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Douglas County Holding Tank Agreement Rev 04-2012 HOLDING TANK AGREEMENT USE ONLY BLACK INK ON THIS FORM DO NOT WRITE IN THIS SPACE Agreement Date Town / Village / City of: Holding Tank Owner(s) (please print) State Sanitary Permit Number We acknowledge that application is being made for the installation of a holding tank(s) on the following described property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also the property cannot now be served by a municipal sewer. Legal Description of Property: Return to: Douglas County Zoning Tax Parcel Number: (required) As an inducement to Douglas County to issue a sanitary permit for the above described property, we agree to the following: 1. Owner agrees to conform to all applicable requirements of WI Administrative Code SPS 383 relating to holding tanks and the maintenance requirements of such. 2. The owner agrees to contract with a person who is licensed under Ch. NR 113 Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract with the Douglas County Zoning Office. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the Douglas County Zoning Office within ten (ten) business days from the date of change to the service contract. 3. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall submit to the county a report of each servicing event within 30 calendar days of the servicing of the holding tank(s). The Douglas County Zoning Office may enter the property upon owner consent or with a special inspection warrant to investigate the condition of the holding tank(s) when pumping reports may indicate that the holding tank(s) is not being properly maintained. 4. This agreement will remain in effect only until the Douglas County Zoning Office certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with WI Administrative Code SPS 383. 5. This agreement shall be binding upon the owner, the heirs of the owner, and the assignees of the owner. The owner shall submit this agreement to the Register of Deeds and the agreement shall be recorded by the Register of Deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank(s) is installed. USE BLACK INK ONLY Property Owner(s) Name(s) – Please Print ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. County ) Personally came before me on the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of Wisconsin My Commission □ Is Permanent / □ Expires Notarized Property Owner(s) Signature(s) Form Completed By: (name, title) Personal information you provide may be used for secondary purposes [Privacy Law s. 15.04(1)(m)]