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• <br /> O�lO�PV A N�CiyMG�fTy 9 Division of Public Health <br /> 4,..16 Environmental Environmental Health Section 4011 <br /> 2 <br /> a Director—Lynn Green <br /> • <br /> DANE COUNTY Director of Public Health for Madison&Dane County— <br /> Thomas Schlenker,MD,MPH <br /> DEPARTMENT OF HUMAN SERVICES <br /> Director of Environmental Health—James P.Clark <br /> KATHLEEN M.FALK <br /> DANE COUNTY EXECUTIVE <br /> REPORT ON SITE EVALUATION AND NECESSITY FOR SOIL TESTING <br /> !h IDI 1 UE-r6x(pbs, , s'c1/2PL y Ix — sAiri Al ,,� 7y <br /> Owner Owner Mailing Address <br /> 5 3Tf 014 LY , <br /> sNdY MAI X(E, (i✓.1 <br /> Property Address City <br /> ,_/ Vil 8c11A'K�✓1/4 SN 1/4, Sec?((,T N,RL0 E <br /> CSM c f 0 / /7j <br /> Lot Number Block Number Subdivision 4 <br /> Parcel Number oefo- 2 '( es-00-7 <br /> An initial investigation has been made regarding compliance of the above-referenced private sewage system <br /> with Wisconsin Statutes and the Administrative Code. This investigation is authorized by Sec. 145.20(2)(g)and(2)(h) <br /> Wisconsin Statutes. <br /> T / 1 <br /> A soil test report by Certified Soil Tester CJ`4 1" ,CST # /is on file in <br /> this office. An onsite verification inspection was conducted on , 19 . The soil in the <br /> vicinity of the system soil absorption area is free draining in the absence of bedrock to a depth of at least 3 feet <br /> below the bottom of the soil absorption area. <br /> The site evaluation which was conducted did not reveal conditions which require soil borings for further system <br /> analysis. <br /> The site evaluation which was conducted on , 19 , revealed conditions which <br /> are not in compliance with Wisconsin Administrative Code sCOMM83._. Orders to correct the non <br /> complying conditions have been issued on , 19 . <br /> This inspection is limited in scope to soil suitability. If you have any question as to the age, size or construction <br /> of the existing system,or any concerns about whether or not the system is properly functioning,this office urges you to <br /> contact a licensed master plumber. <br /> Comments: - 6 rS (Afr rgiVA .1- i7/G6 .s'/J rf1' IvAS .reef rA.zi ,,D <br /> p - - (coo 7 ' .rA,r(7/y Peg/Pi(7" I5"zs(/l4yey o, (71-2 y-1978, <br /> El-(JIM 5157E/11 If 11,1°A JEP Fo/2 C- /I( e•Q 0 Gfrf W4 <br /> Fog PRolb, Off« 519 4/T <br /> Date Issued 4' /6--2<x?S County Authority /( (I4, ) G <br /> This instrument drafted by Dane County Community Support&Health Services / <br /> 1202 Northport Drive, Madison, Wisconsin 53704 • PH (608)242-6515 • FAX (608) 242-6435 Ca <br />