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Home My WebLink About117-26('U--e:5P-00qF3 Wisconsin Department of Safety& Professional Servic3O1 L TEST # 1(7-2L Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, 4.7 but not limited to vertical and horizontal reference point (BM), direction and percent slope, i flaM4 I.D. scale or dimensions, north arrow, and location and distance to nearest road. TAX 1 33 So Page I of Z (OVet) Please print all information. Re i e 2 Date/ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). 3/I D Z11p; Property Owner Property Location ❑ Kv C-1 'i I 1 I -amt', C.4 ,IV T-JarneS Cifrq Govt. Lot A/ IF % A/ E ''/ S y T t{ 6 N R E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: Z E Sm S -r- 97So Icv%v-rSv,n Drive City, State, Zip I Phone Number ❑ City ❑ Village ® Town Nearest Road _ ..- __ ..r /'..t3 a .'.A.7..n 7 1 t.. 1T- L -- n _..— ❑ New Construction Use: IN Residential/ Number of bedrooms Code derived designflow rate _(000 GPD ® Replacement 0 Public or commercial —Describe: Flood Plan elevation if applicable ft. Parent material dtv O DePoSi'CS EMT General comments and recommendations: 6 b RECEIVED G fl'4 9f»a ( I Boring # V Donny W Pit Ground surface elev. Ib.ift. Depth to iimitircrjr78 / elev. I�ft. Planning and Zoning Agen cy Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 'Eff#1 -Eff#2 I O4 to R3 — IS r L 3co .--7 116 2- -I'4 7.Sy/4 — Ismv4r CS .'7 1.6 3 -78 SRS — 1 — .-7 1.6 Boring # Boring Pit [Pit Ground surface elev.ft. Depth to limiting factor 73 in. / elev.ra.� ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 *Eff#2 I -6 ,0YR3 - IS atjr r LS rn .? 1.6 Z - IS 9R3/ - 15 Cs 2w .7 1.6 3 -if 7.SYRs/ — S to - 14 1.6 CST Name (Ple se Print) ro1kock I Signature CST Number 11O6$ -5i - o Address $-t t c CT'( '4I lf: Date Evaluation Conducted Telephone Number o R's St{ 4 — -Z6 -3 1-70 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 SBD-8330 (R03122) Pay2__ of 2.- 3 Boring # ❑ Boring Pit Ground surface elev. r !' (ft. Depth to limiting factor 0 in. / elev.I I ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FF *Eff#1 'Eff#2 I 0- 0 P-3/? I 4r CS 1 r - I S ,S R3/y - I w „„ r.6 3 -Po 7.cvtc/4— 5 i4 t. 6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. R. Depth to limiting factor in. / elev. R. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color .Te ture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 `Eff#2 ❑ Boring ❑ Boring # ❑ Pit Ground surface elev. R. Depth to limiting factor in. / elev. R. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 Eff#1 *Eff#2 * Effluent #1 = SOD > 30 £ 220 mg/L and TSS > 30 £150 mg/L * Effluent #2 = BOO, 5 30 mg/L and TSS S 30 mg/L Combined Soil Evaluation Plot Plan - System Plot Plan Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 Owner: Cirilli Family Cabin Trust - James Cirilli Site Address: 9750 Knutson Drive, Iron River, WI 54847 Tax ID: 13350 Legal Description: NENE SO4-T46N-RO8W PAR IN NE NE IN V.537 P.109 LESS V.738 P.234 727 (CIRILLI FAMILY CABIN TRUST DTD 11/01/2024) IN DOC 2024R-605346 i Approx Property Line o Soil Test Pits: 1 - Elevation - 96.9' 2 - Elevation - 98.6' 3 - Elevation - 97.7' A Benchmark - Screw in Maple tree Elevation - 100' B Existing Well Ir--- I i Soil Evaluated By: Ton Polkoski - 11068 -ST {-�/lost; I Plumber: Allan Polkoski - PMRS 220090 ro County High y `_------ aY \o m I 0 50 100'ft Y i \\ 2 Trenches Quick 4 Plus\ S e� Standard Chambers t\ �yJsUn0 me°\ P e� sys\ eba°33 n 9z' \, 38563\\aio° 1o03 Tank - Wieser' W1250 -MR Filter - PolyLoc PL -525 a ,fit 111 Aide o a n 20 99' All piping shall conform to: SPS Table 384.30-3 SPS Table 38430-5 Frost Protection: SPS 382.30 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): R Check List • Index Page / Title Sheet (Optional) Z Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) l$ Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) R Tax Identification Number (must be 5 digitTax ID#) DO NOT USE 12 digit, they are no longer being used 0 Property Owner's Information (not prospective buyer's name) Z 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 D( Complete Soil Boring / Pit Information X Date Soil Evaluation was conducted * CST Name, Signature, Number, Address and Phone Number i* *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) X Bench Mark (Description, Elevation and Location) X Contour Lines (Example = 98.0' /96.0' /94.0') iD< Property Location (Sec/Twp/Range/, Accurate Legal Description) R Borings (Locations and Elevations) lZ Percent and Direction of Land Slope IWell Location (Including Neighboring Wells, if applicable) U Location of Wetland Areas, Floodplain and Navigable Waters CK Buildings, Driveways, and Structures (Location and Descriptions) R Location of Property Lines M Existing System Location X Address Number and Road Name 51 Current Surface Elevation of Wetlands and Navigable Waters CK CST, Owner and Property Information a North Arrow AUG 0,4 Plannin a9Yfieb ;. Fee: 1� Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/ch ecM ist/checM istforests B-AYFIELD 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: CIRILLI FAMILY CABIN TRUST, 602 E 8TH ST SUPERIOR, WI 54880 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00483 Transaction Number: SR-00483-4B6F6 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6341 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 8/21/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit.