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Soil Test #fc.',--1,. -.„.'
Bayfield County
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1-10(d))
1 r\ (\Y \ g.i/t <^_(^tOA/ _ a certified soil tester determine that in my professional
judgment the following site (&ee 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 fVJoi/^Hgi4 [^/ ^^o^^^oi Contractor.
Property Address ,^'^50 fei^'Ru^ ^ct Authorized Agent_
\\ey\D^€\^ f Uj^ ZTS^<y-c/- Agent's Telephone.
Telephone 7/5^ <f ^7- ~?^><^^? _ Written Authorization Attached: Y or N
Accurate Legal Description is requested:
S£"1 /4 of 5^_1 /4 Section 3.1 Township £7?)N. Range 01 W. Town of Cloven
Additional Legal Description: 5E ^F. / -&5S V. / ^D PAW ^- ^c3 ;^-$~?^5-7
4-77
Govt. Lot Lot _Block _Subdivision
Lot _ CSM#_ Vol. _ Page _ CSM Doc #.
Volume_Page_of Deeds Tax I.D# s , "1 ^ _Acreage "
Indicate reasoning for your determination: C^\.QL\f <=>0( /< , Kte'l^tf^ bhlA^lA^
4^1^ ^^^c^-Signature of Certified Soil Tester
5-^/-^O^y-
Date
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>/^Z-^^-~——^_ Certification #
Signature of County Official
f / -> - / -xn (Submit a Plot Plan & Fee)ff/ ^ / ^ — ^,^ <^o ^CV\ -11 U2.^Date
u/fonns/soiltestwaiver(KLK)
June 2018
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BAYFIELD COUNTYCHECKLIST FOR CERTIFIED SOIL TESTS
Submit the Following (Use Permanent Ink):
•^f Check List
ff^-Index Page / Title Sheet (Optional)
^Tbriginal Soil Evaluation Report (Submitted in Deed Holders Name - ngt prospective buyers)
^"Original Plot Plan
O^Cross Section Soil Profile Sheet (optional)
^Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
arcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
0'Property Owner's Information (not prospective buyer's name)
Property Location (Accurate Legal Description with Sec/Twp/Range)
"B^Road Name (where driveway is/will be coming off of)
.Floodplain Elevation, Flow Rate, Comments and Recommendations
Soil Boring / Pit Information
•P^Date Soil Evaluation was conducted
^SsCST Name, Signature, Number, Address and Phone Number
D *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
Bench Mark (Description, Elevation and Location)
Btontour Lines (Example = 98.0' ,96.0' ,94.0')
Location (Sec/Twp/Range/, Accurate Legal Description)
'MBorings (Locations and Elevations)
^Percent and Direction of Land Slope
-fefWell Location (Including Neighboring Wells, if applicable)
KfLocation of Wetland Areas, Floodplain and Navigable Waters
a. Driveways, and Structures (Location and Descriptions)
Location of Property Lines
Existing System Location
Address Number and Road Name
Current Surface Elevation of Wetlands and Navigable Waters
CST, Owner and Property Information
North Arrow
Fee:
certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts