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PRIVATE ONSITE WASTEWATER TREATMENT DANE COUNTY <br /> SYSTEM COVENANT: ADDITION/REMODELING REGISTER OF DEEDS <br /> IL'95•49i <br /> This covenant is between Al t c�A� A/ C� Z,ocN G L <br /> 07-03-2001 3:38 PM <br /> OTrans. Fee <br /> grantors,and the County of Dane,regarding the private onsite wastewater <br /> treatment system(POWTS)on the following described parcel(s)located in the Reg. Fee 10 1 <br /> Town of ?L .sA 5 f'R4 tJCiS Pages 1 <br /> in the S tv quarter of Section a Ca ,T G N,R / ( E. <br /> Type or neatly print the legal description of your property in the space below. If <br /> you need more space, use the reverse side or attach a copy of the deed.) <br /> Record this document with the Register of Deeds <br /> ..x:..«. . _Your name and return eddres ---- ---.a..... <br /> Loll. 1 C'S m 7023 <br /> Tax Parcel# qr <br /> I(We)the undersigned are applying for a building permit for a repair,alteration or addition to the dwelling located on <br /> the above referenced property that will involve 25%or more of the existing living space or the addition of 1 bedroom. <br /> This construction is intended to accommodate existing family members only. <br /> In compliance with the-requirements Dane County Cbde ch.46,or acts amendatory thereto,this affidavit is to <br /> acknowledge that the existing POWTS(is)(2K)sized in accordance with the current 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 NO(is <br /> not)an approved area for the purposes of siting a replacement POWTS on this parcel. <br /> I(We)certify that the existing private sewage system is not failing by causing back-up of sewage into the structure, <br /> discharge of sewage to the ground surface or discharge to a drain tile. I(We)agree to replace the system with a code <br /> complying system when and if any additions or changes to the structure result in additional wastewater load as determined <br /> . by definitions or criteria in state and county code,and/or when the system fails as defined in s.145.245 Wis. Stats. This <br /> agreement is binding upon the owners of the described parcel and his,her or their heirs,successors or assigns. <br /> ACKNOWLEDGEMENT <br /> r)geyerig,ed.,,j.f • <br /> Owner Name(Signature Owner Itlame(Signal <br /> 1`'1 ;chate ) 2an31 dahc 2a.viq/ <br /> Owner Name(Print) Owner Name(Print) .J <br /> STATE OF WISCONSIN <br /> ss. <br /> COUNTY OF DANE ) <br /> Personally came before me this <br /> to me known to be the �o day of 0700 1 the above named person(s) <br /> persons who executed the'foregoin: inshurnent and acknowledged the same: <br /> -Tr Public—sane County,Wisconsin <br /> My Commission is permanent. (If not,expiration date is 3-441-1900y) <br /> Dane County Environmental Health 5/01 <br />