HomeMy WebLinkAbout64-26JUN 16 2026
BaYfietd Co.
planning and Zoning A9 Waiver of
a
SR-ooggr
Soil Test # _a
Bayfield County T tP
Thorough Soil & Site Evaluation
(subject to 15-1 -1 0(d))
a A 1/ a,//t F's) RC) S d 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 needed to make such a
determination.
Property Owner �/ e n J 0 `1 Cr v S /1� -i—S o i
Property Address7 3 D SJc +c / /3
Contractor_
Authorized Agent
Agent's Telephone
Telephone -7 1 5 q/ 3 7 z w Written Authorization Attached: Y or N
Accurate Legal Description is requested:
52 1/4 of S t1/4 Section 3 a Township S O N. Range W. Town of i e r LJ h j
Additional Legal Description: Q) Z C U
Govt. Lot Lot Block Subdivision
Lot CSM# Vol. Page CSM Doc #
Volume Page of Deeds Tax I.D# Acreage
Indicate reasoning for your determination: 3 S r c' 3 —ID c: c N1
s
7
Signature of CountOfficial
(,7/I/�6
Date
O
Signature of Certified Soil Tester
ip-l— Z lG
Date
Certification #
(Submit a Plot Plan & Fee)
u/form s/solltestwaiver(KLK)
June 2018
aw,iero Ltgo.l De.scr,pfsert
C12'n do, 0sIar^Sol1 se4 ce4 Scc3°T-5 N 9KW
7f3D cf Cie 1-fa.JL�(3 w2ea''
{ c'v + wr r L,1sv'k6'0wn of v Por%�• •j
I.
tb 2b7
G
Tj
LCLat
Ct-r
Zeo
7Q30 5+r b -I wy13
40l�rwef i 7sll�iYiee.�'s'.1( f21rn, SE4eit.k5 CsPs.3an)
Above 1i. c.( cl vetiJF
u;e)l
i3�ow.S.�,k an 1,11: Cc r.=
' d31 vPp rl�f le®.or
,=s=ra: 5ck Ne PvC w/ -Flow 4 7rekAe,w =
N As'sr1 D 7b"S�tp�oevtcaI p.PE wte tar,e_l �,l
e'!" 0Ccramm5;, A'
o r Seal Ber'r�u! . N
sic s l t o l= qe .. less n e 4e d.
Ntctvcs+ RA: .Sfim'r+e Hwy /3
- cc gallon w. csev cencv-e4C iankt
it "L-ro'L"u! 143" ¢ren.1 bmtter✓1 of
fete k •1'e rjow n.e, in) t+.
Sta
`/ 13
He 107 aiy,Ttet k Icel117aAEt Ic J
,vitanu.tLJ QsIec(;I/7dzm .t iyip�
nv& �J113y o r1,i'R,S'.22eog0
Rt.t3oK S2 -Z
Xv en hruev; wr Sy8Y7
BAYFIELD COUNTY FZ*L-CE)VED
CHECKLIST FOR CERTIFIED SOIL TESTS
JUN 16 2026
Submit the Following (Use Permanent Ink):
Bayfield Co.
Planning and Zoning Agency
21 Check List
fib Index Page / Title Sheet (Optional)
10 Original Soil Evaluation Report (Submitted in Deed Holders. Name — not prospective buyers)
fd Original Plot Plan
❑ Cross Section Soil Profile Sheet (optional)
❑ Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
® Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
L✓I Property Owner's Information (Aot prospective buyer's name)
10 Property Location (Accurate Legal Description with Sec/Twp/Range)
f✓J Road Name (where driveway is/will be coming off of)
Z Floodplain Elevation, Flow Rate, Comments and Recommendations
! Complete Soil Boring / Pit Information
m Date Soil Evaluation was conducted
i CST Name, Signature, Number, Address and Phone Number
0 *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
d Bench Mark (Description, Elevation and Location)
d Contour Lines (Example = 98.0' /96.0' /94.0')
t>n Property Location (Sec/Twp/Range/, Accurate Legal Description)
0 Borings (Locations and Elevations)
16 Percent and Direction of Land Slope
LI Well Location (Including Neighboring Wells, if applicable)
61 Location of Wetland Areas, Floodplain and Navigable Waters
Z Buildings, Driveways, and Structures (Location and Descriptions)
E6 Location of Property Lines
IKE Existing System Location
Z Address Number and Road Name
9 Current Surface Elevation of Wetlands and Navigable Waters
21 CST, Owner and Property Information
1 North Arrow
Fee:
d Certified Soil Tests - Review & Filing Fee $ 50.00
U/forms/sanitary/checkllst/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:
GUSTAFSON, CLENDON W
7830 STATE HWY 13
PORT WING, WI 54865
Description
Certified Soil Tests - Review & Filing Fee
Submission Number:
SR -00445
Transaction Number:
SR -00445-4809D
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 6321
Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847
Payment Type: Check
Transaction Date: 6/19/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.