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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 3 INSPECTION REPORT Sanitary Permit No: 463428 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Ce ielski, Joe I Kinnickinnic, Town of 022 - 1065 -50 -200 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No: 9q. Gs C 23.28.18.356G TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic BenchmarkAV�- Z 2 .75 9 T Dosing OJw�2S (o:56 am C Jf� i�j, lay, Action -- / Bldg. Sewer 7.%3 14 - .� Holding St/Ht Inlet 1 , 06 '13 . TANK SETBACK INFORMATION SUHt Outlet 9, 93 - 15 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 Z AA -;b' � i Dt Bottom t , - 7 � �q Z Dosing 7 Z5 1 �� Header /Man. z -25 106 ' -5 Aeration Dist. Pipe u L J ,6o Holding Bot. System 1 �J ' Final Grade Qt 7 PUMP /SIPHON INFORMATION • �5 Ids ' Manufacturer C De ^and St Cover e , /^ Model Number 45Y vs ) NT+ 3.45 TDH Lift Frictio Loss System Head TDH F a.d 3,z� /5.3i Forcemain Lengt r 1 Dia. 2 f� Dist. to well /��-}- / SOIL ABSORPTION SYSTEM /� BEDlTRENCH Width 1 Length No. Of ench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � b __1 ____ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION T Of S stem UNIT Model Number: 1 CHAMBER OR Yp Y � /� DISTRIBUTION SYSTEM Header /Manifold / Distribution Z I x Hole Size /I x Hole Spacing Ve to Air Intake I Pipe(s) Length Dia Length *4 Dia r Spacing 7 i 24 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only — ✓...- Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ' t — 1 Bed/Trench Edges \ Topsoil \ 'VYes j No Yes J No I � COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: s / � S nspection #2: 1 / Location: 258 Deerwood Court River� Falls, WI 54022 (SE 114 NE 1/4 23 T28N R18W) NA Lot 11 �( °� �' ` Parcel No: 23.28.18.356G 1.) Alt BM Description o�- 2.) Bldg sewer length = '� - amount of cover Plan Use other de for additional in Yes No -- Re quired? . �✓ formation. I ��_ _ 1 4 Date Insepctors ignature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Bo `' �scans�n M n, WI 5 - �CE'V nitary ermit Number (to be filled in by Co.) Department of Commerce 266 151 3 I ld Sanitary Permit Apphcsk A pR 2 1 to PI I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal inforinn y e I/ O 3 may be used for secondary purposes Privacy Law, sl5.04(1)( ST. CROI)k CO ject A ress (if different than mailing a - 7 0 NING OF I. Application Information - Please Print All Information CiJ At S Property Owner's Name Pa 1 # Lot Block # �C �S ,' � 3 y - ) -)hX.gyp -ao Property Owner's Ma ilin Addr ss X35 1 1 �A, _%,Section City, State Zip Code Phone Number E clutr �A �), � I 5 0 j 0 ,� - Z- 5 y.; (circle one) II. Type of Building (check all that apply) 2 �/ fJ T N; R E or W )-1 or 2 Family Dwelling - Number of Bedrooms J 7/ Subdivision Name CSM Number ❑ Public /Commercial - Describe USA Nei l- 6_ ❑ State Owned - Describe Use ❑City_ ❑Village NiTownship of ,� 9(" 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ;9 New S ystem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable s it At -Grade Single Pass Sand Filter El Constructed Wetland El Pressurized In- Ground El Holding Tank El Peat Filter 11 Aerobic Treatment nit Recirculating Sand Filter El Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line El Gravel-less Pipe El Other (explain) L' (t r V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System ElevationS A 0 � . A F"? VI. t ank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank % 5 J to Aerobic Treatment Unit i L A I Dosing