HomeMy WebLinkAbout038-1055-20-500 Wisconsin Department o f Commerce
Safet;iand Buildings Di PRIVATE SEWAGE SYSTEM Cour, Croix
INSPECTION REPORT
, 'GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes (Privacy Law, s.1 5.o4 (1)(m)i.
Permit Holder's Name: []City ❑ Village ❑X own of: State Plan ID No.:
Insp. BM Elev.: I BM Description: gj [
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 1 E K5 Ct Benchmark * 3 - Z- 0 03. DO • `FS
Dosing /
g �•6Z o1•03 Alt
Aeration Bldg. Sewer .10 q. 5-s- /
Holding St/ Ht Inlet 3. p'
TANK SETBACK INFORMATION St /Ht Outlet
TANK TO P! L WELL BLDG. Air I nt a ke ROAD Dt Inlet
Air
Septic '+ 3� 1 g ' NA Dt Bottom
Dosing _- NA Header/ Man. ci'en
2
Aeration � NA Dist. Pipe_ r0 S
Holding �� �� Bot. System
PUMP/ SIPHON INFORMATION Final Grade S 310'
Manulso Demand 3. W 3 St pi;vpf
Model Numb GPM
TDH I Lift Fri, 5 stem TDH Ft
Forcema' Length Dia. Dist. To Well -
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Len th J J No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIME N S IONS 3 (0 s 0 D IM E N S ION S
SETBACK
SYSTEM TO P! L BLDG I WELL LAKE /STREAM LEACHING - Manuf acturer: INFORMATION Type of J, tis r n Ah $ r --�`� model r.
Num e
System: CHAMBER : Wes" OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pip #-L Hole Size I x Hole Spacing Vent To Air Intake
Length Dia. Leng Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Seeded/ ded / Sodded xx Mulched
Depth Over Depth Over xx Depth Of
Bed / Trench Center Bed /Trench Edges Topsoil ❑ Yes [I No C] Yes [] No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: 1'x'/ Inspection #2: ,- (
Location: 2135 Cty Rd. C New Richrpond, WI 54017 (NW 1/4 SW 1/4 13 T31N R18W) - 133118237F -Lot 4
1.) Alt BM Description 2QQ�`J
2.) Bldg sewer length = 1 V t $ 4
- amount of cover=
Plan revision required? ❑ Yes t@ No
S
Use other side for additional information. p y (�' o l
SBD -6710 (R.W97) Date Inspector's Signature Cert. No
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2 ( 35 GTE - C Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1. Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
'\V,SCOnS Personal informatio n
p
i n [Privacy Law, s. 15.0 ide be used for secondary p urposes Madison. WI 53707 -730^
you provide � may P P
Dep of Commerce (Submit completed form to county if r
4(1 )( m )J p
state owner
Attach complete plans (to the count) copy only) for the system, on Eaper not less than 8 -1/2 x 11 inches in size.
County State S P Number ❑ Check if revisipwtp previous application State Plan 1. D. Number
7
I. Application Information - Please Print all Information Location:
Property Owner Name EL��'t' EU Pr operty Location
t }
/l; is l /4,SUA IM S I S T :3 f,N, R/ .0
Property Owner's Mailing Addre f G UU Lo I Number Block Number
ST ; :it3tX u
City, State t , Zip Code Ph a be ` bdivision Name o CSN umber 5 /
r 1�31'ItiVG FICI:
3 3
II Type of Building: (check one) / / ❑ City
1 or 2 Family Dwelli o. of Bedrooms: ❑ village
g — _� _ � -.
13 b C Pu lic/ ommercial describe use):
J? Town of
❑ State -owned st,
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road
G FI - L
A) 1. #,New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existing System D - CL?
