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• 4,%c‘ �■D fi <br /> r DANE COUNTY HUMAN SERVICES DEPARTMENT <br /> 1.-% ir '`� DEPARTMENT DIRECTOR - Helene Nelson <br /> • <br /> DANE COUNTY PUBLIC HEALTH DIVISION <br /> DEPARTMENT OF HUMAN 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 /> (s-S--- 3��o) s �fb RiP6� ,E'oao <br /> die � If U ( 1E-U-re M Ag f f <br /> Owner Owner Mailing Address <br /> s-f/G ,rb6 veo1i • <br /> Property Address CITY <br /> 41-,44, Sec . r61 , T N, R /2- E 476P/oVA <br /> CSM or <br /> Lot Number , Block Number, Subdivision ° _ nr4.6c�,r6D S'I4./7) <br /> ,.CLO7 6 - Gf N?2ECUr'-'fk 0 <br /> Parcel Number /� ti �°� o ' �° S i SE/Pr, c°r 6. <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 /> P//—A soil test report by Certified Soil Testerr , <br /> CST # ( 'Q is on file in this office. An onsite verification <br /> inspection was conducted on /42 -1X-7_5— , 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 <br /> which require s• ' 1 brings 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 /> Comments: <br /> �Rt yi7E C6/4/4 6:E Syr.rcr.. :LA(5 ritt i i) 2 - (- '7 6 f" A <br /> 3 AE=0,<'42,/\ Ref;D EN b (71\°1:71o5 API)/17.2"1 /V.° 7 <br /> C fEc 7 PR! v,4 /KC" �B <br /> — Z2 --y3 <br /> Date Issued County Authority <br /> This instrument drafted by Dane County Community Support & Health Services <br /> eb <br /> 1206 Northport Drive, Madison, Wisconsin 53704 �� <br />