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° AND "'°�• DANE COUNTY HUMAN SERVICES DEPARTMENT <br /> • <br /> rf <br /> DEPARTMENT DIRECTOR-Helene Nelson <br /> FZ <br /> PUBLIC HEALTH DIVISION <br /> DANE COUNTY DIVISION ADMINISTRATOR-Gareth R.Johnson, (608)242-6511 <br /> DEPARTMENT OF HUMAN SERVICES <br /> ENVIRONMENTAL HEALTH SECTION PUBLIC HEALTH NURSING SECTION <br /> James P.Clark,R.S., (608)242-6515 Joanne M.Bongard,R.N.,M.S., (608)242-6520 <br /> REPORT ON SITE EVALUATION AND NECESSITY FOR SOIL TESTING <br /> R Lc 1,,,,,d A m o r- ( g93 Pro i Ct-t) 6 <br /> Owner Owner Mailing Address <br /> Property Address CITY <br /> Me '15e 1� VIL J � <br /> , Sec . Zy T N, R // E � <br /> '2 CSM or <br /> 3 <br /> Lot Number L/ , Block Number Subdivision �ra ('rim V)JV <br /> Parcel Number <br /> An initial investigation h.:s been made regarding compliance of the <br /> above-referenced private sewage system with Wisconsin Statutes and the <br /> Administrative Code. This investigation is authorized by Sec . 145 . 20 (2) (g) <br /> and (2 ) (h) Wisconsin Statutes . <br /> y- A soil test report by Certi ied Soil Tester Ucr14e a Sl41,ur-e_ <br /> CST #55 -2/10-51s on file in t is offic . An onsite verification <br /> inspection was conducted on QL'f- /6 , 19 7, The soil <br /> in the vicinity of the system soil absorption area is free draining <br /> in the absence of bedrock t• a depth of at least 3 feet below the <br /> bottom of the soil absorption area. <br /> The site evaluation which •w_ s conducted did not reveal conditions <br /> which require soil borings or further system analysis . <br /> The site evaluation which was conducted on , 19 <br /> revealed conditions which are not in compliance with Wisconsin <br /> Administrative Code sILHR83 . . Orders to correct the non complying <br /> conditions have been issued .n , 19 <br /> This inspection is limited • n scope to soil suitability. If you <br /> have any question as to the age , size , or construction of the existing <br /> system, or any concerns about wh -ther or not the system is properly <br /> functioning , this office urges yeti to contact a licensed master plumber. <br /> Comments: V 7 U ric C�Gk r 3Z X ao d"t 6 YU'U7'+1 <br /> 3 L'ednzrr s 3 c s cdak M <br /> < J& g X22 L- ✓- � Co 4-t o� Se Srs; � <br /> 8-63-- 9-7 Date Issued I'�� 116,/, <br /> County Auth. 1 <br /> This instrument drafted by Dane Iounty Community Support & Health Services <br /> 1202 Northport I rive, Madison, Wisconsin 53704 ., <br />