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FLOWS AND LOADS 8 0Tx:4022762 5 <br /> AFFIDAVIT 446082 <br /> BURNETT COUNTY WISCONSIN <br /> Legal Description: See Attached RECORDED ON: <br /> 06/19/2017 1:52 PM <br /> Parcel ID: 07-012-2-40-15-26-5 05-004-015000 PAGES: 2 <br /> JEANINE CHELL <br /> Property Owner: Nancy Sue Erickson REGISTER OF DEEDS <br /> REC FEE:30.00 <br /> Mailing Address: N8337 Northshore Road TRANSFER FEE:0.00 <br /> FEE EXEMPT# <br /> City, State, Zip: Menasha,WI 54952 Return to: Burnett County Zoning <br /> I (we) do hereby acknowledge that the use of the existing private onsite wastewater treatment <br /> system (POWTS), as installed on the above described real estate is based on the following <br /> flows and loads: <br /> 450 gallons per day <br /> 220 mg/L BODS 150 mg/L TSS 30 mg/L FOG (monthly average of each) <br /> Furthermore, I (we) acknowledge that the modification to the structure served by the existing <br /> POWTS will not result in a change that affects the wastewater flow or wastewater contaminant <br /> load beyond the maximum capabilities of the existing POWTS and the following flows and loads <br /> shall not be exceeded: <br /> 450 gallons per day 6 persons (maximum occupancy for structure) <br /> 220 mg/L BODS 150 mg/L TSS 30 mg/L FOG (monthly average of each) <br /> I (we) hereby state that should the flows or loads increase beyond those indicated, the POWTS <br /> shall be modified to conform to all applicable rules. I (we) also state that, should the existing <br /> POWTS show any signs of failure in any component of the POWTS, said POWTS shall be <br /> repaired or replaced according to applicable rules. <br /> Owner Name(Print) Subscribed and sworn to before me on this date: <br /> 2 /` �ypeeununpuprp .t <br /> Notarized Owneil Signature Notary Signature <br /> My commission expires: <br /> y x <br /> ' ElflllleeeeJee•`` <br /> Drafted By: Burnett County Land Use/Zoning Office <br />