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PRIVY INSTALLATION AGREEMENT <br /> To be completed in black ink. (Attach copy to Non-Plumbing Sanitary Application) <br /> Property Owner(s): <br /> Burnett County FC <br /> � R��!� <br /> Mailing Address: �. <br /> 8150 State Rd 70 0it• �. <br /> Siren,WI 54872 t'' O <br /> Property Address: <br /> 5648 County Rd A <br /> Webster,WI 54893 <br /> Location <br /> '/<, S 31 ,T 40 N, R 15 W <br /> Town Of: <br /> Jackson <br /> Parcel Identification Number: <br /> 07-012-2-40-15-31-5 05-008-011000 <br /> Legal Description: <br /> That part of NE 1/4 NW 1/4 lying West of County Highway A,W''A NW 1/4 NW'/ <br /> SW'/ except Lot 1 of Certified Survey Map#1579 recorded in Volume 8 on Pages <br /> 134-135 as Document#224338,SW % SW 1/4,Section 29,Township 40 North, <br /> Range 15 West,Town of Jackson,Burnett County,Wisconsin. <br /> Tax ID: <br /> 5895 <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 I. <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 FMin. 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 /> EIA rit# 01/11(rki eirc(c <br /> Owner(s) Signature: Notary?ublic: <br /> --01R7--01/1"- d4A)14.. jaafiy:kkAAA\ 1/LAil&A-Qt-, <br /> Q V rvv-tft C.CflAvikiM co o aeddil e S <br /> 14g.1011(f)Count3► rk `: <br /> Drafted By: Burnett County Land Services epa t ent Date: <br /> Personal information you provide may be used for secondary purposes.[Privacy Law,s.1504(1Xi <br />