Chamber ( Iv/! VII. Responsibility Statement- I, the undersigned, assume responsibility for install mafthrPVWTS shown on the attached plans. Plum is Name (Prin t) Plu Signa ture M u Business Phone Number Y6 Y Plumber's Add P ess (Street , Ci Sta // t i� e, Zip Code) fZv AV VIII ount /De artment Use Onl Approved Disapproved Sanitary Permit Fee (includes Groundwater Date Issued wing Ag t Signature o tamps) Surcharge Fee) l ❑ Owner Given Reason for Denial IX. Conditions of Approval /Reasons for isa proval S YSTEM ML EFt D Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to a County on for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) P Lor /a I r .. ffeS rid 4. tjoy P • -.�.s e d �-> 3 6 da.� �.en,C Ga•+f c r- /cr�C9��,sb pall!••. 44C s .1 S V p ��f ��ea7� 14 - jo to l 2u I't- v � P��cd •«J.h y al f••�ve�lrr S� AlC Q CY ►' loo.O s �y r ~tea i i o• � �..Y•p�.f .� E Y o 1 :n t�i:J 1 l.i. +.l'o FcX�Ta` 'e erwe.�lie4Ca� d } J *j.r Tyo�. �•�. ♦G� ji, 6i.y.o•+ *Ol /o0�4 87e. o•�tsP ►•wd�E�"y98 —� e -- i/tdj��l�' /oc vT /atl4il� �J Tic Not T � P / i* C . r �r p '!- Q . h rwrrer /� ��t�!atJi�1F love 0� 1pvis/'i P k I ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - - Hudson, WI 54016 -7710 (715) 386 -4680 • Fax (715) 386 -4686 EROSION & SEDIMENT CONTROL PLAN Parcel #23.28.18.356G Site: 258 Deerwood Ct., Lot 11 CSM 16/4338 (Kinnickinnic Two) — owner(s) Joe & Doreen Ce ielski Under St. Croix County Zoning Code 17.70(3)(b)5: `The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and /or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion & Sediment Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be excavation for the driveway and house foundation as well as any soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on any exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement off site. Surface drainage is southerly, toward Oak Drive drainage ditch and will be >500 feet from tributary streams of Kelly or Nye Creeks. 2. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. Do not allow diverted runoff to be directed onto neighboring properties. (Refer to specification sheet for Temporary Diversions provided by county) 3. If sediment cannot be contained on owner's property with temporary diversions and vegetative buffers, then installation of approved sediment control products will be required. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. This helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Please feel free to contact me with questions regarding erosion & sediment nstall Prepared by: Pamela Quinn, Soil Erosion Inspector #6650 Owner acknowledgement of ESC Plan requirements: L` T. "' / / 2005 Safety and Buildings PO BOX 7162 commerce MADISON WI 53707 -7162 i TDD #: (608) 264 -8777 i sco n s i n www.comm www.vfisconsin.gov www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary March 21, 2005 CUST ID No.220673 ATTN.• POWTS Inspector CHARLES L WEBSTER ZONING OFFICE WEBSTER EXCAVATING, INC. ST CROIX COUNTY SPIA N5815 770TH ST 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/21/2007 Identification Numbers Transaction ID No. 1120355 SITE: Site ID No. 695987 Joe Cegielski - Dwelling Please refer to both identification numbers, Deerwood Ct Labove, in all correspondence with the agency. Town of Kinnickinnic, 54022 St Croix County SE 1/4, NE 1/4, S23, T28N, R18W, Lot: 11 FOR: Description: New At -Grade System / 450 gpd Object Type: POWTS Component Manual Regulated Object ID No.: 1009036 Maintenance required; 450 GPD Flow rate; 39 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual, SBD - 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. b De No person may engage in or work at plumbing in the state unless licensed to d o so y the Department p er s.145.06 , stats. