HomeMy WebLinkAbout33-25S^- 002.HI
Bayfield County
Soil Test #
Waiver of a Thorough Soil & Site Evaluation ^_S^ST
(subjectlo 15-1-10(d)) <-^
la.iA Tol^oski\ fi I 1<^IA F€) I y^OS, IC.t 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.
l^i < L <k (^ *^- c~i ^^ ^+L»°-
Property Owner be- ^v^^
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f^:Lll^Contractor
Property Address_Z^_o^°_' r p^ ^'t~R^
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Authorized Agent.
Agent's Telephone.
Written Authorization Attached: Y or NTelephone "7 / ^ t// 3 o^^7
Accurate Legal Description is requested:
' $ 'vJ 1/4 of 51^1/4 Section ^ Township ^ ^ N. Range 7 W. Town of_^_
Additional Legal Description: L^S-S <^J (/\y u.'^
Govt. Lot Lot
Lot_CSM#_
Volume_Page.
Block Subdivision
Vol. _ Page _ CSM Doc #.
_of Deeds Tax I.D#_2-_^7^Z_Acreage ^ °
Indicate reasoning for your determination: ^J^t Ci'^'y «e-(y ^&1 I s. - /^e> of ^.-<-x '^^C
PD ^-J T ^ <^. -1 ^-< / — s-^^ ( (^1 ^^7L-
Signature of Certified Soil Tester
--/ <^-^^~
A^J7/^
Signature of County Official^/^^/^^
Date
<fit
Date
CXT "WZZoocjo
Certification #
I EG I! I! J| :(S"bmitaPlotPlan&Fee)
till MAY 1 Q '/{Y/^ ^lUIJ 11 Hi > 0 L^LJ ^ u/forms/soiltestwaiver(KLK)
June 2018
Sayrieid Co. ZcnifK, U°pL
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BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
Submit the Following (Use Permanent Ink): j^ | ^ |J
1^0 Check List II MAY 192025
El Index Page / Title Sheet (Optional) i;:ayFieid Co. Zoning Depf •
El Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers)
\^ Original Plot Plan
D Cross Section Soil Profile Sheet (optional)
D Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
El Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
E Property Owner's Information (not prospective buyer's name)
E Property Location (Accurate Legal Description with Sec/Twp/Range)
El Road Name (where driveway is/will be coming off of)
IZI Floodplain Elevation, Flow Rate, Comments and Recommendations
0 Complete Soil Boring / Pit Information
El Date Soil Evaluation was conducted
12 CST Name, Signature, Number, Address and Phone Number
a *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
@1 Bench Mark (Description, Elevation and Location)
E] Contour Lines (Example = 98.0796.0',94.0')
3\ Pioperty Location (Sec/Twp/Range/, Accurate Legal Description)
10 Borings (Locations and Elevations)
S Percent and Direction of Land Slope
S3 Well Location (Including Neighboring Wells, if applicable)
1/1 Location of Wetland Areas, Floodplain and Navigable Waters
[3 Buildings, Driveways, and Structures (Location and Descriptions)
El Location of Property Lines
Ef Existing System Location
El Address Number and Road Name
0 Current Surface Elevation of Wetlands and Navigable Waters
2S CST, Owner and Property Information
^ North Arrow
Fee:
E3 Certified Soil Tests - Review & Filing Fee , $ 50.00 . u/forms/sanitary/checklist/checklistforcsts