DCPZP-2016-00751 - Laserfiche WebLink

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HOLDING TANK AGREEMENT This AGREEMENT is made by u !! I Uq� As grantor,hereby acknowledge that a holding tank is being installed on the parcel of real estate located in the Town of /i j•c)c) / -kd r' in the S►:f t/ dt gGarter of Section )7- ,T 7 N,R E. Type or neatly print the legal description of your property in the space below. (The legal description is found on your deed and usually on your tax bill. If you need more space use the reverse side or attach a copy of the deed.) S k�, t(Li N 1 f v Your name and return address Record this document with the Register of Deeds ( l kl•,,IL .S k. c I✓a ; PO x Gzgocy to otal,lQit ,,,r.J S316t Tax Parcel# 0j7(�g )71 - 9000-- As an inducement to Dane County to issue a sanitary permit for the use of a holding tank system for the collection of wastewater from the structure located on this property,we agree to the following; 1. The property owner agrees to conform to all applicable requirements of ch.SPS 383,Wis.Adin.Code and Dane County Code ch.46 • relating to holding tanks. 2. The property owner agrees to pay all charges and costs incurred by Dane County or the Town for inspection,pumping,hauling or otherwise servicing and maintaining the holding tank as may be necessary to abate or prevent a human health hazard caused by the condition or use of the holding tank. In the event the owner does not pay the costs within thirty(30)days after notification,the owner specifically agrees that all costs and charges may be placed on the tax roll as a special charge for the abatement or prevention of a human health hazard, 3. The property owner agrees to contract with a person who is licensed under ch.NR 813,Wis.Adm.Code,to have the holding tank serviced and to file a copy of the contract with Public Health Madison and Dane County,Environmental Health Division. The owner also agrees to file a copy of any changes to the service contract,or a copy of a new service contract,within ten(10)business days from the date of any change or new contract. 4. The property owner agrees to maintain a service contract with a person licensed under ch.NR 813,Wis.Adm.Code. That person must agree as part of the service contract to submit a report of the servicing events on a semiannual basis,not later than January 10 and July 10 of each year. The property owner agrees to allow the Environmental Health Division or Township to enter upon the property to investigate the condition of the holding tank at any reasonable time, 5, By signature on this agreement the Town agrees to collect all costs and charges identified in item 2 above as specified. 6. This agreement shall remain in effect until Dane County certifies that the property is served by public sewer or another method of wastewater disposal that complies with ch.SPS 383 Wis.Adm.Code and Dane County Code ch.46. • 7. This agreement is binding upon the owner and all heirs or assignees. ACKNOWL DGE1V T O ame(Si.•• ire) Torw„.0fficialN: e • a ured ` Title O to \ T. / t_O(A t �t)t Q iYg•V r Owner Name(Print) I� / ` Sk t A 0✓�t Town Official Name (Print) w STATE OF WISCONSIN ) ss, COUNTY OF DANE L /fh 9-01 (�e Personally came before me this T day of af..,�.1i/�' bQ ,the above named person(s)to me known to be the persons who executed the foregoing instrume t�$nd ac okn wl d the s e. .-1 � No :ry Public Dane County,Wisconsin SCIYGt- L. 1—�C�1'��C My ommission is permanent. (If not,expiration date is L4 1 t D ab Public Health Madison and Dane Co 4/6/2015