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`Z c-,- (. ...___0 C t.)...._ 4...... \ CR <br /> , AND CO44� <br /> G.4� I,. <br /> i 4 'PI! Division of Public Health -, <br /> 4 4,, <br /> 1 <br /> �0 Environmental Health Section <br /> DANECOUNTY Director—Susan Crowley <br /> Division Administrator—Gareth R.Johnson FEB L 6 200 <br /> DEPARTMENT OF HUMAN SERVICES <br /> KATHLEEN M.FALK <br /> DANE COUNTY EXECUTIVE .,:r i <br /> REPORT ON SITE EVALUATION AND NECESSITY FOR SOIL TESTING- _ ,_ <br /> -0fv( the RcL L SifAiW __ <br /> Owner Owner Mailing Address <br /> 21 2q Alh„eiry Z. g !C-44y <br /> /MAD(foif �T S3 7(3 r <br /> Property Address r City <br /> Vil <br /> CV 1/4 JV1/4,Sec. 7 T 7 N, R q E ' n .c. ,( <br /> CSM or <br /> Lot Number— Block Number_ Subdivision <br /> Parcel Number O 72(0 70 9 -- 2 '73 — , ' S <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 /> VA soil test report by Certified Soil Tester zs s�9 y <br /> p° y �G A. f-/"�� ,CST # is on file in <br /> this office. An onsite verification inspection was conducted on 2 —5——Zcup z-,5- . 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 master plumber. <br /> SrrrA-14 4 TD.r op XEPm-cenG- T Pie/KA4 f '4 - jr <br /> Comments: o ccrl,4,C.So .z—l9 —OZ. ,I}f .r..tevvc.'vnf Ev 4s y c ch-f.y.cc—f. r y c q' 74 -y <br /> fi✓¢frt r o z,_..,O'r. .fyrTef,, If .17z+P /'- s} 3- eitIoA.›04, /9°Lc.r . /T /f <br /> Oit To Z,1 ti}ZG A- 051-4f,oo - (/Y• Tl �' c /V.r 7 <br /> T TK P,t�** r f' 7 tr r ft co, q,.e.T �� 7,-E <br /> g e.r't)Er'1/At- K.rE or- 7 tt— e<1,0r ?Y /4/4, ger(a' xG-r <br /> Date Issued Z„2S—O._ County Authority At... 7"/ C <br /> This instrument drafted by Dane County Community Support&Health Services <br /> 1202 Northport Drive, Madison. Wisconsin fiR7(l4 • (Angl 9A9_R51 F . VA V (cno■ 040 cnrc ^ <br />