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Bayfield County
Soil Test #^9-^
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1-10(d))
I EDWARD J WROBLEWSKI a certified soil tester determine that in my professional
judgment the following site (see below) is unsuitable for any treatment component other than holding
tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a
determination.
Property Owner WILLIAM N KURTZ JR
Property Address xxxxx NEMEC RD
MASON Wl 54856
Telephone.715-209-0154
Contractor EDIS MECHANICAL LLC
Authorized Agent EDWARD j WROBLEWSKI
Agent's Telephone.715-209-4055
Written Authorization Attached: Y or IN I
Accurate Legal Description is requested:
NE 1/4 of SE 1/4 Section so Township 47 N. Range °5 W. Town of EILEEN
Additional Legal Description: LOT30FCSM2316INDOC2024R602613
Govt. Lot _Lot _Block
Lot _CSM#_ Vol.
Subdivision
Page
Volume _Page_
CSM Doc #
of Deeds Tax I.D# 39145
Indicate reasoning for your determination:CLAY SOILS AND HIGH GROUNDWATER
.Acreage.20.21
Signature of County Official
l^/ff/^O^
Date
A^Signature pf Certified Soil Tester
b / 2^'l -^^
Date
SP-72000013
Certification #
(Submit a Plot Plan & Fee)
u/forms/soiltestwaiver(KLK)
June 2018
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v
EDWARD J WROBLEWSKI, CSTi!<SP-72000013
SOIL TEST PLOT PLAN
WILLIAM NKURTZJR
XXXXX NEMEC RD
MASON Wl 54856
LOT 3 OF CSM 2316 IN
DOC2024R-602613
S30 T47N R05W
TOWN OF EILEEN, Wl
SCALE 1"= 50'
N
FUTUREGARAGE
SITE
FUTURE DRIVEWAY
>1000'TO WEST LOT LINE
FUTUREHOMESITE SOILBORING
>400' TO SOUTH LOT LINE
SHEET 2 OF 2
BAYFIELD COUNTYCHECKLIST FOR CERTIFIED SOIL TESTS
MAY •:'. ''• 9!i',';:Submit the Following (Use Permanent Ink);
Check List
a Index Page / Title Sheet (Optional)
Jp Original Soil Evaluation Report (Submitted in Deed Holders Name - nst prospective buyers)
[|ZI Original Plot Plan
D Cross Section Soil Profile Sheet (optional)
D Additional Information (Warranty/Quit Qaim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
)^ Parcel Identification Number (must be 2idigrt Tax ID#) DO NOT USE 12 digit, they are no longer being used
Property Owner's Information (nsi prospective buyer's name)
Property Location (Accurate Legal Description with Sec/Twp/Range)
Road Name (where driveway is/will be coming off of)
D Floodplain Elevation, Flow Rate, Comments and Recommendations
D Complete Soil Boring / Pit Information
^ Date Soil Evaluation was conducted
/E^ CST Name, Signature, Number, Address and Phone Number
&*Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
D Bench Mark (Description, Elevation and Location)
D Contour Lines (Example = 98.0796.0794.0')
^C-l Property Location (Sec/Twp/Range/, Accurate Legal Description)
Borings (Locations and Elevations)
D Percent and Direction of Land Slope
Well Location (Including Neighboring Wells, if applicable)
D Location of Wetland Areas, Floodplain and Navigable Waters
Buildings, Driveways, and Structures (Location and Descriptions)
Location of Property Lines
D Existing System Location
Xl Address Number and Road Name
a Current Surface Elevation of Wetlands and Navigable Waters
'0 CST, Owner and Property Information
j2^North Arrow
Fee:
^ Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts