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^<-y Bayfield County
Soil Test #7b-Z4
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1-10(d))
l /A 11 ^ J ~s>! f<-o S i'c. i 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.
^.c^c^i f^l.Jrk^Property Owner /n -^^^^\ [ c (' TJ:^_—_. Contractor.
Property Address ^; ? <7 S"<> "7 /i L/^ ^ f Authorized Agent__
B ^./ /^ d /-^^ ^ <>s -fce ^ ^J7 ^V(f ^Agent's Telephone_7~7 —7-
Telephone ^ / -?_ ^ ci ^ I e? s~ lt ______ Written Authorization Attached: Y or N
Accurate Legal Description is requested:
J/4 of_1/4 Section_U_Township_^_N. Range LP W. Town of_^_
Additional Legal Description: F^^o-h -/~^< A/^-^^£^
Govt. Lot ^- Lot 2~_Block _Subdivision "^\~~t^^^ ^.-e.^ ^c^y
Lot _ CSM#_ Vol. _ Page _ CSM Doc #
Volume_Page_of Deeds Tax I.D#___^_LELZ_Acreage /
Indicate reasoning for your determination: UJ e-'t" c la-y e.^- So .( - /-* ° D
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^^ — ^Signature of Certified Soil Tester
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Date
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Certification #
Signature of County Official
(Submit a Plot Plan & Fee)
Date
, u/^rriis/soiltestwaiver(KLK)
>0i/ ^ V^XA _ June 2018
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BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
Submit the Following (Use Permanent Ink):
0 Check List
10 Index Page / Title Sheet (Optional)
El Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers)
B? Original Plot Plan
a Cross Section Soil Profile Sheet (optional)
D Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
0 Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
13 Property Owner's Information (not prospective buyer's name)
E Property Location (Accurate Legal Description with Sec/Twp/Range)
^ Road Name (where driveway is/will be coming off of)
13 Floodplain Elevation, Flow Rate, Comments and Recommendations
E] Complete Soil Boring / Pit Information
E Date Soil Evaluation was conducted
0 CST Name, Signature, Number, Address and Phone Number
n *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
|7) Bench Mark (Description, Elevation and Location)
LJ Contour Lines (Example = 98.0'/96.0794.0')
13 Pioperty Location (Sec/Twp/Range/, Accurate Legal Description)
0 Borings (Locations and Elevations)
u Percent and Direction of Land Slope
0 Well Location (Including Neighboring Wells, if applicable)
^\ Location of Wetland Areas, Floodplain and Navigable Waters
\E Buildings, Driveways, and Structures (Location and Descriptions)
El Location of Property Lines
Ef Existing System Location
Ef Address Number and Road Name
13 Current Surface Elevation of Wetlands and Navigable Waters
2l CST, Owner and Property Information
North Arrow
Fee:
^ Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checklistforcsts