Laserfiche WebLink
PRIVY INSTALLATION AGREEMENT <br /> To be completed in black ink. (Attach copy to Non-Plumbing Sanitary Application) <br /> Property Owner(s): <br /> Mailing Address: FOR REVERENCE <br /> 3/026 7-460 LTC DP afOokfiy- O1" .S' IT36 ONLY <br /> Property Address: <br /> Location <br /> S L 7 ,T /. N, R / ' W <br /> Town Of:S 4/(S 5. <br /> Parcel Identification Number: - <br /> 6 3 2 -.5'2I 7 ` a - 1" <br /> Legal Description: o U d T 3) <br /> ®� ir 2 e5v 7 P/p 6ftslG <br /> CSM 14I4 1' 1411 ,tov 2-17A-165t`7�-t'yIrl,R15W <br /> Tax ID: /3 <br /> Return To: Burnett County Land Services Dept. <br /> 7410 County Road K,#120 <br /> Siren,WI 54872 <br /> 1. No plumbing will be installed in the privy. <br /> 2. No plumbing will be installed on the premises served by the privy unless:a code compliant soil absorption system or holding tank <br /> exists,or a valid sanitary permit to install such a system has been issued. <br /> 3. A privy vault/pit shall maintain minimum setbacks as specified in Table 1. <br /> Table 1 Well Building Lake/Stream Additional Setbacks <br /> Open Pit 50 Ft 10 Ft Min.75 Ft 25 Ft to all lot lines <br /> Sealed Pit 25 Ft 5 Ft Min.75 Ft 25 Ft to all lot lines <br /> 4. Privies for public buildings shall comply with Wis.Adm.Code.SPS 391. <br /> 5. Privies used for one-and-two-family purposes shall be constructed in such a manner so as to exclude flies,rats and other vermin. Doors should be <br /> self-closing and vault ventilators should terminate at least one foot above the roof. <br /> 6. A privy vault shall be constructed of watertight plastic,fiberglass,coated steel or monolithic concrete. Materials shall comply with intent of Wis. <br /> Adm.Code SPS 383.20&SPS 391. <br /> 7. SPS 391.12 Privies—requires the storage chamber of a vault privy to conform with SPS 384.25 requirements. The vault shall have a minimum <br /> storage capacity of 200 gallons or one cubic yard. <br /> 8. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR 113,Wis.Adm.Code. <br /> 9. This agreement shall be binding on the owner,their heirs,and assignees. This documentation shall be recorded by the register of deeds in a <br /> manner which allows its existence to be determined by reference to the property where the privy is installed. <br /> 10. The property owner shall notify the County for inspection immediately after the non-plumbing sanitary system has been constructed. <br /> Printed Owner(s)Name(s): Subscribed and sworn to before me on this date: <br /> 7r--/2 9, .zoo/ <br /> Owner(s) re: Notary Public: <br /> 56';" <br /> My commission expires on: <br /> Drafted By: Burnett County Land Services Department Date: <br /> Personal information you provide may be used for secondary purposes.[Privacy Law,s.1504(1)(m)] <br /> ANN SCHAEFER LAhL. <br /> j lkiociftoolnb <br />