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JA AN..D Co � <br /> <,`O G11,` <br /> T <br /> 20 t <br /> °A� Division of Public Health <br /> Environmental Health Section <br /> w <br /> as <br /> DANECOUNTY Director—Susan Crowley <br /> Division Administrator—Gareth R.Johnson <br /> DEPARTMENT OF HUMAN SERVICES <br /> KATHLEEN M.FALK <br /> DANE COUNTY EXECUTIVE <br /> REPORT ON SITE EVALUATION AND NECESSITY FOR SOIL TESTING <br /> (+V (tLetAA . 4-CIA-A-4-QC C.(' 9So? Ai Pei U .1411 I (eiyi <br /> Owner <br /> Owner Mailing Address <br /> Property Address City <br /> Vil <br /> A/C* 1/454/1/4, Sec.' ,T N, R E n //44-4-difdll‘'‘' <br /> CSM or / W <br /> Lot Number 41'7 Block Number Subdivision �i(f Ij(,� s'!O-�/��S <br /> Parcel Number 07 08- X13- 2201-.0 <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. I45.20(2)(g)and(2)(h) <br /> Wisconsin Statutes. <br /> b A soil test report by Certified Soil Tester ,CST # 8/ 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 <br /> 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 e d master plumber. <br /> U S c.c 0 k a s� - /U. rtt o - 41:41*--1 <br /> Comments: <br /> (c)( <br /> ( Cid Cul • <br /> Date Issued County Authority <br /> This instrument drafted by Dane County Community Support&Health Services <br />