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HOLDING TANK SERVICING CONTRACT Holding Tank Owner(s) Name(s): Pumper’s Name: I/We acknowledge the installation of a holding tank(s) on the following property: PARCEL Legal Description: 1. Owner agrees to file a copy of this contract with the Douglas County Zoning Office. 2. Owner agrees to have the holding tank(s) serviced by the WI DNR licensed pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road so the pumper can service the holding tank(s) with pumping equipment. Owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. Pumper agrees to submit reports for the servicing of the holding tank(s) to Douglas County Zoning Office, as required by Comm 83.55, Wisconsin Administrative Code. Pumper further agrees to include the following in these reports; a. Name, address and registration number of the person servicing the holding tank(s) b. Name of the owner of the holding tank(s) c. Location of the property on which the holding tank(s) is installed d. Sanitary permit number issued for the holding tank(s) e. Dates on which the holding tank(s) was serviced f. Volumes in gallons of the contents pumped from the holding tank(s) for each servicing; g. Disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with Douglas County Zoning Office within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner’s Signature(s) Subscribed and sworn to me on this date: Today’s Date Pumper’s Name (Print) Pumper’s Signature Notary Public Signature Pumper’s Registration Number Commission Expiration Drafted by Douglas County Holding Tank Servicing Contract Revised 1/1/09 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(l)(m)]