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v <br /> PRIVATE SEWAGE SYSTEM MAINTENANCE <br /> AGREEMENT COVENANT <br /> ` ; fS7E'P `nF Orrn,' <br /> This covenant is between (TTT,RF.RT TMAN <br /> prix name at property owner(s) A <br /> ? A i t 1 21 <br /> and the County of <br /> Dane regarding the installation and maintenance of a private sewage system on lands <br /> located in Dane County In the town of MEDINA <br /> COP <br /> Type or neatly print the legal description of your property in the space <br /> below. (The legal description of your property is found on your deed and usualy,on your <br /> tax bill if you need more space, use the reverse side or attach a photocopy of the legal <br /> description.) <br /> SE1/4, SW1/4, SEC.34, TBN, R12E <br /> Record this document with the Register of Deeds <br /> Your name and return address: <br /> GILBERT HEIMAN <br /> 4799 MISSOURI ROAD <br /> MARSHALL, WI 53559 <br /> Tax parcel no. 18 0 812 343 9 5 0 0 2 <br /> As owner,I (we)do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and <br /> approved plans and specifications on file with the Environmental Health Division of Dane County Human Services Department. The system <br /> will be operated In such a manner as to meet the designed plans. <br /> I(we) agree to maintain said private sewage system in accordance with rules established in the Wisconsin Administrative Code,as from time <br /> to time amended,and further agree to have said septic tank(and lift pump tank) pumped every three years or when the solids build up within <br /> said septic tank exceeds one-third of the tank volume,whichever comes first <br /> I (we)agree to submit to the county a certification form(to be provided by the county)every three years which is signed by the owners)and <br /> a licensed private pump':or plumber. The form shall require certification of the following: <br /> a.that said private sewage system is in proper operating condition; <br /> b.that after Inspection,the septic tank(and pump chamber)was pumped or less than 1/3 full of sludge and scum; <br /> c.fee required by ordinance,submitted with the certification form. <br /> i further acknowledge that this agreement is binding on all heirs and assignees of this property,and that failure to comply with this agreement <br /> will result in action to recover damages and costs as per Chapter(2 and Chapter 46,Dane County Ordinance. <br /> owner(s)sign here Dated this (2 day of /gay .19 2.5-- <br /> in the presence of <br /> a notary public <br /> your signature your signally • <br /> 611A err 1-1 -1 man <br /> print name under signature print name under signature <br /> The above named persons)came before me this day of , 19 <br /> NOTARY <br /> PUBLIC Signatur � h ( Name printed Se.\ck �3 rules <br /> Notary Public,Dane County,Wisconsin My Commission Expires (n' c(1 <br /> Dana County Human Serlees Department.Environmental Health°Melon 10/91 <br />