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Soil Test #
Bayfield County
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1-10(d))
I EDWARD JWROBLEWSKI _ 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 _ Contractor EDIS MECHANICAL LLC
Property Address XXXXXNEMECRD _ Authorized Agent EDWARD J WROBLEWSKI
MASON wi 54856 _ Agent's Telephone 715-209-4055
Telephone 715-209-0154 _ Written Authorization Attached: Y or [Nj
Accurate Legal Description is requested:
NE 1/4 of SE 1/4 Section 30 Township 47 N. Range °5 W. Town of EILEEN
Additional Legal Description: LOT30FcsM23i6iNDoc2o24R6026i3
Govt. Lot Lot Block Subdivision
Lot _ CSM#_ Vol. _ Page _ CSM Doc #
Volume_Page_of Deeds Tax I.D# 39145 _Acreage 2021
Indicate reasoning for your determination: CLAY SOILS AND HIGH GROUNDWATER
J^
Signature pf Certified Soil Tester
b / Z^\ z- ^
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Date
SP-72000013
Certification #
-fSignature of County Official
(Submit a Plot Plan & Fee)i^/^l^o^
Date
u/forms/soiltestwaiver(KLK)
June 2018
59-24
EDWARD J WROBLEWSKI, CST#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
^
FUTURE
GARAGE
SITE
FUTURE DRIVEWAY
>1000'TO WEST LOT LINE WELL
0
FUTURE
HOME
SITE SOIL
BORING
>400' TO SOUTH LOT LINE
10 26 36 40 SHEET 2 OF 2
BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
MAY :;i'! '^!?.;Submit the Following (Use Permanent Ink):
Check List
H Index Page / Title Sheet (Optional)
J^l Original Soil Evaluation Report (Submitted in Deed Holders Name - ngt prospective buyers)
[0 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 21djgii Tax ID#) DO NOT USE 12 digit, they are no longer being used
Property Owner's Information f not 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
pd Date Soil Evaluation was conducted
^ CST Name, Signature, Number, Address and Phone Number
&'l:Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
a Bench Mark (Description, Elevation and Location)
D Contour Lines (Example = 98.0'/96.0794.0')
^-1 Property Location (Sec/Twp/Range/, Accurate Legal Description)
IP 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
Address Number and Road Name
Current Surface Elevation of Wetlands and Navigable Waters
CST, Owner and Property Information
J^North Arrow
Fee:
0 Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts