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Home My WebLink About78-265r.', � WiisconsinDepartmentofSafetyandProfessional Services I Q Page of rxl d Division of Industry Services _ �1 G I N !'I 13PS `' SOIL EVALUATION REPORT S�IL TEST # 7S( " 6t 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 arrow, and location and distance to nearest road. Please print all informatio rsonal information you orovide may be used for secondary ihhtua ai lPrivacy Law, s. 15.04(1)(m)). it Property Location LJ la fz ctot s e L[ C Govt. Lot '/. ''h S /9 T VV N R O, E (or) W Property Owner's Mailing Address SiteAddress or CSM and Lot #:p!'//!'fit"! hor /n •!2s O1,'! -, r 3S 4r3.PcarV.3 /'•33 ro%Zd City State I Zip Code I Phone Number ❑ City )❑ Village Town Nearest Road Sf9/c•� /Yilrtntee.49 '' r NA/ 3SYo( ) fJU/HC_T SoctftsAc/e Cd ®. New Construction Use: Residential/ Numberof bedrooms Code derived designflow rate /So GPD ❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable ft. Parent material 6 6.4, / (7c. TkF4 r4 General comments and recommendations: Qk .tk `/* w/r•y' /Y{`rt f or Tan tt "• C p`• 7 / 1 Boring# ❑Boring I I Ground surface elev. ,2_7. Depth to limiting factor ___in. / elev. 9? _7 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/Ff •EN#1 •Eff#2 O -G ,S- r � 1-5 2'i. 6r !pt v re /14c/ /cov . 7 3 2 7-3 6 7, re V/ 1r≤ 0- b- L w `fi F• /• 6 y 3- .z s # 1 $ e- sG s,t — 7 aBoring # ❑Boring Qq ®Pit Ground surface elev. fl 71t. / ft. Depth to limiting factor /O in. / elev.�d'7.At. 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 6-b Z.fl-c2 S .Z.,, r mvP.C b sty /.pr ,.7 /•6 2. G`2-4 ?.r �3 .4s 2,,,,-4j. /t*vs &,c-' "te .7 /•L ?z-3$?$/QV/9 v SSG htt !mow /'G if 'S+' — •7 /.L _3J2O?ryAtk CST Name (Please Print) Signature..,^ ../ CST Number Planning and Zoning Agency S�O/l�IOO[> /• `i ocko Address !i 2749 /30-'o%9d d t'(. ' Date Evaluation Conducted/ ?os Telephone Number Cm6/e u S-6rs'1 r (p .� • Effluent #1 = 8OD >30 5 220 mg/L and TSS > 30S150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS £ 30 mg/L SBD-8330 (R04/21) Page of 3 Boring # ❑ Boring SPit Ground surface elev.'9• ! ft. Depth to limiting factor//0 in. I elev. ci M. Soil Aoplication 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 0-7 2•rYe CS -2.364 kf-'Foe Ski [Court /G 2 -i2 ?si94 L s J'sr emu= -7 z -So . S) -E S O- v 6' aF .6 co -/.?o ?•s 4' s U -sue kr — /•/o ❑ Boring# ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev.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/Ft2 *Eff#1 •Etf#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. 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/Ft2 'EfI#1 'Eff#2 Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30' 150 mg/L cxrs/_ oI2 Imo/ ?s Effluent #2 = BOD, 5 30 mg/L and TSS s 30 mg/L RECEIVED JUL 062026 Bayfield Co. Planning and Zoning Agency Scale / ' r Q' 3j2) w v/L 1'vglos / �a�• Ll Short O aoK 13n7To,oef �-x en's:/mo 13l 9q') OA 99.7 k'398.1 5row7i 42 fro /00 S"°"-' 'o sT 99.7 (joss, c GST 1V $4 P/c. 4 N I Like Pr/�g;7�G drri✓G mwn er ,{',ara Pause LL c .236y G<' .- A-vr,Yzic �4Y E:cfd w;. Tocvnoi Ea.,,c5 rtxr/#R'U S17 rqr r eCo9 +o Ar iK ( tr Lori/- v.1/.1S 7zE /'3SG (T3oI Lsw V3// .33) 49/OS— te�cT s orc RQ RECEIVED JUL ® d 2026 Bayfield Co. Planning and Zoning Agency BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): Check List O Index Page / Title Sheet (Optional) L7 -Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) PjOriginal Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) 2arcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used arooerty Owner's Information (not prospective buyer's name) Property Location (Accurate Legal Description with Sec/Twp/Range) e"Road Name (where driveway is/will be coming off of) ❑ Floodplain Elevation, Flow Rate, Comments and Recommendations 1Complete Soil Boring / Pit Information Date Soil Evaluation was conducted 2CST Name, Signature, Number, Address and Phone Number O *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) r3 Bench Mark (Description, Elevation and Location) Montour Lines (Example = 98.0' /96.0' /94.0') Z 2r Property Location (Sec/Twp/Range/, Accurate Legal Description) ?lcirings (Locations and Elevations) a PPercent and Direction of Land Slope Well Location (Including Neighboring Wells, if applicable) ' 2f Location of Wetland Areas, Floodplain and Navigable Waters �B;L ildings, Driveways, and Structures (Location and Descriptions) ocation of Property Lines ❑ Existing System Location Address Number and Road Name O Current Surface Elevation of Wetlands and Navigable Waters [rCST, Owner and Property Information t(oorth Arrow RECEIVED JUL 062026 Bayfield Co. Planning and Zoning Agency Fee: Eertified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforests I 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: KATZ PAUSE LLC, 2304 OLIVER AVENUE SOUTH MINNEAPOLIS, MN 55405 Description Certified Soil Tests - Review & Filing Fee Total: Submission Number: SR -00454 Transaction Number: SR-00454-497FF Amount $50.00 $50.00 Payment Amount: $50.00 Reference: 5476 Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832 Payment Type: Check Transaction Date: 7/9/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit.