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t , <br /> : PRIVATE ONSITE WASTEWATER TREATMENT <br /> SYSTEM COVENANT: ADDITION/REMODELING <br /> This covenant is between 'fitYYl Gun d bay-,cl -Tat be 1 <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 <br /> Town st <br /> To <br /> n of �Y�i e asci n t �Y 1 (1 S <br /> in the F NFkuarter of Section 21 ,T ' N,R /1 E. <br /> N y� <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) Record this document with the Register of Deeds <br /> I Your name an, return a,dress <br /> 1,01- ki‘ne (9)) FifSi- AC-'1- al St-)ires <br /> . OI 1 t►l5 mQad o ws) ) n --t Ise "Tow to C <br /> ? lPasnit Spr1Y35 ) -bet pie Co v l- /, <br /> LO t S C O n S t n . Tax Parcel# CI--I (Q- D le,t l -2 el 1-0?2 9-t <br /> I`V the undersigned are applying for a building permit for a repair,alteration or addition to the dwelling located on the <br /> above referenced property that will involve 25%or more of tie existing living space 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 Code ch.46,or acts amendatory thereto,this affidavit is to <br /> acknowledge that the existing POWTS(is)(is not)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(is)(is not) <br /> 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 backup 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 defmitions or criteria in state and county code,and/or when the system fails as defiled 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 j <br /> / j N <br /> Owner Name(Si tore�) K3weS N it e Signature)) t <br /> r_ /a1 v. h, 1 0. e✓ /-2 <br /> Owner Namerint) Owner Name(Print) <br /> STATE OF WISCONSIN ) <br /> ) ss. <br /> COUNTY OF DANE ) 3t�Ub <br /> Personally came before me this a day of .JL/1 U ' 9 W .the above named person(s) <br /> to me known to be the persons who executed the foregoi instrument and acknowledged th same. <br /> -� \i' . cQ <br /> No ary Public Dane County,Wisconsin 1 +-���� <br /> `e`��Z t r 1 t 1 1 44/Commission is permanent. (If not,expiration date is <br /> .Nt , <br /> Dane County Environmental Health 5/0\`,>,; ''..S , <br /> =€ / I <br /> -: ¢ J•SOJ•�: I-� to — <br /> sue . <br /> O , Q ;per <br /> Wv� 2 • <br /> .** �S .%.• <br />