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PRIVATE ONSITE WASTEWATER TREATMENT <br /> SYSTEM COVENANT: ADDITXON/REMODELI.NG - <br /> This covenant is between i Z41 4. A�4 e.,e <br /> Z- ..,_.. <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 of„�, (Ac .4 J - , <br /> in the 5 E., quarter of Section toq 3 ,T 7 N,R 11 E <br /> typc 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 /> trE sE i SEC-. 'rc" Your name an. return .•tress <br /> MF__ _Lr.c. ct IS ebU t*Jok , <br /> ' Tax Parcel.#0 ±,6 i itirilliw. <br /> I(We)the undersigned are applying for a htacling pecan' or a repair,alteration,or addition to the •welling locate on <br /> the above referenced property that will involve 25%or more of xisting living space or the addition of I bedroom;or for <br /> a replacement structure. This construction is ibtendec o 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 1 <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 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 /> aOwe me(Signature) OW • 4.x <br /> '41. . h1.--.2) <br /> (Signature) Ow <br /> tnk ;r , ci be f T__mph Y ]LC. <br /> eci _ <br /> _ <br /> Owmtr Name(Print) Owner Name(Print) <br /> STATE OF WISCONSIN ) <br /> ) ss. <br /> COUNTY OF DANE ) <br /> Personally came before me this IS day of 19 _,1he above named person(s) <br /> to me known to be the persons who executed the foregoing instil] lent a d acknovyJ.odget tile same/ <br /> `,e DOUGAi Notary Publu, wane. ounty,Wisconsin <br /> .w N {� My Commission if crmanent. (If not,expiration date is {J 7'a' CU/)t_ <br /> Dane County Fsnimnm? calth ()1 <br /> VA, �l° r <br /> dnllr00 <br />