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a <br /> 'aaa' <br /> ". ' I ublic Health • <br /> MADISON Sr DANE COUNTY Janet Heinrich,MPH,MA,Director <br /> Healthy people and places Environmental Health Division 608 242-6515 Well&Septic <br /> 2701 International Lane,Suite 204 808 243-0330 Lic.Establishments <br /> Madison,Wi 53704 608 242-8435 fax <br /> www.publichealthmdc.com <br /> March 17,2015 POWTS#13-2015-00048 <br /> JACOB K BREUNIG <br /> 2016 TUMBLEWEED DR <br /> PRAIRIE DU SAC,WI 53578 <br /> Reference: Tax Parcel No:0907-183-6077-0 <br /> SE 1/4 of SW 1/4 of Section 18, <br /> Property Address: <br /> Subdivision: BLACKHAWK FIELDS, Lot: 17 <br /> Owner Name:Jacob K Breunig <br /> Dear Jacob K Breunig: <br /> Sanitary Permit#13-2015-00048 was conditionally issued in your interest to your system <br /> installer on 03/17/2015.This permit is valid for two years (until 03/17/2017)and may be renewed <br /> or transferred as indicated on the face of the permit. <br /> A condition of the issuance of this permit is that you, as owner of this private septic system, <br /> ensure that appropriate system inspection and maintenance is performed as required by <br /> s145.245,Wisconsin Statutes and by Dane County Code Chapter 46.11(5). The appropriate <br /> inspection and maintenance for your system is described in the private septic system <br /> management plan provided by your installer.The licensed professional that you hire <br /> to perform this service will document their results on forms provided by Public Health Madison <br /> and Dane County.These forms must be submitted to this Department for your system to be in <br /> compliance with State and County laws. Fees associated with this program will be assessed <br /> annually on the property tax bill. Currently this fee is$8.67 per year. <br /> You will be notified by the Environmental Health Section approximately three months before the <br /> servicing is due. Faiure of notification will not relieve you of the obligation to have your system <br /> serviced. Failure to either have the private sewage system serviced or failure to report same to <br /> the Environmental Health Section are prohibited practices.All prohibited practices are subject to <br /> fines or forfeitures as specified by County Ordinance. <br /> All heirs or assigns of this property shall be notified of these requirements. <br /> If you have any questions, please fell free to call me at 242-6515 between 7:45 and 9:30 AM <br /> Monday through Friday. <br /> Sincerely, <br /> #°45SL5' <br /> John Hausbeck <br /> Environmental Health Services Supervisor <br />