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One & Two Family <br /> * The existing system must be inspected for compliance to <br /> bedrock and high groundwater requirements of the code . <br /> If the existing system does meet minimum requirements for <br /> groundwater and bedrock depths and if it is functioning, one <br /> bedroom could be added in most instances without updating the <br /> existing system and if the existing system is utilized for the <br /> addition, every attempt should be made to locate and reserve an <br /> area which is suitable for a code complying replacement system in <br /> case of failure . If more than one bedroom is going to be added, a <br /> substantial increase in discharge would be anticipated and the exist- <br /> ing system shall be replaced with a code complying private sewage <br /> system. <br /> 1 <br /> 4 4 (Subdivision) Section Township <br /> �. <br /> Rural Number Address City Zip Code <br /> Parcel Number (tax records) <br /> (I) (We) /'/,IL /// ae,„, r5 1-1 5 plan to <br /> remodel) the building at the above named location. The present <br /> private sewage system appears to be working satisfactorily. If the <br /> present private sewage system does fail, it will be replaced with <br /> one that is code complying. <br /> /2 <br /> (2)l4- 1(7/. <br /> (Owner s ignature <br /> / - '' - 7:7 <br /> Date <br /> Subscribed and sworn to before me <br /> this 027.442day of 4, , <br /> - Gz <br /> Notar ubl c <br /> County, Wisconsin <br /> My Commission Expires 7/- �_2< _ -L2 <br /> DANE COUNTY ENVIR/OOIENTAL HEALTH DIVISION <br /> (Sanitarian's Signature) <br /> Plot plan attached <br /> (show location of building addition to drainfield and septic <br /> tank) <br /> *Extracted from Plumbing Code Interpretation 109 <br /> 163 . 15( 3) (e)l, H63 . 12( 3) <br /> THIS DOCUMENT MUST BE RECORDED WITH THE DANE COUNTY REGISTER OF DEEDS. <br />