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This system is to be constructed and located in accordance with the approved plans and with the component manuals listed above. P t 2. On page 3, the observation pipe detail is incomplete. The observation pipes in the dispersal cell shall be a Gvl (1 minimum of 4 inches in diameter, have the bottom six inches perforated, covered with a watertight cap, and be suitably nchored. Refer to Figure 2 of the approve "At -Grade Component Manual Using a 1. P y h PP Pressure Distribution System for Private Onsite Wastewater Systems ", (SBD- 10570 -P (R.6/99)]. D/vI�ap4`t 1 3. On page 4, the following adjustment was made to the distribution network as specified in the approved jJ component manuals: F C J ( pR R Minimum required orifices (holes) for network = 4� First orifice location = junction with force main System flow = 29.49 gpm A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits , CHARLES L WEBSTER Page 2 3/21/2005 required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. :eter incerely, �` Fee Required $ 175.00 Fee Received $ 175.00 I Balance Due $ 0.00 agel Private Sewage Plan Rev / wer , Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0630 - 1500 Hrs pepagel@connnerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 WEBSTER EXCAVATING, INC. ��-- N5815 770th St. Ellsworth, WI 54011 x (715) 273 -3430 _ POWTS Index Sheet Page i of 8 At -Grade System for a 3 Bedroom Residence Property Owner/Proiect Name Joe Cegielski SE 1/4 NE 1/4 S23 T28 N R18 W MAC 20p5 Lot 11 CSM 16 -4335 Town of Kinnickinnic, St Croix County, WI D^ Contents Page 1 of 8 Index Sheet Pa e 2 of 8 Plot Plan t �v� .c`� � Oaee *o8 Plan View Cross Section Distribution Pi Re Layout aL C~I ���� ` Page 6 of 8 Pump Performance Cu Page 7 &8 of 8 Management Plan c��' � §2 \S O /v r' CHARLES L i ' " WEBSTER i E -18803 fC ELL SWORTM# •r ••. WIS. m ss •••• ... ••��,G` lo NAL Component manual used: Name: At -Grade Component Manual for POWTS Version: SBD10570- P(R6/99)�� 3, Date: 6/99 Name: Pressure Distribution Manual for POWTS C Version: SBD 10573 (R.6/99) a i Date: 6/99 ��Gs f'!o iw,, �o r f4 f de Jo it ler � fK 4.tl/ l.edtjoy i O v I E'•rc6 .w J.k yJ � t..* S� �C a • H Corrfav � y� r • KEY op.'s rw ► � : � rl�;r sc.� l� /.;►. _ ,S'pe'+ ry k c p,,l K, dr'•.o+,t i e. e d C 8/f �'/ r Ty, �.i. re�li, 6.4..•• �Eo��►ow.dE /r /e 34 i4. reL7 BiM. of ��►o �` /' a er No�c: Tic arr►,,,,►�d r /erJf f' /_c>.., r4.: •al to �h l /er l ti i.++o7f f BBS�t LA •+• swrr e1.o• -s rove �, /1 Old K p`,•r� At �rlde P /dam tur foe fp� ie�s/�� F oN L •I 2 5� e 115 If r o — �✓ A ` �,�,70 ,h a df� > 54 fi oice. M /.h �■ U Feet g= `z O Feet ro p4-Np chlw6er _ Linear Loading Rate- 5 • O GPD /LN FT Lia ." C-) L- It? O . Feet Design Loading Rate=O�G_ pD /SQ - FT W i,■ Z Z W3 �` Feet O � " .o Fabric Distf bution . Late' al servati / Well 12 _ 2 11 pe 2:5 A =2' > 5 1 co »mw. �Qdc� / e- /n y' �c � c� /� ri Ic cv v e k- 0 2 . p -•ve o! - eotek 7' //C �d 6�.'c r a� �.., a�•�,s 7-v s . c o.r, fi . 