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HomeMy WebLinkAbout44-24:X- wWc F M.'iV : . .'i)Z4 . \ \ ••w JL Bayfield County Soil Test # Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) 1. All. a^l T© / KQ S /<^ ^ _ a certified soil tester determine that in my professional 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. . . ^ ' ^j> o <?4 ^'^ r/^ /^ '-r^^ Property Owner ^' ^^ P^^ ^. j -/~ ^^ Contractor_ Property Address ^ / <&o L^- ^ ^ ^^ ^Authorized Agent__ •^/i^o^ ^Li ^ e^ ^J 7^ <T^S^7 Agent's Telephone.7 Telephone '7 t ^ ^C7 2- - L^> ^ _ Written Authorization Attached: Y or N Accurate Legal Description is requested: S ^ 1/4 of /JL^1 /4 Section 3>^ Township ^ ^ N. Range 7 W. Town of C^ u ( ^ Additional Legal Description:. Govt. Lot _Lot _Block _Subdivision Lot _ CSM#_ Vol. _ Page _ CSM Doc #. Volume_Page_of Deeds Tax I.D# -Z-~7 "S 3 u _Acreage l/° Indicate reasoning for your determination: tJ -e-1~ C/ ^c^ <L L/ & &c /^ — ^<? 0 t ^< ^ ^?o^^5 ^c-^ L^ '^^s{-^^^l /^— r-^^^- Signature of Certified Soil Tester <^^ -z-^- ^ Date csrc ZZQO^O Certification # Signature of County Official r^ ^ (Submit a Plot Plan & Fee) Date u/forms/soiltestwaiver(KLK) June 2018 # 44-24 -.^^ no. -3^ ^ ^s" v» »^> . '$ -3 y ^ a^1-? -••+:c ^o-~*^ £^^^» tr»•^r^ ^ ^.j S " ^ 'o « - ^. & ~3* ~0 ^GQ^ QC ^•~z ^ ~t>^•^ if ^<l ~3 3 ^--.^»: ^ ^N i^s ~—'^<0sf<M-Q~>) 0-1^ 0-.^:c? + .^'^f- -ssv»^^Q w ~-r^ -^ ST-\iT ^y^i1 ^0 ^ • 0 :l: ^-'<4- <t ^ ^- s3^^ s- ,%^5^ 0^ f^ ^ 0 ffi ^..j' si(^0)— <^ . " *+°' ^ I fr-r^ ^ T- 0 0- ^ U Q / -» »u»f^ ^ ^ ^ ^ •s ^ f ^ •^ fA ^ (i ^'^ ^-2 £ ) C~^i co CZl -s ^ (/t -> ^^^ >- 0 0 -3 ^ 3 y 0 ^ ^-'- 'v^ Ji-f '^'^.^V?5'l<'^ --/ ^.^"^-^^•a^^^^'y^^^s^""t?L-"S'^, / --^s J J-^ '/^ a, ja W-m-"^-€, //^"".s o-2'S ^ T>^^ IV .0^ ~f5^Sn^c-^iJI.^^'5? '^.\W.. T ~^~?1T ^ori ^» ?py c~> rs~ »».s s -^•-^^ ?il;^ Oo& h3 ^ y^iffj•^ Is^p ^to•"<! •</> a.•^ \J i£ ,^ y^ '^. ^ i ? -T'<??^^ 0' .&, •^1€ (I a? £^«?- L ad-^ M^-a"s V)^Sl—o ' ^ ^ & -,! »-a tf^z''?".'0'^ tf — Vt ^ 0 ?°'.J.^ -^ n-^- ^ $' 0 ^ ^ 0. §•j ^-\ '{d '-•^^ ^-j.^??:lil ^ 3 -? V» ^ 0 5^ 0.0 ^ ^i^ "'4 ^°.?^ ^ l\- "j » > ^> 0 ^ ^' Q. -^ <iy sif•"—>« -i~^"' ? .. '?'j^. «+ -^ .^ »1'%Q&U- '; i* rf ~^s ^ £ *' ^ < - €J. -^ BAYFIELD COUNTS i CHECKLIST FOR CERTIFIED SOIL TESTS y\K' 06:^iZ'i Submit the Following (Use Permanent Ink): El Check List 10 Index Page / Title Sheet (Optional) El Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers) IZ? 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) B Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used EQ Property Owner's Information (not prospective buyer's name) 12 Property Location (Accurate Legal Description with Sec/Twp/Range) 0 Road Name (where driveway is/will be coming off of) El Ftoodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information GZ1 Date Soil Evaluation was conducted [3 CST Name, Signature, Number, Address and Phone Number a *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) 121 Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0' ,96.0' ,94.0') 12 Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) 0 Borings (Locations and Elevations) 23 Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) 1/1 Location of Wetland Areas, Floodplain and Navigable Waters IZI Buildings, Driveways, and Structures (Location and Descriptions) El Location of Property Lines Ef Existing System Location IZf Address Number and Road Name 13 Current Surface Elevation of Wetlands and Navigable Waters [73 CST, Owner and Property Information North Arrow Fee: [^ Certified Soil Tests - Review & Filing Fee $ 50.00 . u/fprms/sanitary/checklist/checklistforcsts