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'.*m Public Health <br /> MADISON & DANE COUNTY Jane!Heinrich, MPH, MA,Director <br /> Healt y people Grid places Environmental Health Division 608 242-6515 Well&Septic <br /> 2701 International Lane,Suite 204 608 243-0330 Lic. Establishments <br /> Madison,WI 53704 608 242-6435 fax <br /> www.publichealthmdc.com <br /> February 26,2016 POWTS# 13-2016-00036 <br /> PATRICIA K KARLEN <br /> E2975 JAMES LN <br /> CARYVILLE,WI 54701 <br /> Reference: Tax Parcel No:0511-212-9111-9 <br /> SW 1/4 of NW 1/4 of Section 21, <br /> Property Address: <br /> CSM: 07484 Lot:2 <br /> Owner Name: Patricia K Karlen <br /> Dear Patricia K Karlen: <br /> Sanitary Permit#13-2016-00036 was conditionally issued in your interest to your system installer <br /> on 02/26/2016. This permit is valid for two years(until 02/26/2018) 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 /> t4LC <br /> John Hausbeck <br /> Environmental Health Services Supervisor <br /> ij <br /> { <br />