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. 111111111111111I1111111111411111 BOLDING TANK AGREEMENT Tx:8903864 " - This AGREEMENT is made by 71-k 44 k,c a C KRISTI CHLEBOWSKI DANE COUNTY As grantor,hereby acknowledge that a holding tank is being installed on the REGISTER OF DEEDS parcel of real estate located in the Town of /17 ve‘rriz a DOCUMENT it in the_-- —_quarter of Section, 42 vi ,T 5 N,I1, 'Y' E. 5376836 . 12/07/2017 03:21 PM Type or neatly print the legal description ofyourproperty in the space below. (The Trans Fee: legal description is found on your deed and usually on your tax bill. Ifyou need more Exempt it: space use the reverse side or attach a copy of the deed.) Rec. Fee: 30.00 e— /il'✓ 14y vf' 7-74. s W f'e—.. . ) . Pages: 1 Sic GTE/V n) ,./ 1 17 7—,_<—N, Q 771E' 641.1C �� , /',Z. /1-;/ 42v ra 12.1( S- 7/3 /Cel.e.5' p6L.1 v-' Pte. .63-0X G,Z a 331::, / 6 7 c*" i✓,,Gv S:- s-6..Z Tax Parcel 41 t2 o.-- _o ..-'.7 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: L The property owner ugrces to conform to all applicable requirements of ch.SPS 383,Wis.Adm.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 eller 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.Mrs.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. /� ACI NOWLEDC.EM>&NT4 ' _ '• �L n'/ % it / / , /� To Offi.ar(Signature)and Title Owner Name(S gnature) /� � cei N►Sl�ols4n • t_ 1U eA .tr'`/ sot Owner Name(Print) Town Official Name (Print) a _n. l[ e, o j't. ,oii1t1111/0 STATE OF WISCONSIN ss. COUNTY OF DANE ) �'� TQ y' S'. ., day of Ju ___ , the above natn arson}t e l:noi�n Personally came before me this y @ ®�� .*_ to be the persons who executed the foregoing instrument an wled�the same= 4 IX . 5.. Notary P f is Dane County,W sconsin , . 0*T• My Coi f ission is permanent. (If not,expiration date is llllll��` •(lane County Environmental Health 5/01 0 _