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2011/09/20 - LAND USE - LUP - Other
Burnett-County
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TOWN OF JACKSON
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6264
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2011/09/20 - LAND USE - LUP - Other
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Last modified
3/5/2020 10:29:42 PM
Creation date
9/28/2017 9:22:43 PM
Metadata
Fields
Template:
Property Files v2
Document Date
9/20/2011
Document Type 1
LAND USE
Document Type 2
LUP
Document Type 3
Other
Tax ID
6264
Pin Number
07-012-2-40-15-07-5 15-135-011000
Legacy Pin
012910101100
Municipality
TOWN OF JACKSON
Owner Name
WILLIAM & BESSIE KOSTECKI 2010 REV JT TRUST AGREEMENT
Property Address
28905 SEIBEN RD
City
DANBURY
State
WI
Zip
54830
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PRIVATE ONSITE WASTE TREATMENT SYSTEMS Burnett County <br /> N Isconsin ( POWTS) Pmpcq Ad&m:ago <br /> Department of Commerce INSPECTION REPORT <br /> safty MW&*kva a non (ATTACH TO PERMIT) <br /> Sm"Parma Na <br /> GIENERALINFORMATION <br /> Parorol iRft=Naa W, n. W mad far anal Pri L,,.s.Is.04 1 m - <br /> Pam*Holder's Name: <br /> . citya �. Town of. StMs Plan TransactionTransactionTransactionDO: <br /> 8,1 ) 1 kb�� <br /> CST BAA Eley. Imp BM Ely.eBM Desa4eon:��,nn Pared Ta No: <br /> /6V. 00 --dr— –rot, of CoNcg&x rA-VO <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Do" �SkAW 800 GAi-LOr4 Bendunark 3./ 103.I <br /> Bldg.Sewer 4,34 28,so <br /> 9 St/Ht Inlel $ g 7. 7/0 <br /> TANK SETBACK INFORMATION St/Ht outlet <br /> TANK TO PA WELL BLDG ,R MTOup ROAD Dt Inlet <br /> swk >75 >50 3p — NA OtBotlan <br /> Dosing NA Installation <br /> Contour <br /> Aeratlarl NA Helder/Man. <br /> Dlsl.Pipe 5 f329732 <br /> PUMP I SIPHON INFORMATION Infilbalve <br /> Surface <br /> ManulacAner Demand Final Grade <br /> Model Number GPM <br /> TDH Lift Friction Loss System Head MH Ft <br /> Famemain Length Dia Dist To Wen <br /> DISPERSAL CELL INFORMATION <br /> IMIIENSIONS I WE (e LNO 72 NadCda Type of System Manufacturer <br /> SETBACKLEACHING <br /> NFORMATION P/L Bldg wa oHvru d Nw ( <br /> wdere Me CHAMBER Model Number: <br /> CELL To >A5' <br /> DISTRIBUTION SYSTEM X Pressure system only <br /> Header/Manifold Dielibulon Prpe(s) X Hole Sae X HoleELWO— Dia Observatlon Pipes <br /> SOK COVER �_ Ing O Yes ❑No <br /> De pm Over Depth OverDam Seeded/Sodded Muldred <br /> Cel CME T '1 ❑Yes O No O Yes O No <br /> COMMENTS: (Include code discrepancies,persons present,etc.) <br /> Permit Posted? e N <br /> Schedule 40 Vents and Observation Pipes?© IN <br /> Cover Material: 7TVYA12 <br /> Effluent Filter Manufacturer XAUJ— Model A /600 <br /> Components Not Inspected: <br /> Plan revision requkWM Yes O No �, <br /> 7 v d61 / 1 <br /> Use odw aide for&Wftnal infamadon Date ss, Cert No <br />
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