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Ba field Count
Soil Test # /2 _a /
Y Y
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1 -1 0(d))
I EDWARD J WROBLEWSKI 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.
nENT
Property Owner BETA M BODIN REV TRUST Contractor ED'S MECHANICAL LLC
Property Address 78795 BODIN RD
WASHBURN WI 54891
Telephone 715-209-7604
Accurate Legal Description is requested:
Authorized Agent EDWARD J WROBLEWSKI
Agent's Telephone 715-209-4055
Written Authorization Attached: Y or NO
NE 1/4 of NE 1/4 Section 21 Township 49 N. Range 04 W. Town of BAYVIEW
Additional Legal Description: ALL OF GOVT LOT 1 W OF RR IN 2022R-596888 187C
Govt. Lot Lot 1 Block
Lot CSM# Vol
Subdivision
Page CSM Doc #
Volume Page of Deeds Tax I.D# 6535
Acreage 8 51
Indicate reasoning for your determination: CLAY SOILS & EVIDENCE OF SEASONAL GROUNDWATER
fmilci /
Signature ofCounty.Offiicial
I W.II "IJr1r11Xn
Date
Signature of Certified Soil Tester
Date
RECEIVED
AUG 087076
SP -72000013
Certification #
(Submit a Plot Plan & Fee)
u/forms/so i Ite stwa iver(K LK)
June 2018
;F.rld ^o.
pastsavianio Ager y
EDWARD J. WROBLEWSKI, CST #SP -72000013
N
SOIL TEST PLOT PLAN
BETA M BODIN REV TRUST
78795 BODIN RD
RN, WI 54891
WAALL
ALL OF GOVT LOT 1 W OF RR IN 2022R-5968881870
OF
S21 T49N R04W
N
G
TOWN OF BAVVIEW, WI
-.
N
SCALE 1"=60'
Co
a>100'TONORTHLOTLINE
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0
Ct'
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CD
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'C
I00' WEST LOT LINE
SHEET 2OF 2
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BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
Submit the Following (Use Permanent Ink):
j� Check List
❑i Index Page / Title Sheet (Optional)
Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers)
>I Original Plot Plan
Li 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
Property Owner's Information (not prospective buyer's name)
Property Location (Accurate Legal Description with Sec/Twp/Range)
I Road Name (where driveway is/will be coming off of)
❑ Floodplain Elevation, Flow Rate, Comments and Recommendations
❑ Complete Soil Boring / Pit Information
Date Soil Evaluation was conducted
vl CST Name, Signature, Number, Address and Phone Number
I *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
❑ Bench Mark (Description, Elevation and Location)
O Contour Lines (Example = 98.0' /96.0' /94.0')
QJ Property Location (Sec/Twp/Range/, Accurate Legal Description)
t l Borings (Locations and Elevations)
O Percent and Direction of Land Slope
A Well Location (Including Neighboring Wells, if applicable)
❑ Location of Wetland Areas, Floodplain and Navigable Waters
`I Buildings, Driveways, and Structures (Location and Descriptions)
Location of Property Lines
Existing System Location
Address Number and Road Name
❑ Current Surface Elevation of Wetlands and Navigable Waters
). CST, Owner and Property Information
North Arrow
RECEIVED
AUG 062026
Bayfield Co.
Planning and Zoning Agency
Fee:
QI Certified Soil Tests - Review & Filing Fee $ 50.00
U/forms/sanitary/checldist/checkl istforests
B-4YFIELD
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:
BODIN REV TRUST, BETA M SR -00484
78795 BODIN RD
WASHBURN, WI 54891 Transaction Number:
SR -00484-4C144
Description Amount
Certified Soil Tests - Review & Filing Fee $50.00
Total: $50.00
Payment Amount: $50.00
Reference: 3064
Paid by: Ed's Mechanical, 1491 County Hwy C, Washburn WI 54891
Payment Type: Check
Transaction Date: 8/14/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.