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- � - 11 II I III 111111111111111 <br /> • * 4430394 2 * <br /> PRIVATE ONSITE WASTEWATER TREATMENT DANE COUNTY <br /> SYSTEM COVENANT: ADDITION/REMODELING REGISTER OF DEEDS <br /> DOCUMENT # <br /> This covenant is between Marta. bV ' - cave S i<fl 2K, 4430394 <br /> grantors,and the County of Dane,regarding the private onsite wastewater 05/13/2008 01:24PM <br /> treatment system(POWTS)on the following described parcel(s)located in the <br /> Town of O tre. U?, Exempt #: <br /> in the quarter of Section I ( ,T 03 N,R 09 E. Rec. Fee: 13.00 <br /> Pages: 2 <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 /> Lot 3 GSMS2'LS CS,D-1/9,S,94 Your name and return address <br /> !Ma r'1a,D ybvt%K Oa(te. S Prue K� <br /> 8►7x�;i-dy-ii.pyw,ril-onvsad3a)1 <br /> Tax Parcel#dSdQ- 173 - x`Ast <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,this affidavit is to <br /> acknowledge that the existing POWTS(is)(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)(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 /> ACKNOWLEDG T A :21.441,;;140-c. <br /> t+• V/� <br /> Owner Name(Sign: e) <br /> er Name(Signature) <br /> Mari D bev i Kv c S Krt`PK,a <br /> Owner Name(Print Owner Name(Print) <br /> STATE OF WISCONSIN <br /> ss. <br /> COUNTY OF DANE M f� <br /> Personally came before me this day of 1 :r 3A•2 0 ,the above named person(s) <br /> to me known to be the persons who executed the foregoing instrume t a • S1 owledged the same. , <br /> Notary Publi Dane County,Wisconsin . • <br /> My Commission is permanent. (If not,expiration date is Illet D o 1 I) <br /> Dane County Environmental Health 5/01 <br /> a1 \3 <br />