31 ('6) ��. u�� s �9 d,� _ cod e ol Plate �a r Joe_ Distribution Pipe L ayout of Place the holes at the bottom of the distribution pxyas at equal spacing, &ecove all burrs from the p1pe and holes. Exknd t$c eud of each lareW = wiry them of long turn or 45 * fitting to a point widen six itzchm of dw final grade. Terminate the cads of the lar=als with a valv*�-tfircedd tap or . threaded plug. Provide ac.;= fm= final pzdc ibr the valve, threaded yap or t>•=ded plel. •�cCEs$ Box_ pv c. PV G Y r 2 ix �F SpoY p L Pc►� v �Ew ���CF , o- .. f c�vc�s9 Q.o p Hole Diameter 3 _ �. Inch '7 Ft. lateral I 'a IncgeS) X °Z Inches For a4a-"- Inches I of holeslptpe Invert Elevat on o aterals L L S � �(u•v �j t ae.. x �1. �O � P N• e °� _ '� �'� ��ar '�i( i.al, o F. f c J F Cpl / " ✓ NFF TFSID OFp Pb Page J 0f �o.v6 /eJf,'. Sc� /,' ck�y6�, -. '�1•, �•.L.or S��d'4o No Scale) 7 r err P i Approved Locking Manhole Covers f',�,,, ,,�, 'ow or fled, With Warning Labels Attached n at r Jiy1Ke Weatherproof Approved — -� Junction Box Vent Cap 12" Minimum 4" Minimum / F,'AJl C�iJo/o n �'i/�j.A7f.p� murn ,. � Quick. 18" Minimum - -- i 1/4" Weep Ae�, c H o l e Baffle , Pol /b k i A Alarm 6` B On 6 i C � o t t 91, P � *APPROVED Off 6' F _ 4" i ,.`a / &." of'coyor to JOINTS WITH D P�o►•.�r��« APPROVED PIPE Conc. Block 3' ONTO SOLID SOIL 3" of Bedding Under Tank— pw-f PIMPdleYl^.rr oJi ,fit► fJ otF -d7`@ ci wcv�jS Number of Doses:3 S Day Gallons Per Day /j o - Doses: I 4' Gallons Volume of Backfl ow:•.����!?c+ P 9. Gall ons Tank Manufacturer: G�/�'e�� c"""wm Total Dose Volume :........ = /b Gallons Tank Size Septic /Pump: / Ov ..5 p Ga ons ;,l arm Manufacturer: L Capacities: A inches or,374- Gallons Model Number: 94 Y + B - inches or 3 �F Gallons Switch Type: + C or & a, Gallons Pump Manufacture Ci• �-i - + D = i nches or /3 6 Gal 1 ons Model Number: EPe2 S _ I Total ..... = inches or. 6'�� Gailons Minimum Discharge ate: `I - Vertical Difference Between Pump Off and Distribut'on Pipe: 8 7 Feet Minimum Required Supply Pressure:. - 0 Z - . S_ • • •� 7� ;5,57Feet / kO Feet of Force Main x I .Y3 Friction Factor /100 Feet: + a — .a Feet ;' Inch Diameter Force Main Total Dynamic Head: ... = 1,4.)_ Feet ,rr, Wi dth 64;n Li qui d Depth 3b' " 0. .�h /�f � 4 3; a. Internal Tank Dimensions: Length ��� , -y a Jci i.h �t.,w C17�h•✓C�' l 7- 00� �1Ch ���•1- M`/LJ A a • P /d � �a �— . Goulds � fc (et = is k," Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, • Capable of running lubrication and efficient strength, and durability. following uses: dry without damage to heat transfer. ■ Motor Cover. Thermoplas- • Effluent systems components. tic cover with integral handle • Homes motor: Available for automatic and and float switch attachment tor: • Farms manual operation. Automatic points. • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- Solids handling capability.: automatic reset. plastic Semi -open design AGENCY LISTING 3 /; maximum. • Power cord: 10 foot with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Sp• Canadian Standards Ilmdatlon • Total heads: up to 24 feet. with three prong grounding m EP05 Impeller: Thermo- • Discharge size: 1 NPT. plug. Optional 20 foot (GSA listed model numbers plastic enclosed des length, 16/3 SJTW with design for end in "F" or "AC ".) • Mechanical seal: carbon- three prong grounding plug improved performance. rotary/ceramic- stationary, standard on EP05). ■ Casing and Base: Rugged BONA -N elastomers. (standard thermoplastic design provides • Temperature: superior strength and 104 °F (40 °C) continuous corrosion resistance. 140 °F (60 °C) intermittent. • Fasteners: 300 series METERS FEET I stainless steel 10 — • Capable of running " dry without damage to s 30 ,. components. 