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Home My WebLink About52-26SR..-ooHYt, Soil Test # Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I Keith Wiley a certified soil tester determine that in my professional 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 nee to make such a determination. /'ENTERJJ �6/l/ad Property Owner John M. & Margarette A. Broberg Contractor Property Address 89025 Bark Point Rd Authorized Agent's Telephone Telephone 715-817-2400 Written Authorization Attached: Y or N Accurate Legal Description is requested: 1/4 of 1/4 Section 27 Township 51 N. Range 07 W. Town of Clover GITCHE GUMEE SHORES LOT 1 CSM #1880 IN V.11 P.118 Additional Legal Description: (LOCATED IN LOTS 12- 14) IN DOC 2019R-577833 Govt. Lot Lot Block Subdivision Lot I CSM# 1880 Vol. 11 Page 118 CSM Doc # 2019R-577833 Volume Page of Deeds Tax I.D# 04-014-2-51-07-27-4 00-177-10000 Acreage 3.050 Indicate reasoning for your determination: Saturated soils within 6" of ground surface. ouh 012026 SayOeta co. Pwnnino end zoning Agency v/ t I oc3 Signature of ounty Qifficial Date Signature of Certified oil Tester 5/25/2026 Date 654921 Certification # (Submit a Plot Plan & Fee) u/forms/soiltestwa iver(KLK) June 2018 Wisconsin Department of Safety & Professional Services fi % Division of IndustryServices SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north avow, and location and distance to nearest road. Please print all Information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Page 1 of 2 County Bayfield Parcel I.D. 04-014-2-51-07-27-4 00-177-10000 Reyiewed b`. . r IWI -S , Date Property Owner Property Location ❑ John M. & Margarette A. Broberg Govt. Lot ''A ''A S 27 T 51 N R 07 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 66130 W Iron Lake Ln GITCHE GUMEE SHORES LOT1 CSM #18801N V.11 P.118 City, State, Zip Phone Number ❑ City ❑ Village Town Nearest Road Iron River. WI 54847 ( 715 1 817-2400 clever 89025 Bark Point Rd n New Construction Use: Residential/Numberofbedrooms 6 Code derived designflow rate 900 GPD 9 Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable N/A ft. Parent material Sally lacushne or oulwash deposits overlying loamy lecusinne or till deposits (losco series) General comments and recommendations: Soil saturated to ground surface. A+0 conditions. Holding Tank recommended. H Boring # ❑Boring ® Pit Ground surface elev. 108 ft. Depth to limiting factor 0 in. / elev. 108 ft. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Cu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 'Eff#1 'Eff#2 1 0-6 10YR3/2 — Is 0Sg ml as 1m/2vf 0.7 1.6 2 6-12 5YR 3/2 c2p 7.5YR 5/8 S Osg ml aw 1f/lvf 0.7 1.6 3 ' 12-20 5YR 3/4 c2d 7.5YR 5/6 S Osg ml — — 0.7 1.6 H2O seeping into it at 15" ❑ Boring # ❑Boring ® 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 E C n unvrrr•�sur CST Name (Please Print) Signature CST Number Keith Wiley 654921 Bayeid Go Address Date &atuation Conducted Telephone NumberPlammn 11623 E Larson Dr. Lake Nebagamon, WI 54849 5 S _2.C I 218-451-2611 ' Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L ' Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L SBO-8330 (R03/22) Broberg (6 bedroom) Soil Report Plot Plan North �� Scale 1:60 - r NOTES: * Bench Mark = Top of well Elev = 100.0' 14- i o N Q iii t om N v ''11 �Y o(. N O. a - Lake Superior elev x 40' CST 119900002-SP 1990000002-SP Page 2 of 2 John M. & Margarette A. Broberg BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 12' Check List ❑ Index Page / Title Sheet (Optional) 9' Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) ' Original Plot Plan O Cross Section Soil Profile Sheet (optional) O Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) 1' Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used (2'Prooerty Owner's Information (not prospective buyer's name) 9 Property Location (Accurate Legal Description with Sec/Twp/Range) V Road Name (where driveway is/will be coming off of) V Floodplain Elevation, Flow Rate, Comments and Recommendations V Complete Soil Boring / Pit Information 1' Date Soil Evaluation was conducted I 'CST Name, Signature, Number, Address and Phone Number U' *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) lVBench Mark (Description, Elevation and Location) ItQ'Contour Lines (Example = 98.0' /96.0' /94.0') 'Property Location (Sec/Twp/Range/, Accurate Legal Description) E' Borings (Locations and Elevations) [D'Percent and Direction of Land Slope V Well Location (Including Neighboring Wells, if applicable) V Location of Wetland Areas, Floodplain and Navigable Waters 9 Buildings, Driveways, and Structures (Location and Descriptions) EYLocation of Property Lines 12' Existing System Location VAddress Number and Road Name U' Current Surface Elevation of Wetlands and Navigable Waters E2' CST, Owner and Property Information ID' North Arrow Fee: VCertified Soil Tests - Review & Filing Fee $ 50.00 � cE1VED JUN 01202E Bayfield CO. planning and Zoning Agency U/forms/sanitary/checklist/checklistforests B^YFIELD 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: BROBERG, JOHN M & MARGARETTE A SR -00428 66130 W IRON LAKE LN IRON RIVER, WI 54847 Transaction Number: SR-00428-47AED Description Amount Certified Soil Tests - Review & Filing Fee $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 1104 Paid by: Coyote Septic Works LLC, 11623 E Larson Dr, Lk Nebagamon WI 54849 Payment Type: Check Transaction Date: 6/ 12/ 2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit.