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• <br /> . _ . <br /> . . , <br /> . . <br /> • 111JIll*IIJ II I III I III I II613 1 * <br /> PRIVATE ONSITE WASTEWATER TREATMENT REGIANERCOUNTY <br /> SYSTEM COVENANT:ADDITION/REMODELING • <br /> DOCUMENT # <br /> • <br /> • This covenant is between CDLLEEt( K(1 TGESb� 4478613 <br /> grantors,and the County of Dane,regarding the private onsite wastewater 10/31/2008 08:49AM <br /> treatment system(POWTS)on the following described parcel(s)located in the <br /> Town of PeRRY Exempt #: <br /> in the SE quarter of Section 2 2 ,T 5 N,R 6 E. Rec. Fee: 11.00 <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.) Record this document with the Register of Deeds <br /> Lo 1 I — C`4lA IC VE Y pti/ • Your name an, return a,dress <br /> tom` l( ��IN'� Cez4E-64 KfT eopf <br /> f(TE PDRE : /0073 C. ry, 4 i°°73 cT�.4 'A w <br /> A mt. 144 tig. s 35-3z <br /> • • Tax Parcel# O5.o6=22Y— gO'JO Z <br /> . I(111%)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;or for <br /> a replacement structure. This 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 0111)(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)(UM) <br /> an approved area for the purposes of siting a replacement POWTS on this parcel. ` <br /> I(!)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(fir)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 /> • <br /> ACKNOWLEDGEMEIV . <br /> ,u.04117tel "61C /417 <br /> Owner Name(Signature) Owner Name(Signature) <br /> c 01 Eft{ K(T TLe.foW SGG /l i e/eSD <br /> Owner Name(Print) Owner Name(Print) <br /> STATE OF WISCONSIN ) <br /> ) ss. <br /> COUNTY OF DANE ) • <br /> Personally came before rime this, ' S I day of iOV"4 t9a0os ,the above named persons) <br /> to me known to be the persons ho executed the foregoing instrument and acknowledged the same. , . . <br /> (Co lleL•t. K;-H-1C5 31t c ( ,-.o . . . <br /> Notary Public Dane County,Wisc sin J <br /> My Commission is permanent. (If not,expiration date is /.- I /10 ) .,4 <br /> �l L re-s� �� F <br /> Dane County Environmental Health 5/01 . <br /> • <br /> • 1■ <br /> • <br />