B) 4 Permit Number RwNftwed
❑ A Sanitary Permit was previously issued I h 3, 3 j g
IV. Type of POWT System: (Check all that apply) `I
X,Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ ecirculati g Other: ,
V Disp ersal/Treatment Area Information: /I I — // Z - 1 -
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation t41#de "
Required Proposed Rate (Gals. /day /sq. ft.) (MmAnch)
„ /—S
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing Crete structed
Tanks Tanks
❑ ❑ ❑ ❑
❑ 11 ❑ ❑
VII Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumbe ' I re (no s P PRS No. Business Phone Number
Plumber's Address (Street, City, State, Zip C? e) _
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
Approved ❑ Owner Given Initial Adverse Surcpge Fee) t
Determination �' �o2s• 12 - I$-7;�
IX. Conditions of A wroval /Reasons for Disapproval• / � v l�a eb ce��
�'el A�+��tQ- _ o w¢. .�- t 1
AA K SJ�ks �a� b� ,nw� .vti � � s St, LOS . 5L L-1412 .
w, tre_c..0•� �� � .
SBD -6398 (R. 07/00)
035
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16 -rye")
5 4:
ay9 ai 77 3
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Wisconsin DepWtment of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor ;rte Human Relations
Division of,safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to ne„areekroad _, 038 - 1055 -20 -000
APPLICANT INFORMATION— PLEASE PRINT.k N'F"ORMATI0, ,,,,\ rp IEWEDBY �DATE t �
PROPERTY OWNER: PROPERTY LOCATION
/ - ....i Y/.
G G LOT NW 1/4 SW 1 /4,S 13 T 31 N,R 18 t(or) W
PROPERTY OWNERS MAILING ADDRESS i T LQT BLOCK # FSUBD. NAME OR CSM #
1416 Third St. S _, /: ' i "? 199 ; na I Csm
CITY, STATE ZIP CODE :P4NE NUN 'EFVROIX []VILLAGE [MOWN NEAREST ROAD
Hudson, WI. 54016 1:713 ' tar Prarie I C.T.H. "C"
[� New Construction Use [x ] Residential/ Nti*r of bedrogms 4 [ ] Addition to existing building
j J Replacement ( ] Public or commercial 'ri
Code derived daily flow 600 gpd Recommended design loading rate _-7 ed, gpd /ft gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate _ _ j 7 bed, gpd /ft gpd/ft
Recommended infiltration surface elevation(s) 95.55 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material oLtwas;h Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem RIS ❑U ®S ❑LI I ®S El @S ❑U QS ❑U ❑S QU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -11 10yr2 /2 none 1 2msbk mfr c3.w if .5 .6
1
2 11-22 10yr4/4 none sil 2msbk mfr gw if .5 .6
Ground 3 22 -84 7.5yr4/6 none Co s Osg ml na na .7 .8
elev.
9
Depth to
limiting
factor
+
�b
Remarks:
Boring # 1 0 -12 10yr2 /2 none 1 2msbk mfr gw if .5 1.6
2 2 12-29 10yr4/4 none sil 2msbk mfr gw if .5 .6
3 29-84 7.5yr4/6 none ms Osg ml na na .7 �.8
Ground
elev.
9 9.45 ft.
Depth to
limiting
factor
><y
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715 -246) -6)200
Address: 1554 200th. Aim., New Richmovd, WI 54017
Signature: Date: 10 - - CST Number: m02298
I � 0( - �Amy
I
PROPERTY OWNER Greenwood Ent. SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # 038 - 1055 -20 -000
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD /ft
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Twch
2 10 -24 10yr4 /4 none sil 2 f p1 mfr gw if np .3
Ground 3 24 -84 7.5yr4/6 none ms Osg ml na na .7 .8
elev.
98 ft.
Depth to
limiting
factor
+84 �l
Remarks:
Boring #
1 0 -10 10yr2 /2 none 1 2csbk mfr gw if .5 1.6
4 2 10 -22 10yr4 /4 none sil lcsbk mfr gw if .2 .3
3 22 -84 7.5yr4/6 none ms sOg m1 na na .7 .8
Ground
elev.
98 ft.
Depth to
limiting a�
factor
+84"
Remarks:
Boring #
1 -12 10yr3 /3 none 1 2msbk mfr gw if .5 .6
2 12 -27 10yr4 /4 none sil lcsbk mfr gw if .2 .3
................
3 27 -84 7.5yr4/6 none ms Osg ml na na .7 .8
Ground ---------- ,
elev.
98-, g5- ft.
