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NOFFICIAL COPY <br /> 1 1111111111111111 III <br /> PRIVATE ONSITE WASTEWATER TREATMENT 9 1 4 5 2 5 8 <br /> SYSTEM COVENANT: UNDERSIZED SYSTEM Tx:8853047 <br /> • <br /> "Bedroom Addition" KRISTI CHLEBOWSKI <br /> DANE COUNTY <br /> REGISTER OF DEEDS <br /> This covenant is between <br /> DOCUMENT # <br /> 4011 13at tier/ (on,r jj' Todd in KW/7er 5326246 <br /> grantor k,and the County of Dane,regarding the private onsite wastewater 05/17/2017 11:08 AM <br /> treatment system(POW )on the following described parcel(s)located in the Trans.Fee: <br /> Town of P�T1411 Exempt#: <br /> ' Rec. Fee:30.00 <br /> in the of the of Section ,T N,R E. Pages: 1 <br /> 7))pe 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.ot"ho0 l?)� Ch rtf ft Su t Wr p No. ?83' re fora Your name and return address <br /> r►� Volume ll of rer*rrd Su mo of One(/Cvt�l4 ,. Ti 4 "11. Lo be r <br /> W1 1146 11. Pale i$' , aS j/uitvwt Nv• r, 7[�i511 TOW, 3`lVo oil rile? Pct <br /> oe" ealai , pa t.e(001iy, to k. SigpiiPA, w1 S3S$1 <br /> Tax Parcel#Qi ?4no— SS/ 'Tyro <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,l(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 /> ACKNOWLEDGEMENT t` <br /> 1\-1- T012 <br /> Owner Name(Signature) Owner Name(Signature) <br /> M th l e y M &Ai-2..1 e r /K,l e i ke O r 1 b1t.� lNL 4l%e i lote- <br /> Owner Name(Print) Owner Name(Print) <br /> STATE OF WISCONSIN <br /> ss. <br /> COUNTY OF DANE <br /> Personally came before me this f 6 day of rn e vy A* P017 ,the above named person(s) <br /> to the known to be the persons who executed the foregoing' strument and ackdo dge/the same. <br /> ,1 <br /> TO i r(Lbr Not Publ c Dane fount isconsin <br /> My ommission is p anent. (If not,expiration date is 3'8'AV? <br /> Public Health Madison Dane County EH 4'14 <br />