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i`•�M <br /> '. ` ' Public Health <br /> MADISON Ei DANE COUNTY Janel Heinrich, MPH, MA, Director <br /> Health ea le and laces Environmental Health Division 608 242-6515 Well&Septic <br /> .1 F +l 2701 International Lane,Suite 204 608 243-0330 Lic. Establishments <br /> Madison,WI 53704 608 242-6435 fax <br /> www.publichealthmdc.com <br /> December 01, 2015 POWTS# 13-2015-00370 <br /> THOMAS J BOBEK <br /> 3115 HAWKS HAVEN TRL <br /> DEFOREST, WI 53532 <br /> Reference: Tax Parcel No: 0911-224-9510-0 <br /> SE 1/4 of SE 1/4 of Section 22,TOWN OF BRISTOL <br /> Property Address: 6925 ELDER LN <br /> CSM: 13936 Lot: 1 <br /> Owner Name: Thomas J Bobek <br /> Dear Thomas J Bobek: <br /> Sanitary Permit# 13-2015-00370 was conditionally issued in your interest to your system installer <br /> on 12/01/2015. This permit is valid for two years (until 12/01/2017) 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 <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 /> 5.tbi-Z.J2 <br /> John Hausbeck <br /> Environmental Health Services Supervisor <br />