8 - - - - -- - -- -- _ - -- - -- - - ! �;^"� Pump: EP05 • Solids handling capability: 0 7 25 I 3 h' maximum. - - -- - -- - - W • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. S • Discharge size: 1 NPT. Z 5 • Mechanical seal: Carbon- c 15 rotary/ceramic - stationary, a a BUNA -N elastomers. • Temperature: 3 10 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 —t - 5 I—N, 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 math CAPACITY Effective May, 1995 0 1995 Goulds Pumps, Inc. B3871 - � Leo S t e-r.) � L P�►u R�u�e.� � I isconsin Department of Commerce t -- v hL UH f f V N PORT Page N of 3 Won of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Sr- Ctz.c� lx ~' /attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 2�[ G' a J percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Q ! N V 'LSTM �hJTS Govt tbt S 1/4 N t� 1/4 S Z 3 T N R L$ E (o Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# I C - t!�'j . cs � /�° 3 City State Zip Code Phone Number ❑ City ❑ Village Q Town Nearest 146ad 1+0S-)So )v w S�oL6 () 3$I- s33yc ��1r,,�Le�tJMrj LC ��zwrov c.T- New Construction Use: Residential / Number of bedrooms _ Code derived design now rate b OO GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material STU _ •V? S Flood Plain elevation if applicable ft. General comments M /V � and recommendations: �T -6 � - j W / [ O X- 1 Z , p situ l3 WED �.VED ��sr ��PL EZ.ev 488. APR a Boring # ❑Boring ST. CROIX COUNTY pit Ground surface elev. 9 8 a S ft. Depth to limiting factor 3l in. ZONING OF lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o -b lO`1R 3L3 - V Z'PZ�i YA T CUS Z 6 -39 10 tfL3L6 - leSb►z yrtU�i- eta l� •4 b ,� 3 39 -q$ [ ri - 1 I - L -�,[ 1.5 `f fL 5/8 'Fs Ow, Y>7 v - • q •6 E Boring # ❑ Boring pit Ground surface elev. �� - 7 ft. Depth to limiting factor L Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 O - 6 LO'M 3 t I — �`� Z`� 9 H h1 V -(�- z 6 -q Z lo•trz 3t6 - 1 �bt� ►nv•A ew 1 w� • �( ,s 3 Ll 2 S 2 S O Yvt F1• - , . (, Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign re CST Number Arthur L. Wegerer � O A L Z- - >> 220254 Address W e g e r e r Soil T e s t i n g & Design Servi Date Evaluation Conducted Telephone Number 421 N. Main St. River Falls, (1I 54022 3_'Zb -o2 715 -425 -0165 i r Property Owner RW [� W U Z - - rm Qw -rs Parcel ID # Y�) A/ G Page Z of 3 ❑ Boring # ❑ Boring 3 pit Ground surface eiev. '18-1 • —1 ft. Depth to limiting facto in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I o - b list R.3 1 Z b -fib 1o�1�z 3l6 - + w .6 .s 3 Lr y .6 F-1 Boring # ❑ Boring Ground surface elev. Pit ft. Depth t • ❑ p o limiting factor in. Soii Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. sau -8330 (R.W00) PLOT PLAN Page 3 of 3 Scale 1' =50 ' r Swl 1 '�z 4 88.6 ' otj - v1 -'I 'T� ), - - -- X85-4' ors � d 1 �o t \RO S 5 ` � g88•b 4 `-O Ci'��11�N SIZ �j lap .. L V T 13 M�D SOT C()1"l P Pre.} - otZ O t sYvr� LET m k s 1TE Lor Li 3 -Z6 - oZ 715 425 - 0165 220254 - 61 - 1► CST Signature Date Telephone No. CST No. Job NO. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND O INERSHIP CERTIFICATION FORM OvvnerBuyer i 5 lc 1 Mailing Address � � y -� Address Property 5 �'►� w © a (Verification required from Planning Department for new construction) C -1 ' City /State ��'�' 1 <!