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.S•�� <br /> es ee Public Health <br /> MADISON & DANE COUNTY Janel Heinrich,MPH,MA,Director <br /> Healthy people and paces 2Environmental <br /> International Suite 608 243-0330 Well Septic <br /> Establishments <br /> 701 shments <br /> 204 608 242-6435 fax <br /> Madison.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 114 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 subrilhitted to this Department for your system to be in <br /> compliance with State and County laws. l=ees 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 /> #79-%5P4'°2' <br /> John Hausbeck <br /> Environmental Health Services Supervisor <br />