HomeMy WebLinkAbout14-26RECEIVED
SR.- o0 3 17 MAR 0 4 2026
Soil Test#
Bayfield Co. `� (p
Bayfield"Y n9 Agency
Waiver of a Thorough Soil & Site Evaluation ENTERED
(subject to 15-1-10(d))/
TOvn1 I o I k OS iC. 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.
Property Owner 3CAMeS L. J4ncoy\ Contractor
Property Address Wpy e. — .NQvJ 5 i It Authorized Agent
w Copy Ri. Trb.% R ver. wT Agent's Telephon
Telephone %/S - 61 4 - 6 Z S I Written Authorization Attached: Y or N
Accurate Legal Description is requested:
5 W 1/4 of t/4 Section 2 U Township"19 N. Range g w. Town of 0u/ t)
Additional Legal Descri
Govt. Lot Lot Block Subdivision
Lot CSM# Vol. Page CSM Doc #
Volume Page of Deeds Tax I.D# 39 G e ff Acreage
Indicate reasoning for your determination: &'ra.c e 0) M ct5S _`'u a. (p r f.) C
�1i2/4n _4d
Signature of Certified Soil Tester
Date
Un 0S -5T
Certification #
Signature of Co my Official
Date
(Submit a Plot Plan & Fee)
u/forms/soiltestwaiver(K LK)
June 2018
W Colby Road
Page 2 of 4
System Plot Plan - Holding Tank Version 2.1 0 50 100 ft
Owner: James L. Johnson
Legal Description: SW1/4 of the SW1/4, Section 20, Township
48N, Range 9W Town of Oulu, Bayfield County, WI Pipe Marerial /ASTM
Standard (Tables 384.30-3 &
384.30-5)
RECEIVED
MAR 0 4 2026
Bayfield Co.
Planning and Zoning Agency
Wieser aQ Proposed O Proposed Well m
WLP2500.2 3 Bedroom Location
Home m
ID
r
BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
Submit the Following (Use Permanent Ink):
MAR 04 2026
1 Check List Sayfiea Co.
IQ Index Page / Title Sheet (Optional) planning and Zoning Agency
O Original Soil Evaluation Report (Submitted in Deed Holders Name - nt prospective buyers)
,0 Original Plot Plan
O Cross Section Soil Profile Sheet (optional)
F Additional Information (Warranty/Quit Bairn Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
l Property Owner's Information (nQt prospective buyer's name)
' i Property Location (Accurate Legal Description with Sec/Twp/Range)
&I Road Name (where driveway is/will be coming off of)
O Floodplain Elevation, How Rate, Comments and Recommendations
P Complete Soil Boring / Pit Information
1p Date Soil Evaluation was conducted
CST Name, Signature, Number, Address and Phone Number
4] *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
$i Bench Mark (Description, Elevation and Location)
❑ Contour Lines (Example = 98.0' /96.0' /94.0')
12 Property Location (Sec/Twp/Range/, Accurate Legal Description)
c Borings (Locations and Elevations)
❑ Percent and Direction of Land Slope
1, Well Location (Including Neighboring Wells, if applicable)
O Location of Wetland Areas, Floodplain and Navigable Waters
I Buildings, Driveways, and Structures (Location and Descriptions)
SI Location of Property Lines
❑ Existing System Location
❑ Address Number and Road Name
❑ Current Surface Elevation of Wetlands and Navigable Waters
t CST, Owner and Property Information
09 North Arrow
Fee:
Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checldist/checklistforests
13-4-Y FIELD Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
JOHNSON, JAMES L
10257 BOBCAT LAKE DR
MINOCQUA, WI 54548
Description
Certified Soil Tests - Review & Filing Fee
Submission Number:
SR -00387
Transaction Number:
SR-00387-3FC91
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 2503
Paid by: Polkoski Soil 2 Septic, 5115 County Highway B, Iron River WI 54847
Payment Type: Check
Transaction Date: 3/ 6/ 2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.