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rnyyrL DANE COUNTY HUMAN SERVICES DEPARTMENT <br /> • <br /> DEPARTMENT DIRECTOR - Hcicnc Nelson <br /> • x PUBLIC HEALTH DIVISION <br /> DANE COUNTY <br /> IMPARTMENT or Nt'11AN 7i6RYlCCN <br /> DIVISION ADMINISTRATOR-Gareth R.Johnson, (608)242-6511 <br /> ENVIRONMENTAL HEALTH SECTION PUBLIC HEALTH NURSING SECTION <br /> Jarncs 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 /> 6000 c 777, t' . r <br /> 7:Z6 /i'1 y/(1E^,f /17 V r#AL/_, i/72, <br /> Owner / T Owner Mailing Address <br /> 6 (( 1 7"" <br /> Property Address CITY <br /> VIL Cc-7) t'� <br /> m <br /> Nt Is Ni A , Sec . 6 , T e N , R /1 E Ni ✓� !t� <br /> —' —" CSM or <br /> Lot Number , Block Number. Subdivision <br /> Parcel Number Ut?/Z -- 0617 z7?( <br /> An initial investigation has 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 /> ✓ A soil test report by Certified Soil Tester /MOL=D. Nq,VA <br /> CST # 3(37 is on file in this office. An onsite verification <br /> inspection was conducted on "Tc4d6 2S- , 19 qr .. The soil <br /> in the vicinity of the system soil absorption area is free draining <br /> in the absence of bedrock to a depth of at least 3 feet below the <br /> bottom of the soil absorption area. <br /> The site evaluation which was conducted did not reveal conditions <br /> which require soil borings for 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 on _ , 19 <br /> This inspection is limited in 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 whether or not the system is properly <br /> functioning, this office urges you to contact a licensed master plumber. <br /> cosrnents: ft /host/YD— —ryt .. Of P,''ii'# -r& Sy_rrcc-h2 G✓ftl -��`+1S7�94"Et <br /> /O, / g/ f c'ck I V 77 P in T q/—eases-0 <br /> ? C„ /Cp <br /> Date Issued County Authority l <br /> This instrument drafted by Dane County Community Support & Health Services <br /> re <br /> 1206 Northport Drive, Madison, Wisconsin 53704 �� <br />