� Parcel Identification Number - LEGAL DESCRIPTION Property Location S' E V., /V ' /,, Sec. T N -R W, Town of 41 11 1 iC ,? Subdivision B f ' ft - <:'��� "� C� � , Lot # . Certified Survey Map # �/� g 7 3 3 , Volume . Page # V Warranty Deed # � Vq� , Volume S . Page # 3 � Spec house ❑ yes V no Lot lines identifiable El yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment 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 masWplumber, jomueymanplumber, manctedplumber or a licensed pumper verifying that (1) the on site waswmterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the thrCey expiration date. S I OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property desprilqed above, by virtue of a warranty deed recorded in Register of Deeds Office. I S A OF APPLICANT DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. m the Register of Deeds office «« this application: a warren include with stamped warranty deed from Intl PP a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa9e,7_ofR FILE INFORMATION SYSTEM SPECIFICATIONS Owner ro C `r, .r l� �' Septic Tank Capacity ' /000 al ❑ NA Permit # V a Septic Tank Manufacturer �,p ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer P, / / /C ❑ NA Number of Bedrooms ,� ❑ NA Effluent Filter Model S ❑ NA Number of Commercial Units NA Pump Tank Capacity �'.O al ❑ NA Estimated flow (average) D O gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) ¢5 al/da . Pump Manufacturer (' d ❑ NA Soil Application Rate Q. al/da /W Pump Model Ro , - ❑ NA Influent/Effluent Quality Monthly average' Pretreatment Unit X NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand/Qravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 420 mg /L ❑ Mechanical Aeration ❑ Wetiand Total Suspended Solids (TSS) 5150 m /L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg /L )<At -grade ❑ Mound Fecal Coliform (geometric mean) 1 510 cfu/100m1 ❑ rip-line ❑ Other Maximum Effluent Particle Size Y inch diameter • Values typical for domestic (non- commerclaq wastewater and septic tank effluent. • Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months 14 year(s) (Maximum 3 yrs:) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume Inspect dispersal At least once every [3 months year(s) (Maximum 3 yrs.) cell() Clean effluent filter �2 �fio'Yt t least once every i ; months ❑ year(s) Inspect pump, pump controls &alarm At least once every ❑months ❑yea r s (� ❑ NA rcd e- Flush laterals and test At least once every ❑ months ❑ year(s) ❑ NA ✓ A* dal* tv Other. At least once every ❑ months ❑ year(s) 7 NA Other. At least once every D months ❑ year(s) )k NA MAINTENANCE INSTRUCTIONS Inspectio licenses or ns of tanks and disp ersal cells shall be made b an individual carrying one of the g nspectio P Y certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatIment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. /Vf d h 1 J a •� err �l Jti Page _ k of System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloadin tents of the tank rem r esul t i a e backup or surface discharge of effluent To avow oontact a PI mbar or POWTS Maintainer to Septage Servicing Operator prior to restoring power to the effluent pump or as sist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at- ter stream may improve the performance and prolong the life Reduction or- elimination of the following from the waste of the POWTS: antibiotics; baby wipes; cigarette b tts;con and vegetable peelings 9eeas herbicides; meat disinfectants; fat; foundation drain ( pump) w a t er, scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONM i</' ste When the POWTS fails and/or is permanently taken out of servic hi Comm 8 3 fol Wiso shn IAdministrat�enCode at the system is properly and safety abandoned in compliance with • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement be ev area should be protected from disturbance and compaction and should not absorption system. The replaceme be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback o and/o so the failed POWTSng advances in POWTS echnology a holding tank may be installed as a last resort p ace e site V ate t bee valud to I� a ss table e acemet area. Upon fe lure of t a POWTS a soil le and a s/ e eva u e rf0� a lace the POWTS. holding ay mV aye s a last re o r p d in lace following removal of the biomat at Mound and at -grade soil absorption systems may be reconstructe p the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS DO NOT ENTER A SEPTIC, PUMP OR OTHER TR � UNDER ANY CIRCUMSTANCES. F DEATH MAY OXY GEN. RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS MAINTAINER POWTS INSTALLER E !,v t.� Name To nz L(Jdn E,r�1VJ *' � Phone 7!.$" — 2S— LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR (PUMPER) Agency S f C'r.,;L Name U.. fhb.. phone 74S + 6 O Phone This document was drafted by the staffs of the Green Lake, Marquette and V2 &h3rawiu� in Administrative Code. g Use of this document does not the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1). () (). GMW (2/01) guarantee the performance of the POWTS. U 2755P 379 - 7 88296 r` KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., MI State Bar of Wisconsin Form 1 -2003 RECEIVED FOR RECORD WARRANTY DEED 02/28/2005 09:15AN WARRANTY DEED Document Number Document Name EXERT # REC FEE: 11.00 THIS DEED, made between RWP Investments, LLC, a Minnesota Limited Liability TRANS FEE: 262.50 Company COPY FEE: ( "Grantor," whether one or more) CC FEE PAGES: 1 and Joseph M. Cegielski and Doreen Cegielski, husband and wife, as survivorship marital property ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Recording Area needed, please attach addendum): Name and Return Address Scenic Title and Abstract, Inc 220 Locust Street suite 1 Lot Eleven (11) of Certified Survey Map filed July 23, 2002 in Volume 16 of Hudson, WI 54016 Certified Survey Maps, Page 4338, as Document No. 684833. Located in the SE 1/4 �f/OZZ of the NE 1/4 of Section 23, Township 28N, Range 18W, Town of Kinnickinnic, St. Croix County, Wisconsin. Being part of Lot I CSM in Volume 5, Page 1408 as Document No. 392275 and Lot 3 22- 1065 -50 -200 of CSM in Volume 6, Page 1635, as Document No. 409847. Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and ri ghts -of -way of record. Dated February 15, 2005 (SEA (SEAL) * o W. Pla tte, its a Manager (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on St. Croix COUNTY ) Personally came before me on Februay 15, 2005 the above -named Roger W. Platte, Chief Manager of TITLE: MEMBER STATE BAR OF WISCONSIN RWP Investments, LLC a MN Limited Liabilty Company (Ifnot, ..> ..ao me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § Smi SCOtt ECkh trument and acknowledged the same. Notary Public 1 THIS INSTRUMENT DRAFTE BBUt�, „I UV;�consin RWP Investments LLC rian Scott Eckholm 641 Hoover Stree t , P M is MN 55413 Notary Public, State of Wisconsin My Commission (is permanent) (expires: 9 -11 -05 ) (Signatures may be authenticated or acknowledged Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 • Type name below signatures. Parcel #: 022- 1065 -50 -200 04/25/2005 08:56 AM PAGE 1 OF 1 Alt. Parcel M 23.28.18.356G 022 - TOWN OF KINNICKINNIC Current ,X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * RWP INVESTMENTS LLC RWP INVESTMENTS LLC 641 HOOVER ST NE MINNEAPOLIS MN 