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HOLDING TANK MAINTENANCE AGREEMENT <br /> Contract Date <br /> /0-/3- This contract is made between the <br /> Holding Tank Owner(s)Name(s) and P mper's Name <br /> A;e -o " —nom. p Vez-JU ' <br /> N `cit I Soc L <br /> We acknowledge the installation of(a)holding tank(s)on the following property: (Provide legal description) <br /> otot_ t o r ( 4) 4-----0-2 - . _._ 1_,5u.-C.-vc _1� -- F LP 117_r-t_.�__c�ecvrdecL _.cert------ <br /> Vo me_ ' . 4-5_. ctrl c�_76 J)ot.- 02016,2. t n n �/ <br /> I Dem 7 ..�' Ck-/%-r. 't £:- - .�ca-a-C/ do - 2 "d- <br /> Tax Parcel# � <br /> D 7'-- _.a._ 01 -3 S-a s-- s o 5--_Co 9_15D20-- 1 e--c, a�1 , <br /> .i-ee� Vileo& . 6uv.rte.tt <br /> -.._.._._._.._.._._.._.... ._._ . ____._. ._._. Cay„ _,_.Gu1-k4.6..0 <br /> 1. The owner agrees to file a copy of this contract with \){ '\e-‘\ C }.)0,11 <br /> 2. The owner agrees to have the holding tank(s)serviced by the pumper and guarantees to permit the pumper to have access <br /> and to enter upon the property for the purposes of servicing the holding tank(s). The owner agrees to maintain the access <br /> road or drive so that the pumper can service the holding tank(s)with the pumping equipment. The owner further agrees to <br /> pay the pumper for all charges incurred in servicing the holding tank(s)as mutually agreed upon by the owner and pumper. <br /> 3. The pumper agrees to submit reports for the servicing of the holding tanks as required by DSPS 383.55, Wis. Adm. Code. A <br /> report for the servicing of the holding tank(s) shall be submitted within 30 business days. The pumper further agrees to <br /> include the following in the report: <br /> a. Name and address of the person responsible for servicing the holding tank; <br /> b. Name of the owner of the holding tank; <br /> c. Location of the property on which the holding tank is installed; <br /> d. Sanitary permit number issued for the holding tank; <br /> e. Dates on which the holding tank was serviced; <br /> f. Volumes in gallons of the contents pumped from the holding tank for each servicing; <br /> g. Disposal sites to which the contents from the holding tank were delivered. <br /> 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change of this <br /> contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the <br /> local governmental unit and the County named above within ten (10) business days from the date of change to this service <br /> contract. <br /> r ---__-int) -- ignature n- n to —___ <br /> Owners)Name(s)(Print) Owner' s) Subscribed and sworn to me on this date: <br /> // <br /> ��..g.� �.e�t� -. � aux- i- ,, <br /> do <br /> G�/f 7 _ ____. jTo•ay's <br /> Date <br /> I <br /> Pumper's Name(Print) Pumper's Signature No ary -ublic Signature <br /> --S—Cts c/o "cd,4sc7c) <br /> Pumper's Registration Number Commission Expiration <br /> gc1/8 <br /> �___--_----------.---_______ _ _ .4,,,4 .--__--BR+AN THOMAS HotEN <br /> Drafted by the Land and Water Resources Department `� �, <br /> ,;A ;, Notary Public <br /> ._< e� Minnesota <br /> ___4,• My Commission Expires <br /> :�.. Jan 31, 2024 <br /> Form 12-003 Revised 1/2015 <br />