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i•es <br /> 0:•- Public Health <br /> MADISON & DANE COUNTY Janel Heinrich,MPH,MA,Director <br /> Healthy people and places Environmental Health Division 608 242-6515 Well&Septic <br /> 2701 International Lane,Suite 204 608 243-0330 Lic.Establishments <br /> Madison,WI 53704 608 242-6435 fax <br /> www.publichealthmdc.com <br /> June 25,2015 POWTS#13-2015-00206 <br /> HART FAMILY TR <br /> 2916 PEBBLE VALLEY CT <br /> SUN PRAIRIE,WI 53590 <br /> Reference: Tax Parcel No:0911-194-7076-2 <br /> SE 1/4 of SE 114 of Section 19,TOWN OF BRISTOL <br /> Property Address:2916 PEBBLE VALLEY CT <br /> Subdivision: PEBBLE VALLEY, Lot:6 <br /> Owner Name: Hart Family Tr <br /> Dear Hart Family Tr: <br /> Sanitary Permit#13-2015-00206 was conditionally issued in your interest to your system <br /> installer on 06/25/2015.This permit is valid for two years(until 06/25/2017)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 /> .724. <br /> 5"t4. 2 <br /> John Hausbeck <br /> Environmental Health Services Supervisor <br />