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• <br /> • PRIVATE ONSITE WASTEWATER TREATMENT <br /> SYSTEM COVENANT: ADDITION/REMODELING <br /> This covenant is between c a.Ll-rZ ^ 8e7 .- LL <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 yoAK , <br /> in the !4 iNJ quarter of Section /3 ,T N,RJcLE. \c®F v <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 /> LC-C.- <br /> / 1 l JUL 1 4 2008 u ,; ! ii 539 <br /> . Tax Parcel#0 •[•]'/G1/t:—Str, <br /> I(We)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, <br /> this affidavit is to <br /> acknowledge that the existing POWTS(is is not) ized 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 the (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 /> r <br /> r Name{Signature) Owner Name(Signature) <br /> 4 � °" a/4Z, / <br /> Owner Nar (Print) Owner Name(Print) <br /> STATE OF WISCONSIN ) <br /> (44 l a r.�h,.: ) ss. <br /> COUNTY OF-e 1 E ) �. <br /> Personally came before me this <br /> �/ / day of ���,r' u >/ -4-9- ,the above named person(s) <br /> to me known to be the persons who'executed the foregoing instrument at/acknowledged the same. <br /> `� <br /> i <br /> Noy .��'�li v.., ;- •?.unty,Wisc sin• <br /> ,,`` 60 • ton•i , ,, ent (tf'not,expiration date is G-/S1-a <br /> kr• by; NOTA1�y - - <br /> Dane County Environmental Health 5/01 <br /> ,... (4. Pusoc ,.•::: ,s. <br /> 080..... i <br />