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1 * <br /> Public Health <br /> MA Di3ON a DANE COUNTY Janel Heinrich,MPH,MA,Director <br /> f tk people and plates Environmental Health Division 608 242-6515 Well&Septic <br /> 2701 International Lane,Suite 204 608 243-0330 Lic.Establishments <br /> Madison,W 53704 608 242-6435 fax <br /> www.publichealthmdc.com <br /> July 02,2015 POWTS#13-2015-00221 <br /> NIESEN HOME FARM LLC <br /> 5729 WHIPPOORWILL RD <br /> CROSS PLAINS,WI 53528 <br /> Reference: Tax Parcel No:0807-134-9740-0 <br /> SE 1/4 of SE 1/4 of Section 13, <br /> Property Address: <br /> CSM: 14002 Lot: 1 <br /> Owner Name: Niesen Home Farm Lic <br /> Dear Niesen Home Farm Llc: <br /> Sanitary Permit#13-2015-00221 was conditionally issued in your interest to your system <br /> installer on'07/02/2015. This permit is valid for two years(until 07/02/2017) 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 /> 41;t2— <br /> John Hausbeck <br /> Environmental Health Services Supervisor • <br />