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Home My WebLink About23-26Wisconsin Department of Safety and Professional Services SOIL TEST # Page 1 of 3 Division of Industry Services a 3-a (. In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on pape ess than 8 1/2 x 11 inches in size. Plan must include, County BAYFIELD Parcel I.D. but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 4313 rev l weQ py j I� Date Please print all information. Personal information you provide may be used for secondary ur oses(Privacy Law, s. 15.04(1)(m)). 8 / ,, Property Owner Property Location ❑ CHRISTOPHER L BERGREN & REBECCA L LEVOIR Govt. Lot SW V. NE 'It S 01 T 50 N R 04 E (or) W Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# 1421 CARRIAGE RD City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road WOODBURY MN 55125 (651)278-6652 BAYFIELD COUNTY HWY J ® New Construction Use: ® Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial — Describe: _ REC RECEIVED EIVED Parent material SANDY OUTWASH Flood toif applica a NA ft. General comments and recommends ons: SITE SUI ABLE FOR AN AT -GRADE SYSTEM APR 102026 us _. 1❑ Boring # ❑ Boring 0 Pit Ground surface elev. 97.1 ft. Depth to limiting factor 37 in. Planning and Zoning Agency Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' *Eff#1 *Eff#2 1 0-8 7.5YR 312 NA Is 0sg dl cs 2f 0.7 1.6 2 8-15 5YR4/6 NA s Osg dl gs if 0.7 1.6 3 15-37 5YR 7/6 NA s 0sg ds cs 1vf 0.7 1.6 4 37-46 5YR 7/6 c2d 5YR 5/8 s 0sg dsh NA 1vf 0.0 0.0 2❑ ❑ Boring Boring # ® Pit Ground surface elev. 100.4 ft. Depth to limiting factor 38 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' *Eff#1 *Eff#2 1 0-3 7.5YR 3/2 NA s 0sg dl cs 2f 0.7 1.6 2 3-6 7.5YR613 NA s Osg dl cw 1f 0.7 1.6 3 6-15 5YR4/6 NA s Osg dl cs 1vf 0.7 1.6 4 15-38 5YR 7/6 NA s Osg ds cs tvf 0.7 1.6 5 38-45 5YR 7/6 c2d 5YR 5/8 s Osg dsh NA 1vf 0.0 0.0 CST Name (Please Print) Signat CST Number EDWARD J WROBLEWSKI SP -72000013 Address Date Evaluation Conducted Telephone Number 84805 HATCHERY RD, BAYFIELD, WI 54814 11/14/2025 715-209-4055 SJ AUJU-aJJU KU4/1J) 3❑ ❑ Boring Boring # Pit Ground surface elev. 101.9 ft. Depth to limiting factor 37 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-3 7..5YR 3/2 NA Is Osg dl cs 2f 0.7 1.6 2 3-6 7.5YR6/3 NA s Osg dl cw if 0.7 1.6 3 6-14 5YR4/6 NA S Osg dl cs 1vf 0.7 1.6 4 14-37 5YR 7/6 NA s Osg ds cs 1vf 0.7 1.6 5 37-46 5YR 7/6 NA s Osg dsh NA 1vf 0.0 0.0 ❑ ❑ Boring Boring # — ❑ Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/Ft' *Eff#1 *Eff#2 Bayfield C o. Pie ng and Zoni ig Agency ❑ ❑ Boring Boring # — ❑ Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' *Eff#1 `Eff#2 Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 s 150 mg/L ` Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L EDWARD J. WROBLEWSKI, CST MSP-72000013 SOIL TEST PLOT PLAN CHRISTOPHER L BERGREN AND REBECCA L LEVOIR 36499 COUNTY HWY J BAYFIELD, WI 54814 PAR IN SE NW SW NE W OF CO HWY J IN 2022R-595061 501 T50N R04W TOWN OF BAYFIELD, WI SCALE 1" = 60' APPROX. 750TO WEST LOT UNE FUTURE 3 BEDROOM HOUSE APPROX. 75010 WEST LOT LINE 101.9' t00A' 11 1019 UI 97.1' EXISTING MANMADE POND O EXISTING GARAGE RECEIVED APR 102026 Bayfleld Co. Planning and Zoning Agency APPROX. 60010 EAST LOT UNE AND COUNTY HWY J FUTURE DRIVEWAY N 1 =6M 1O'OAK. NAIL IN BASE+ISO 0 0 0 4 5 60 T SOUTH LOT LINE SHEET 3 OF 3 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): Vl heck List ..-9 Index Page / Title Sheet (Optional) Cl2'6iginal Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) riginal Plot Plan --ErCross Section Soil Profile Sheet (optional) efl7additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) RECEIVED APR 10 2026 Baru Co. planning and Zoning Agency P Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used U3'Prooerty Owner's Information (not prospective buyer's name) l�operty Location (Accurate Legal Description with Sec/Twp/Range) l9'Road Name (where driveway is/will be coming off of) iloodplain Elevation, Flow Rate, Comments and Recommendations 6] -Complete Soil Boring / Pit Information V6ate Soil Evaluation was conducted IW(ST Name, Signature, Number, Address and Phone Number ❑ *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) ,L24�ench Mark (Description, Elevation and Location) 'Contour Lines (Example = 98.0' /96.0' /94.0') '�roperty Location (Sec/Twp/Range/, Accurate Legal Description) 2'Borings (Locations and Elevations) ' ' rcent and Direction of Land Slope El Well Location (Including Neighboring Wells, if applicable) ti R ❑ Location of Wetland Areas, Floodplain and Navigable Waters f2'�Buildings, Driveways, and Structures (Location and Descriptions) WLocation of Property Lines trk ❑ Existing System Location lli' ddress Number and Road Name N.P.- El Current Surface Elevation of Wetlands and Navigable Waters l'C//ST, Owner and Property Information 6d'North Arrow Fee: ,Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforests / i C O U N T Y Property Owner: BERGREN, CHRISTOPHER L 1421 CARRIAGE RD WOODBURY, MN 55125 LEVOIR, REBECCA L 1421 CARRIAGE RD WOODBURY, MN 55125 Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00394 Transaction Number: SR -00394-43C20 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 2956 Paid by: Ed's Mechanical, 1491 County Hwy C, Washburn WI 54891 Payment Type: Check Transaction Date: 4/24/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit.