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I 1 H III fill II llIllJ1 <br /> PRIVATE ONSITE WASTEWATER TREATMENT 9 Tx: 8833767 3 <br /> SYSTEM COVENANT: UNDERSIZED SYSTEM <br /> "Bedroom Addition" KRISTI CHLEBOWSKI <br /> DANE COUNTY <br /> REGISTER OF DEEDS <br /> This covenant is between DOCUMENT# <br /> • <br /> Ell IC. 1 . -- WMI R 6dIec 5307415 <br /> 02/21/2017 11:23 AM <br /> grantors,and the County of Dane,regarding the private onsite wastewater Trans.Fee: <br /> treatment system(POWTS)on the following described parcel(s)located in the Exempt#: <br /> Town of .12)(A4Hc flC4 Rec.Fee:30.00 <br /> Pages:1 <br /> in the of the of Section ,T N,R E. <br /> Record this document with the Register ofDeeds <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 /> 1 1 � I q acU(��� I Yota name and return address <br /> -to�` 1 Eri k t- NY11• i Kactlec. <br /> Talley .Il'e t9hfs I --own c}F ,u-I•-lard , 4'14 Roosevel} ss-. <br /> "P-Olie Coun-I , Wl5COvlSIn Oregon 1 wz. s --3-5 <br /> Tax Parcel# &5(210S tl—)S2,-3)%-7 <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 tan is not size n accordance with the current regulations for the waste water load <br /> generated by the building served.The existing sot 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 1 <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 :xist g soil absorption area is determined to be failing as defined in s. 145.245 Stats,I(We)will replace it in <br /> accordance • • the tate and c'uiity codes in force at that time. This is binding on all future heirs,owners and assigns. <br /> al ACKNOWLEDGEMENT <br /> • <br /> 4/Mark d4d4e) <br /> Owner Name signature) Owner Name(Signature) <br /> ER\Y. L.K1411.-G-C 1\RGi C.14kb1..-Q_ <br /> Owner Name(Print) Owner Name(Print) <br /> STATE OF WISCONSIN ) <br /> ) as, <br /> COUNTY OF DANE ) t <br /> n I <br /> Personally came before me this 2.0 day of hif UaiY A.190/1 ,the above named person(s) t <br /> to me known to be the persons who executed the foregoing i .t. .nd ackdowled:ed :me. <br /> Nota r•ubl Dane County,Wisconsin <br /> My Commission is permanent. (If not,expiration date is( •Q1,o20at7) <br /> Public Health Madison Dane County EH 4/14 Qhanle z <br /> 0 <br /> w Notary rn <br /> Public ,' <br /> \ or Wisp°' <br />