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0Oc t_ 8__ 2609J.1 1 ; 27AMM:DAtsE CO REG DE=EUS 608 237 3110 T0:924264N°. 1466 P. 2/22,2 <br /> PcoPY <br /> PRIVATE ONSITh WASTEWATER TREATMENT <br /> SYSTEM COVENANT:ADDITION/REMODELING - <br /> This covenant is between_ 1 it-r �-r <br /> grantors,and the County of Deno,regarding the private ou ito wastewater <br /> treatment system(POW'TS)alt the following described parcol(()leoatod in the <br /> Town of f DD erkf f <br /> in the 56: quarter of Section g ,T _N,I, '' B. <br /> • <br /> Type or neatly print the legal description of yeti'property in the space?below. Z[f _ <br /> you need more space,use the reverse side or attach a copy of the deem) Recent thus daeumeru with thr' ;tsar• pacts <br /> j 7r J Crr2.1fie keie J's7 /I+ Yo pn�a m e a �� rn od.. s <br /> st-r6 MAResr ag`t A-Kker m IPPteriy-pta sis-6t <br /> Tax parcel f# ' o8`— Co. , • v— <br /> I(0)the undersigned arc applying(br a building permit fbr a repair,alteration or ttddition to the dwelling located en the <br /> above referenced property that will Involve 25%or more of lie existing living apace or the addition of 1 bedroom. This <br /> construction is intended to accommodate existing family members only. <br /> In compliance with the requirements Dane County Cada alt.46,or nets amendatory theroto,this affidavit is to <br /> acknowledge tat the existing POWTS dID(is not)sized In accordance with the tiutront regulations for the wastewater load <br /> generated by the building served by the system after this work is finished, This is also to acknowledge that there( (is not) <br /> an approved area for the purposes of siting a replacement PO'W S 611 this parcel. <br /> I( t)certiti that the existing private sewage system is not failing by causing backup of sewage into the Ftrucutre, <br /> discharge of`aewago to the ground surface or discharge ton drain tile. 1(e)agree to replace the system with a coda <br /> complying system when and if any additions or changes to the atrualure result in additional wastewater load as determined <br /> by definitions or criteria in state cad county codes and/or when the system fails as doOiiod in x.145.245 Wis.State, This <br /> agreement is binding upon the owners of the described parcel and his,her or their boirs,successors or assigns. <br /> A cKNowuloQIyMnNT <br /> ter Name(Signature) Owner Name(Signature) <br /> Owner N5me(Print) Owner Name(Print) <br /> STATE OF WISCONSIN ) <br /> ) It <br /> COUNTY OF DANE <br /> crA day of ( z00�,t$e nbuvouem petson(s) <br /> Palonally coma before me this• y <br /> to me known to boy the persons who executed the ttrogoin Instrument and acknowledged the same. <br /> Nottlry Pubilo c- *•unty,Wisconsin) <br /> My Commission is permanent_ (gnat,expiration dete is -(C <br /> 'Df0. S4�t11 1. Se,titaaer <br /> Dime County Environmental Health MI <br /> 11 <br />