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Soil Test #
Bayfield County ��YY oG
Waiver of a Thorough Soil & Site Evaluation RECEIVED
ip
(subject to 15-1 -1 0(d)) APR 10 2026
l EDWARD J WROBLEWSKI a certified soil tester determine that in myFWAf, A
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 KOREY J LEMKE
Contractor ED'S MECHANICAL LLC
Property Address 3124 COUNTRY RUN DR Authorized Agent EDWARD J WROBLEWSKI
Telephone
APPLETON, WI 54914
920-737-4287
Accurate Legal Description is requested:
SE 1/4 of NW 1/4
Additional Legal Descri
Agent's Telephone 715-209-4055
Written Authorization Attached: Y or NO
Section 20 Township 51 N. Range 05 W. Town of
BAYFIELD
PAR IN SE NW& NE NWN OF HWY 13 IN V.112 P907 LESS PAR FOR HWY INV. 515 P. 384 806A
Govt. Lot
Lot
Block
Subdivision
Lot
CSM#
Vol.
Page CSM Doc #
Volume
Page
of Deeds
Tax I.D# 5494 Acreage 5.26
Indicate reasoning for your determination: CLAY SOILS
Signature of Cou y Offycial
Date
Signature of Certified Soil Tester
y a 27
Date
SP -72000013
Certification #
(Submit a Plot Plan & Fee)
u/forms/so iltestwa iver(KLK)
June 2018
RECEIVED
APR 102026
Bayfield Co.
Planning and Zoning Agency
EDWARD J WROBLEWSKI CST #SP -72000013
SOIL TEST PLOT PLAN
KOREY LEMKE
26510 STATE HIGHWAY 13
BAYFIELD, WI 54814
PAR IN SE NW & NE NW N OF HWY 13
S20 T51 N R05W
TOWN OF BAYFIELD, WI
SCALE: 1" = 40'
Existing Septic Tank
Lot Line >
4 -
Lot Line> 100' T
BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
RECEIVED
Submit the Following (Use Permanent Ink):
APR 10 2026
] Check List
/❑\Index Page / Title Sheet (Optional)
❑ Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers)
Original Plot Plan
❑ Cross Section Soil Profile Sheet (optional)
❑ Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
Bayfield Co.
Planning and Zoning Agency
%'Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
Property Owner's Information (not prospective buyer's name)
Property Location (Accurate Legal Description with Sec/Twp/Range)
Road Name (where driveway is/will be coming off of)
❑ Floodplain Elevation, Flow Rate, Comments and Recommendations
O Complete Soil Boring / Pit Information
zI Date Soil Evaluation was conducted
XCST Name, Signature, Number, Address and Phone Number
9*Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
❑ Bench Mark (Description, Elevation and Location)
❑ Contour Lines (Example = 98.0' /96.0' /94.0')
Property Location (Sec/Twp/Range/, Accurate Legal Description)
Borings (Locations and Elevations)
O Percent and Direction of Land Slope
Well Location (Including Neighboring Wells, if applicable)
❑ Location of Wetland Areas, Floodplain and Navigable Waters
Buildings, Driveways, and Structures (Location and Descriptions)
Location of Property Lines
Existing System Location
Address Number and Road Name
❑ Current Surface Elevation of Wetlands and Navigable Waters
A' CST, Owner and Property Information
,North Arrow
Fee:
.C? Certified Soil Tests - Review & Filing Fee $ 50.00
U/forms/sanitary/checklist/check istforcsts
B 41YFIELD 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:
LEMKE, KOREY J
3124 COUNTRY RUN DR
APPLETON, WI 54914
Description
Certified Soil Tests - Review & Filing Fee
Submission Number:
SR -00395
Transaction Number:
SR-00395-43C3E
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 2954
Paid by: Ed's Mechanical, 1491 County Hwy C, Washburn WI 54891
Payment Type: Check
Transaction Date: 4/27/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.