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1 PRIVATE ONSITE WASTEWATER TREATMENT 9 0 8 9 3 3 <br /> SYSTEM COVENANT: UNDERSIZED SYSTEM Tx:8820392 <br /> "Bedroom Addition" KRISTI CHLEBOWSKI <br /> DANE COUNTY <br /> REGISTER OF DEEDS <br /> This covenant is between <br /> DOCUMENT # <br /> Shawn and Sandra Cannon 5292662 <br /> grantors,and the County of Dane,regarding the private onsite wastewater 12/16/2016 2:23 PM <br /> treatment system(POWTS)on the following described parcel(s)located in the Trans. Fee: <br /> Town of Blue Mounds Exempt#: <br /> in the SW of the 1/4 of Section 15 ,T 6 N,R 6 E. Rec. Fee: 30.00 <br /> Pages: 1 <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 /> l'� a k-e S E l/ - e Your name and return address <br /> ICI n (ZAP Not.ri4 <br /> c L >v J` J1�12.3 AgPO►ZT FZp <br /> S\J VLI. G 1' J;LA\v'� I I MIPDL.TON , 1A-11 1 5356" Z. <br /> 7ovvr\ � Blue trnoun - <br /> d& ) r0 r-1 <br /> Co Tax Parcel# 010/0606-153-9550-9 <br /> I(We)the undersigned are adding a bedroom. <br /> In compliance with the requirements of Dane County Code ch.46,or acts amendatory thereto,this affidavit is to <br /> acknowledge that the existing septic tank is not sized in accordance with the current regulations for the waste water load <br /> generated by the building served.The existing soil absorption component is located in soil that is suitable for the below <br /> grade absorption area,but it is not sized in accordance with the current regulations for the wastewater load generated by the <br /> building served. This is also to acknowledge that there is/is not an approved area for the purposes of siting a replacement <br /> absorption area on this parcel. <br /> If/when the existing soil absorption area is determined to be failing as defined in s. 145.245 Stats, I(We)will replace it in <br /> accordance with the state and county codes in force at that time. This is binding on all future heirs,owners and assigns. <br /> 4 ACKNOWLEDGEMENT <br /> CaftlnhollY∎ <br /> Owner Name(Si: : re) Owner Name(Signatur <br /> Shawn Cannon Sandra Cannon <br /> Owner Name(Print) Owner Name(Print) <br /> STATE OF WISCONSIN <br /> ss. <br /> COUNTY OF DANE <br /> 20 <br /> '6 1b <br /> Personally came before me this (=1Z1 _ (a. day of nE.0 !' ,the above named person(s) <br /> to me known to be the persons who executed the foregoing instrument and acknowledged the same. <br /> Notary Pub c Dane Coun iscon4' 1111111".-- <br /> 8 2./°4 P ht UtZTI-1 My Commission is perm: . (If not,expiration date is <br /> Public Health Madison Dane County EH 4/14 <br />