Loading...
HomeMy WebLinkAbout102-26I Soil Test # Bayfield County f Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) 1• A 1/ 'Wi 1,C) � t'�-©5 /� t 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 neededto make such a _ determination. O"EINTE ( JUL Property Owners e G (ter `t// V. Contractor Property Address ) I 1D (4, 17&_'y I3 Authorized Agent r j ( e d Z L, Aaent's Telenhone Telephone 7 / S^ 4 `/ 9 - C' &" S3 Written Authorization Attached: Y or N Accurate Legal Description is requested: 1/4 of S k' 1/4 Section 3! ( Township N. Range % W. Town of 0 +' • �• / 9 Additional Legal Description: Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# Z 4 Z / G( Acreage Indicate reasoning for your determination: C �-f Se, I c (LI <, , o,m � p Cr1 04'��i /37 9 Signature of Count Official y71 � Date Signature of Certified Soil Tester —I i- z4- Date Certification # (Submit a Plot Plan & Fee) u/forms/soiltestwa iver(KLK ) June 2018 �s � Wisconsin Department of Safety and Professional Services \' a DivisionoflndustryServlces I SP SOIL EVALUATION REPORT Yd4s" In accordance with SPS 385, Wis. Adm. Code County cc t 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, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 1. et Please print all information. Reviewed by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)) P.rm�p�'2Ll Cry Owner r �_ Property Location LJ II t�✓- L c Govt. Lot /'JI(/Y, ,S t J % S 3 / T N R 7 E (or to Property Owner's Mailing Address Site Address or CSM and Lot #: / o L vcr� rccs Lh City I State I Zip Code I Phone Number ❑ City Y Village ® Town Nearest Road Pagel of3... I I Date NewConstruction Use: Residential/ Numberof bedrooms Code derived designflow rate /.SCGPD Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable ft. Parent material4-/cc., c., 4l T; iI General comments and recommendations: (I /C J {-I G ' ✓l ''7'z % is C yr Ity Boring # ❑Boring �Plt Ground surface elev.ft. Depth to limiting factor in. / elev.ft. '22026 r Horizon Depth In. Dominant Color Munsell Redox Description Cu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDiEt2 `Eff#1 •Eff#2 I b1 10Y133 t frJoNC L OW1 MJ.r qS Ia . Z .2r- -167g-'cc-izvu crs7nJ.F C cm /h e i - v '0 .0 fl Boring # Boring f' Plt Ground surface elev. ft. Depth to limiting factor in. / elev.ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 E##1 Eff#2 CST Name (Please Print) ,TO / All ' Signature , CST Number t�b� r n I o.t J�C ` Z2-0090 Address ., D. BG R SQL vcrt RtItv teUX S'{f+f Date Evaluation Conducted —( z Telephone Number • Effluent #1 = SOD > 30 5 220 mg/L and TSS > 30 5150 mg/L • Effluent #2 = DOD, s 30 mg/L and TSS 5 30 mg/L SBD-8330 (R04/21) Boring # ❑ Boring �{] Pit Ground surface elev. ft. Page of Depth to limiting factor In. I clay. 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 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev._ft. Depth to limiting factor In. / elev. ft. Still Annlicatlnn P.ta 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 , _LULU lu Go. PiLmmfl9 an.l LU{LlYFJC1Y .� ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev.ft. Snit Annllnatinn Rat. 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 Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOO, 5 30 mg/L and TSS S 30 mg/L °r^cfetr "y ®wrier: rr c I Feld "C' I .1r , q 03 eEJe.vci veevi LaI 3 . I e Z S"t(?zo rZip 26 z /? Leol bcscvl7`f erta Tl x; Sal y Scc31 TON RC) W Tswn ®f; Dv,en4e, eew.t4yof i31y•(-%elA a e -f 6cArnnsa -t- a Soi 1 Bor;nt�,!'; IV Scnc e; 1 = tl a a, le.$s m a -¢t d Ntte + R9: c -'I -y H y 5 r Z'.20cc gallon w:eser• conctre4t10.CIkt 9"wF$1311¢torrl6ttor1of T&nk Pe Ftciv d.e in1E1 A- I3ob �v vI f5 :a SlI oo �; �, c ! 1- O c+ ' x yll II atla a r °QQ" 30 v,y • 00 4 V`' H nning aw ZuiunH,�ger y jj IN vF 4 -}, 3 sl v C?y`ht w Co u 1�+yLJttd -'--� 16aC Jeanit {aie@.Ty eq.11 nu'. sc,4LnC(C.S 3 ps es) ALatc-C;..ca ( cf v -cycle rlo vJet(ye4 tJaI;e¢"tfl4 it Baliv2P=Ele /Co.o' M'•d1STf1 D 17 t`✓'- ctpp re (a. pt nieLtl vtetI J'l e Id oi9` t..i k ccn,)9&tEf Nl nu.et/ use_el;llle�n as 1' I;Ra.j)a caa�a/ tiLA2® 7) lJv a a 3 rt fir o PAPR-5 aZeogo ?e ll«s de, Ph. att b, rtes e2°{„C3®-K 52.2 J Sro+1 Alivev; w: cveY% BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): d Check List m Index Page / Title Sheet (Optional) JUL 2 2 202E m Original Soil Evaluation Report (Submitted in Deed (folders Name - not prospective buyers) 16 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 El Property Owner's Information (riot prospective buyer's name) ® Property Location (Accurate Legal Description with Sec/Twp/Range) m Road Name (where driveway is/will be coming off of) EEl Floodplain Elevation, Flow Rate, Comments and Recommendations d Complete Soil Boring / Pit Information fb Date Soil Evaluation was conducted 0 CST Name, Signature, Number, Address and Phone Number ❑ *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) d Bench Mark (Description, Elevation and Location) i Contour Lines (Example = 98.0' /96.0' /94.0') fi0 Property Location (Sec/Twp/Range/, Accurate Legal Description) 0 Borings (Locations and Elevations) LJ Percent and Direction of Land Slope lil Well Location (Including Neighboring Wells, if applicable) L6] Location of Wetland Areas, Floodplain and Navigable Waters m Buildings, Driveways, and Structures (Location and Descriptions) C✓J Location of Property Lines LET Existing System Location m Address Number and Road Name d Current Surface Elevation of Wetlands and Navigable Waters El CST, Owner and Property Information L6 North Arrow Fee: El Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checkllstforests B-4-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: FABIAN, FRED J JR 14032 EVERGREEN LN BRULE, WI 54820 FABIAN,SUSAN V 14032 EVERGREEN LN BRULE, WI 54820 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00475 Transaction Number: SR -00475-4B341 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6336 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 8/3/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit.