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'`'LA"' Dane County <br /> ``1112 ,�=;" Community Support & Health Services Department <br /> Paul Meyer PUBLIC HEALTH DIVISION <br /> Dream <br /> ENVIRONMENTAL HEALTH 0.W.Hintz,R.S.,Director <br /> 1206 Northport Drive,Room 107 (608)241-4481 <br /> Madison,Wisconsin 53704-2088 <br /> REPORT ON SITE EVALUATION AND NECESSITY FOR SOIL TESTING <br /> PE-(V:76- 03/‘‘) M, iiNs — /a- nJ 537(c <br /> Owner nn Owner Mailing Address <br /> -Z-77d7 Gtr, ,/t ju CA esa t e <br /> Property Address —ter <br /> ta '�. Sec . (rD , T N, R k2— E TN C. 112.ts&r/A-7.814 <br /> CSM or <br /> Lot Number , Block Number Subdivision <br /> Parcel Number <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 /> -2L A soil test report by Certified Soil Tester y �, gAvv14/14-6-5 , <br /> CST # 22:3e::. is on file in this office. An onsite verification <br /> inspection was conducted on Aq',�L-IL ZS , 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 evaluation which was conducted did not reveal conditions <br /> which require soil borings for further system analysis . <br /> The site evaluation which was conducted on , 19 <br /> revealed conditions which are not in compliance with Wisconsin <br /> Administrative Code sILHR83 . Orders to correct the non complying <br /> conditions have been issued 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 /> systm, or any concerns about whether or not the system is properly <br /> functioning, this office urges you to contact a licensed master plumber. <br /> • <br /> --Z/ <br /> 4111114,1 i /A (2. c, - <br /> County Authority <br /> This instrument drafted by Dane County Community Support & Health Services <br /> 10/87 <br />