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Home My WebLink About36-26SOILTEST PageIof�— U # 3�'a� cover) M V 07 Zp26 SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County �a Attach complete site plan on @a1t`�� y 8 112 x 11 inches in size. Plan must include, •{r but not limited to vertl'g4ltanu "eti3H4val�a e)erence point (BM), direction and percent slope, PreS I.D. p / scale or dimensions, north arrow, and location and distance to nearest road. p 6 Please print all information. gvipwetj gytil1i -$7 12 u / Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location ❑ A JOY, X20. Govt. LotNw1/.S 1/.S I Ty-] N R E(or)W Property Owner's Mailing Address Site Address or CSM and Lot #: City, State, Zip I Phone Number I ❑ City ❑ Village ® Town I Nearest Road New Construction Use: pv Residential/Numberof bedrooms, Code derived designflow rate 4f SO GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material sun Tai&c loc1WVI0.l W. 05IT5 General comments and recommendations: fl Boring Boring # Pit Ground surface elev. 9,ft. Depth to limiting facto, 9 U 7 nin. / elev.ft. I SoilAnnl Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 •Eff#2 I 0-4 SR 1 - ( ml C -S 2-C , 2 -1 - r c S 3 a- - cs l - I 7 Boring # ❑Boring eO� [Pit Ground surface elev.l .J ft. Depth to limiting factorBin. / elev9,ft. Snil Annlirafinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 •Eff#2 I -S s 3 - l cs a s-ta syg4ig— S 1. 3 V-23 S CcS IrncbIc— CST Name (Please rint) Toth Signature CST Number llo68-S-r os a Address SI C -7-i (,{.w% tt�v. RR,r Date Evaluation Con ucted -z Telephone Number Ia-9668 ti', -a (f- * Effluent #1 = SOD > 30 5 220 mg/L and TSS > 30 5150 mg/L • Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L SBD-8330 (R03/22) Page.. of ❑ Boring o 9 Boring # Pit Ground surface elev. { (_ft. Depth to limiting factor$O__in. / elevq. 7ft. 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 — i 1'.. . 1, 6 2. r S . <r 24 .6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Annlication 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. I Soil Annlication 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 > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L * Effluent #2 = BOO, ≤ 30 mg/L and TSS ≤ 30 mg/L RECENED MAY 07 2026 PAGE 2 OF 4 Baytld Co. planning a Soil Evaluation Site Map System Plot Plan In -Ground Soil Absorption for POWTS Version 2.1 Owner: Jon Shea Site Address: 6570 Iron Lake Rd Iron River, WI 54847 Tax ID: 38865 Legal Description: NWSE S13-T47N-R09W LOT 2 CSM #2245 IN V.13 P.79 AS DOC 2022R-595874 (LOCATED IN NW SE & SW SE) IN DOC 2022R-597108 Town of Hughes, Bayfield County, WI Soil Evaluated By: Tony Polkoski Certified Soil Tester 11068 -ST Licensed Master Plumber: Allan Polkoski - PMRS 220090 0 100 200 ft V V N C] Suitable Absorbtion Area o Soil Borings: SB1 - Elevation 98.9' SB2 - Elevation 98.5' SB3 - Elevation 98.4 A Benchmark -Screw in 4"x4" Post Elevation 100' No Existing Wells on Property 'SB3 // SBi RECEWED BAYFIELD COUNTY 0 /2026 CHECKLIST FOR CERTIFIED SOIL TESTS Co. SubmitIte0x owing(Use ®wino'- Use Permanent Ink SI Check List 1] Index Page / Title Sheet (Optional) QI Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 50 Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) TAX U-Wam t Identification Number (must bedigit Tax ID#) DO NOT USE 12 digit, they are no longer being used �[1 Property Owner's Information (not prospective buyer's name) t Property Location (Accurate Legal Description with Sec/Twp/Range) �l Road Name (where driveway is/will be coming off of) ❑ Floodplain Elevation, Flow Rate, Comments and Recommendations lla Complete Soil Boring / Pit Information Q Date Soil Evaluation was conducted VI CST Name, Signature, Number, Address and Phone Number 00 *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) Bench Mark (Description, Elevation and Location) Qd Contour Lines (Example = 98.0' /96.0' /94.0') 'I l Property Location (Sec/Twp/Range/, Accurate Legal Description) CA Borings (Locations and Elevations) �D 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) l Location of Property Lines ❑ Existing System Location Address Number and Road Name ❑ Current Surface Elevation of Wetlands and Navigable Waters It CST, Owner and Property Information 40 North Arrow Fee: ('Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/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: SHEA, JON R & GENIA M SR -00407 7925 STAPLES AVE IRON RIVER, WI 54847 Transaction Number: SR -00407-45436 Description Amount Certified Soil Tests - Review & Filing Fee $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6307 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.