Depth to
limiting g
factor
+ "
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Greenwood Enterprises, Inc. New Richmond, WI 54017
MPRSW -3254 NW4SW4 s 13 - T31N - R18 w (715) 246 -6200
town of Star Prarie
lot #4 -csm
N
1 =40'
BM.= top of NE lot stake @ el. 100
Alt. BM.= top of SE lot stake C el. 100.45
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Gary L. Steel
10 -13 -98
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567 -P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number 3 83333
Number of Bedrooms 3
Design Flow - Peak (gpd) q5p
Estimated Flow - Average (gpd) cYV
Septic Tank Capacity (gal) std
Soil Absorption Component Size (ft') Z _�
Type of Wastewater Dom stic �s
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absor tion Component
Design Flow - Peak (gpd) - O° t
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the se nd outlet filter shall be assessed at least
once every 3 years by inspection. Th outlet filter hall be cleaned as necessary to ensure
proper operation. The filter cartridge shou no be removed unless provisions are made to
re am soli sin a tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
ore intense and earlier, organic clogging m 9 99 9 of the soil.
2
d ' Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
3
� -12 -00 02:39 PM NEWIHORIZONIHOMES. 17152463513 P.02
• ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Malting Address /
.vi i o a
Property Address 135
c x -k
(Verification required from Planning
g Oepartmettt foe ne con struction)
City /State
Parcel Identification Number e3 j a — /o
AL D>;SC'>aIPTION
Property Location %. zr y S _-j TAN_R / y�W, Town of s ,�,
T? -e,4 e —
Subdivision �r l _ �-�' _ - -- - Lot _-
Certified Survey Map # -5- , Voluma Page # — 35 y9 _
Warranty Deed # �� 3 `� _ Volume ,5 `? , Page It _ _ ey l
Spec house )X yes Q no Lot lines identiftabIc A ycs C no
,SYSTEM HAINTENANCE
Improper use and rnatarenan ceatyour septic system could result L-i its premature failure to handle wastes. Proper maiatcwace
consists of Puri►ping out the septic tank every three years or sooner, if nct:ded by a licensed pumper Wbat you put into the system
can affect the funceion of the septic tank as a treatmeat stage in the waste disposal system,
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plurrtbcr, joutneytnaa plumbet, restricted plumber or a licensed puwper verifying that (1) the on -site wastewater disposal system
is in proper uptraling condition and/or (1) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge.
Iiwe, ths. Undersiped have tend the above retpunements and agree to maintain the private sewage dis
set forth, herein, as cat by the Depanment ofC'ommerce and the Department of Natural Resour es, State Ce rtification
stating that your septic system his becA maintained must be completed and returned to the St. Croix County Zoning Ofrice within 34
days of the three year expiration date.
S OF q ANT
DATE
OWNER CFF,RTMrA
I (we) certify that all stat on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a wartan decd rector i
ty recorded n Register of Deeds Office.
SIGNti3Ttttlr OF APPLICANT
DATE
•���•• Any iqf0Mti0d that is sit- repreknted=y te,SUl fi the sattit&fYPMnit beiaS tavoked by the Zoning Department. ••••••
•• Include wkh this aWkstieo: a stas:tped wanwaly deed fmm the Register of Deeds office
a "VY of the certified survey trap if mfert ttce is made in the warranty deed
• 12 -00 02:40 PM NEWIHORIZONiHOMES. 17152463513 P.03
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�• STATE BAR OF WISCONSIN FORM 1 - 1982 6:23 G
WARRANTY DEED KATHLEEN H. WALSH
� �J REGISTER OF DEEDS
DOCUMENT NO. V 01..156 1 PAU 444 ST, CROIX CO., WI
RECEIVED FOR RECORD
This Deed made between Greenwood Enterprises, Inc., 12 -15 -2000 10:15 AM
a Wisconsin Corporation, WARRANTY DEED
EXEMPT R
Grantor, CERT COPY FEE:
COPY FEE:
and New Hoiriton Homes, Inc. and Bernard J. K= and I TRANSFER FEE: 59.70
Shirley F. Kopp RECORDING FEE: 10.00
PAGESs 1
Grantee,
Witnesseth, That the said Grantor, for a valuable a xisiderati
conveys to Grantee the following described real estate in St. Croix THI SPACE RE FOR RECORDING DATA
County, State of Wisconsin: NAME AND RETURN ADDRESS
Return to:
Edina Realty TW
400 South 2nd Street
Suite #115
Hu on, WI 54016
038 - 1055 -20 -500
PARCEL IDENTIFICATION NUMBER
Lot the CSt recorded in the Office of the Register of Deeds for St. Croix
unty, Wisconsin, on November 10, 199E3, in Volume 13, at Page 354 3, as nocument
tober 5, 91311_ in part.of the NW 1/4 of the SW 1/4 of Section 13, Towns i
31N, Range 18W, Town of Star Prairie, St. Croix County, Wisconsin, excepting
therefrom the Westerly 60 feet.
