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I. • <br /> •..e.. 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 608 243-0330 Lic. Establishments <br /> 204 608 242-6435 fax <br /> Madicnn.WI 53704 www.publichealthmdc.com <br /> September 18, 2015 POWTS# 13-2015-00304 <br /> KIRK W EVERSON <br /> N8545 RIDGE RD <br /> VAN DYNE, WI 54979 <br /> Reference: Tax Parcel No: 0711-042-8180-0 <br /> NE 1/4 of NW 1/4 of Section 4, TOWN OF COTTAGE GROVE <br /> Property Address: 4721 GASTON CIR <br /> CSM: 06734 Lot: 1 <br /> Owner Name: Kirk W Everson <br /> Dear Kirk W Everson: <br /> Sanitary Permit# 13-2015-00304 was conditionally issued in your interest to your system installer <br /> on 09/18/2015. This permit is valid for two years (until 09/18/2017) and may be renewed or <br /> 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 and <br /> 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 the <br /> Environmental Health Section are prohibited practices. All prohibited practices are subject to fines <br /> 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 /> °TerL5 <br /> John Hausbeck <br /> Environmental Health Services Supervisor <br />