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certi d oil Tester, e, NAME C.S.T. # $s/and other information obtained from 1:: rl CC vim- (owner/builder). Phone #,y(6 ' umber's Signature MP/MPRSW# Plumber's Address J PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). rJ ~ ~sz Wes) ~ e L y aa[V~ Do Not Write in Space Below FOR DEPARTMENT USE ONLY Date of Application o`Z f7 Fees Paid: State ©4 CountyvZ - Dig Permit Issued/mod (date) O Issuing Agent Name Inspection Yes_X, No Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4 nlUmhpr (r m 3rv r 1l-, EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SEJiVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, W.I$GOIJISIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS ~f~ j~ 7~ LOCATION: LYJ~'/4, Section 7 , TAN, R V (or)CV, Township or Municipality Lot No. Block, No. County i` Subdivision Name Owner's Name: ~7, l'/c ~~a!?Tr1c /)c e "i! ( - - Mailing Address: L4 Ali rl 11, 5 TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS I- Z 1 7 2 PERCOLATION TESTS -'Z 7 SOIL MAP SHEET SOIL TYPE /-31-1 1 ' PERCOLATION TESTS I CHARACTER OF SOIL HOURS WATER IN TEST TIME IDROP ;N WATER LEVEL, INCHESi RATE i TEST DEPTH NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN~ PER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P__ P 2- 7 2 2 t"( s SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES j NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 13- C E B_ ti ,~t e ~ Y 3.;z -S S. " F d S 1 . > 3c'4 SJ I L. - ~1 7. y ,Z c /5 y" Pi-AN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) ,E et of .,u r~t=o ea Indicate on the plan the location and square feet of suitable areas. Indicate nur;~r: r of n: tided for building type and occupancy. .J /1_ Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 44 L,' b r r > e- t~ f- 1 f9r )7,_ a _ I /C< j I ( © t _ z I N I I i ❑ I / 0 13 I 7 J' .k L t' ZI- C --r-rH El 1, 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 location of test holes are correct to the best of my knowledge and belie /Y .1 - IX {1 1 2- Name (print) i Certification No. S S - ~S Address 1 ~i1 ~t C L 1 Name of installer if known ' I I CST Signature OPY A -LOCAL AUTHORITY - -