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,SP nAnC SOIL EVALUATION REPORT
MAY 01 LULU
- .,; "� In accordance with SPS 385, Wis. Adm. Code
Attach complete site plan on g,( 1 /2 x 11 inches in size. Plan must include,
but not limited to vertid 11ri?!ai r fe?ence point (BM), direction and percent slope,
scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information.
'ersonal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)).
186 7 2 -
by r Date
Property Owner LL Property Location \..J \../ Ii
Ii Li
Br pQ Govt. Lot & Y. Y. Say T y, N R C1 E (oqp
Property Owner's Mailing Address Site Address or CSM and Lot #:
a991 Covn SNW 70Skotltn Rd Zrov'Rh7eI w2 Sy9y
City, State, Zip Phone Number ❑ City ❑ Village I2 Town Nearest Road
Anhatltlo.Ie./AAI SS3o2 (3araaA4-8480 Wt.at,p_S koll,,n4 RdI
N]NewConstruction Use: Residenflal/Numberofbedrooms� Code derived designflow rateH SQ GPD
❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft.
Parent material 50..'.NA4 — 1-1
General comments and recommendations: ENTEPW
Boring# ❑Bodng
nati
Pit Ground surface elev 71ft. Depth to limiting factor I OD in. I elevo.1 ft.
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
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415
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® Boring #
❑Boring ®u.� B
Pit Ground surface elev.11 l R. Depth to limiting factor in. / ele R.
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
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CST Name (Please Print)
TonPo l Ko s k
I Signature]
CST Number
J 1
Address SI I S GTy %* IV B
Ri wts494
Date Evaluation Conducted
4 -a1 -a6
Telephone Number
Z o ar
218-39 -7095
Effluent #1 = BOO' 30 5 220 mg/L and TSS > 30 5150 mg/L ' Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L
SBD-8330 (R03/22)
Page a of
Boring #
❑ Boring
] Pit Ground surface elev%Xft.
Depth to limiting factor 0O in. / elevO8.. ft.
Soil Aoolication 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
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❑ Boring # Boring
❑ —
❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev, ft.
Soil Aoolication 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
❑ Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft.
Soil Aoolication 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
* Effluent #1=BOD> 305220 mg/L and TSS > 30 ≤150 mg/L * Effluent #2 = BOO, s 30 mg/L and TSS 530 mg/L
I
Soil Evaluation Site Map
Owner: Bryn Hagberg
Site Address: 6705 Kolling Rd, Iron River, WI 54847
Tax ID: 18672
Legal Description: A part of Government Lot Six (6) in Section Twenty-four (24), Township Forty-seven (47) North, Range Nine (9) West,
Town of Hughes, Bayfield County, Wisconsin, more particularly described as follows: Commencing at the 1/16 section corner in the SE 1/4
of the aforesaid section; thence South on the 1/8 section line, 8.685 chains to iron pipe driven in the North side of large white pine stump;
(herein designated as point A); thence continuing South on the 1/8 section line, 6 chains to the shore of Iron Lake, the point of beginning;
thence return to Point A; thence East 1/5 chains; thence Southeasterly on deflection angle of 1118, 1 '/2 chains; thence Southwesterly on
deflection angle of 85'27', 5.68 chains to Iron Lake; thence Westerly along the shore of Iron Lake to the point of beginning.
0 25 50 ft A
N
RECEIVED
MAY 012026
BayfeId Co.
Planning and Zoning �x sf'n9 Drainhald
IBM® 700
ro ° 9g
n'
SB2° 96
92 g4 S63
m A Benchmark:
Screw in oak tree
Elevation 100'
K. o Soil Borings:
SB1 - Elevation 96.65'
SB2 - Elevation 94.46'
SB3 - Elevation 96.48'
well Property Line
Garage Existing
®Septic Tanks
Soil Evaluated By:
Tony Polkoski - CST #11068
Iron Lake
Elevation 73.45
RECEIVED
I'ig 0 12026 BAYFIELD COUNTY
aay1eldCo. CHECKLIST FOR CERTIFIED SOIL TESTS
Planning and Zorim9 Agenc
Submit the Following (Use Permanent Ink):
9 Check List
❑ Index Page / Title Sheet (Optional)
I¢1 Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers)
0I Original Plot Plan
❑ Cross Section Soil Profile Sheet (optional)
❑ Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
TAlc ,S
MaPareel Identification Number (must be-23digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
IT Property Owner's Information (not prospective buyer's name)
X Property Location (Accurate Legal Description with Sec/Twp/Range)
X Road Name (where driveway is/will be coming off of)
O Floodplain Elevation, Flow Rate, Comments and Recommendations
;l Complete Soil Boring / Pit Information
El Date Soil Evaluation was conducted
X CST Name, Signature, Number, Address and Phone Number
56 *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
&l Bench Mark (Description, Elevation and Location)
Is 1 Contour Lines (Example = 98.0' /96.0' /94.0')
5l Property Location (Sec/Twp/Range/, Accurate Legal Description) 4
Ql Borings (Locations and Elevations)
N Percent and Direction of Land Slope
X Well Location (Including Neighboring Wells, if applicable)
Vl Location of Wetland Areas, Floodplain and Navigable Waters
1Q Buildings, Driveways, and Structures (Location and Descriptions)
6(I Location of Property Lines
XI Existing System Location
III Address Number and Road Name
1W Current Surface Elevation of Wetlands and Navigable Waters
1$ CST, Owner and Property Information
North Arrow
Fee:
$I Certified Soil Tests - Review & Filing Fee $ 50.00
U/farms/sanitary/check] ist/checklistforests
B'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: Submission Number:
HAGBERG, BRYN SR -00402
2847 COUNTY RD 5 NW
ANNANDALE, MN 55302 Transaction Number:
SR -00402-457D8
Description Amount
Certified Soil Tests - Review & Filing Fee $50.00
Total: $50.00
Payment Amount: $50.00
Reference: 6304
Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847
Payment Type: Check
Transaction Date: 5/12/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.