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C r„„,,,,,,, DANE COUNTY HUMAN SERVICES DEPARTMENT
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<br /> ' DEPARTMENT DIRECTOR - Helene Nelson
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<br /> • PUBLIC HEALTH DIVISION
<br /> DANE COUNTY
<br /> AC,A RM,:NT OF Mt MAN SERVICES DIVISION ADMINISTRATOR-Gareth R.Johnson, (608)242-6511
<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 /> �sr-- jfao) 5f/6 RIP6-6- ,eoao
<br /> dieCG-‘-- t oRAoE=U7ER /►'\ 11 e er C-73 r-s--�
<br /> Owner Owner Mailing Address
<br /> s`fl G lN ien1 A
<br /> Property Address CITY
<br /> NI^fh. Sec . CR T N, R `ti E 47E2/eVA
<br /> CSM or
<br /> Lot Number , Block Number, (1,,f s- - u^GPE� c�D SF,/7,
<br /> Subdivision /)
<br /> 0_„,-r 6, UN1zEc,..exp srz, J
<br /> Parcel Number A/mac ; t` (pi La-r s SF�r . or . GAT (,,
<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) (9)
<br /> and (2) (h) Wisconsin Statutes.
<br /> 7- AI . FA,2ivEL C ,
<br /> A soil test report by Certified Soil Tester TEM
<br /> CST # A-YQ is on file in this office. An onsite verification
<br /> inspection was conducted on /2 -6-75— , 19 . 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 evalu. tion w ch was conducted did not reveal conditions
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<br /> which require s• ' 1 b.rings for further system analysis.
<br /> The site evaluati• which was conducted on , 19 ,
<br /> revealed conditi. which are not in compliance with Wisconsin
<br /> Administrative •ode sILHR83. Orders to correct the non complying
<br /> conditions hav- been ' ssued 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 /> pelt/ATE sE1,✓4 e .s-yr'TC,h : /k(f LGEv r 2 (- 7 6 Ft',2 A
<br /> Comments: 3 Re=0)4'4 ,/\ ,q6-5-,i;% -,„, . /63\0L Ar�.n ADP/ T(' A/0442,0 X/6' 7
<br /> C1fEc T Pf?I 1,11-r& -sri.-A-rE J fT�I /?tv C J-c--c 77 o,
<br /> / NOV 22 1993 - C 4-14-(7- /., f
<br /> Date Issued RECEIVED County Authority
<br /> ZONING DIV.
<br /> This instrument drafted by Dane County Community Support & Health Services
<br /> — 1206 Northport Drive, Madison, Wisconsin 53704
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