This is not homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Crantnr
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements restrictions
and reservations, if any, of record.
I
and will warrant and defend the same.
Dated this 14th day of December xiK 200
OOD SES ,
(SEAL) (SEAL)
« as E. Rusc it President
, 7;1
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
ss.
Rt. Croix County.
authenticated this day of , 19 Personally came before me this 14th day of
!, December. 2000 xc , the above named
James E. Rusch, its president and Mary R.
• Riisch, its secretary.
TITLE: MEMBER STATE BAR OF WISCONSIN -
(If not,
i
authorized by §706.06, Wis. Stats.) to me known to be the person S- - who execu the -foregoing
inst ent and acknowledge the sa 9 - ,
THIS INSTRUMENT WAS DRAFTED BY
Mary R. Rusch
Sandra - M C—brk
_New Richmpnd, Wisconsin Notary Public, __County Wis.
(Signatures may be authenticated or acknowledged. Both are not My miss' n is rmanent. (If n t, state expiration date: I
necessary.) I , 3� 7
- - —
• Names of persons signing in any capacity should by typed or printed below their signatures.
STATE BAR OF WISCONSIN Wisconsin Lapel Blank Co., Inc.
WARRANTY DEED Form No. 1 — 1982 Mdw"96. Wis.
FILED
NOV 1 0 1998 ►
KATHLEEN H. WXM
Register of Deeds 1
SL Croix Co. WI
X91311 `�
ti
CERTIFIED SURYEYMAP
GREENWOOD ENTERPRISES, INC.
Part of the Northwest 114 of the Southwest 114 of Section 13 Township 31 North, Range 18 West, Town of
Star Prairie, St. Croix County, Wisconsin.
�I W114 COR. SEC. 13, r3/N, R/8 W
� I I COUNTY SURVEYOR'S MON.I
N N� MI VI q S/GN EASEmrNT
UNPL A T TED L
4 � 1
S 89.07'26 "E
480.01
_� vl 60.0/' - 20' 420.00'
60' �o ; LOT 3 3
I 5o I p n
/.983 ACRES
(� B6, 386 SO. Fr. O ♦� W M
1, 735 4CRES EX C. R04 R. 0. W. m 2 ? •
y I N O ! 73, 586 SO. Fr. O Q o
t
L 480.01 ' M Q W
J I ^ 60.01 *J
U I 420.00' -- �__"l/ al
Zi
Q N O ( M !2 1 i M ► Q
3 M M \ 1 ` �tllt M Q `f
I. o �� LOT4 J
W
Q O O H ! m 1.983 ACRES
J j • O + O p �n
a °o m ! W s6 , 38 6 S0. F r. m I c
Z i 2 h 1. 73 5 ACRES W a
JI I i Q 75, 586 $0. Fr. m
- 3
420.00'
3 N89 "W 480.01'
caI O.J AccESS ffASFam -KNT
f o UNPLA T TED LANDS
SW COR. SEC.13, r 3/ N, R /8W,
/ COUNTY SURVEYOR'S AION./
�
o
SCALE / "= /00' `Y�• - '� •• �I
o so' loo' /50' 200' 300' . LA R E�� ?
�T r W PHYi
1713 a.
R ER FALLS, a�
Wisc. Q
Legend: � LAND ���.
O l "x 24" iron pipe weighing 1.13 lbs. /fin. ft. set. 8808164$00
R (19.00') Previously recorded data. Laurence W. Murphy
istered Land Surveyor
Owner's Addre4s:
1416 Third St.
Hudson WI 54016 SHEET 1 of 3
Dated.• September 28, 1998 "Revised this 2nd day of November, 1998."
This instrument drafted by Laurence W. Murphy
Vol. 13 Page 3548