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11.04.1 Public Health <br /> MADISON&DANE COUNTY Janel Heinrich,MPH,MA,Director <br /> Healik„,people and places Environmental Health Division 608 242-6515 Well&Septic <br /> . people 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 15,2015 POWTS#13-2015-00389 <br /> CHAD M KITSEMBLE <br /> 205 HEATHER CT <br /> MOUNT HOREB,WI 53572 <br /> Reference: Tax Parcel No:0606-022-9680-0 <br /> SE 1/4 of NW 1/4 of Section 2, <br /> Property Address: <br /> CSM:13900 Lot:1 <br /> Owner Name:Chad M Kitsemble <br /> Dear Chad M IGtsemble: <br /> Sanitary Permit#13-2015-00389 was conditionally issued in your interest to your system installer <br /> on 12/15/2015.This permit is valid for two years(until 12/15/2017)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 /> John Hausbeck <br /> Environmental Health Services Supervisor <br />