55413 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 258 DEERWOOD CT SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 4.021 Plat: 1522 -CSM 16/4338 SEC 23 T28N R1 8W LOT 11 CSM 16/4338 Block/Condo Bldg: LOT 11 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 03/19/2002 673936 1856/398 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 12570 53,100 Valuations: Last Changed: 06/11/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.021 40,000 0 40,000 NO Totals for 2004: General Property 4.021 40,000 0 40,000 Woodland 0.000 0 0 Totals for 2003: General Property 4.021 40,000 0 40,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 259 E 59 BIJI' �'FRII' 0 - 2' 0 ED 5 1 G: 4 1. 1 71E PAGE If"AX m �hjchng cover sh el tJ A FROAL' Land Builders., Ine. COAIA4NY.- 1 J'At-'3E) .101 V North Main Street ftivcr.Fulls, W.1 X4022 (1 425-1130 FoLVI'llone 44 Fax Phone (715) 425-9559 . ..... ... ....... REHAR&Y. N)r rour reoov E J?vpiyASAP Please Comment L e 1G: 41 17154' 9559 _i_II' D BUILDERI PACE K- i I I • j l , I I� i I I i I �I , 1 IF }} I �� I i i �� I� IM• � � �� ( i f h � S (' I f �' N r � ! i ' I I ', I � � J t r (L a! r l � ' f! +, r' I .mf _- ,�..•� ,-�..! I I j ° {I �[ 71, r , i �t t a i >•, { t ii i if i ��""•����� �� ��"�,�' � �� I � ; { r t 1, � J 1 �- e�� � �I i I I � I I i 1 Li i!, 3 i, L 14 r �• f �,i� f 7 � � �I �'n � ,I i 1f rlt ,9 I I II fl. , { 77 •JJ i l I Is`F TTT C I I' I i v . I I f I , I I I f- r I r I I I ; I I ; r' I f• I, i I i K rt: r. - t Y I'�J e4,-"2.0 20Gi5 16: 41 1. r /54259559 I.LlhID BUIL_DEPS: PA(IE VJ4 tJ tl r h i i F i }1` N I + ti ,r 04:' % O.e' 'E_1Cl5 16:41 1 .'154259559 BIJILDERS "AGR 1=15 jI Z , _ .� [rill i. C(,.• ., n- �. a i l i K S:c' _ 4F rr _. T r- -C - " :e s s• s' i Cr dl apps: -0 �,nr H __... 6`48Hg''�:.... ... _. .4 .. 'rte ...... ......, ... V I I 04/2t/2005 Ha -11 7154259_:59 E PAGE: 02 lool { I 4 � I I .. r' I I I I II I I -. r { � L , � • { � I I I , '�I I n , l '. —mi rL II ,'i + { n -Y G � - I � �i' ,Ir �l I r {'I F i t� p I..�y �• -� I ' y { I I � -1 �{, a -�'" - 7� J �- ,^e L -i .7C � I� [� .�,. t � ���� � �� � tr ��� :7C' � „�:. � _L �i t • ' �r � y 7 { , 1 I � 1. it' I I I I I 1 I i I I I �r � II. L � � ! I t. j I , I _ I1' .r 6 4633 VUL 16 PAGE 4338 _ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., WI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 07 - 23 - 200 2 3 PM LOCATED IN THE SE 1/4 OF THE NE 1/4 OF SECTION 23, REC FEE: 15.0f0 T28N, R18W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONS AP-Y FEE: BEING ALL OF LOT 1, CERTIFIED SURVEY MAP, VOLUME 5, PAGE 14 WES: 3 DOCUMENT NUMBER 392275, AND LOT 3, CERTIFIED SURVEY MAP, VOLUME 6. PAGE 1635, DOCUMENT NUMBER 409847. I I NOTE: ALL IRON PIPE C , .S. L M. I OT 3, _C.S (FOUND OR SET) 'LOT 5 � — _ _ ARE DIMENSIONED AS VOL - _1 5� P _ C 4 1 1 VOL . 1 1 I OUTSIDE DIAMETER. I - UNPLA TTED (LAND I DO. W649648 i PAGE 31 18 - _ _ S 89 °41' �5" E 672.43' - 7" 05.51' l" 305.53' $.79' - - - - - - - - 1 1/4" IRON PIPE 12.60' FOUND N 77 °10' 19" W NORTH LINE OF THE 366.92' 1.28' FROM 1 SE 1/4 OF THE NE 1/4 SCALE IN FEET I LOT 7 IRON PIPE. LEGEND I I COUNTY SECTION CORNER 1 a 3 NOT M NT, FOUND (TYPE 0 75 150 3001 VOL. 6 PAGE 1710 W Z �, i DOC. _#4 17132 1 1/4" UNLESS o w m a OTHERW NOTED) o - 0 o a IRON PIPE, FOUND. N o I ~w LOT 13 O O o � co 0D 1 1 /4" x 24" IRON � -j o: z o PIPE WEIGHING 1 .68 #/ 5.01 1 ACRES 1 O m z w LINEAR FOOT, SET. it ° w 218,266 S.F. IQ I — — — — — — — � U m - PROPOSED 12' WIDE 1 w vy o M UTILITY EASEMENT. LOT 6 ^ LOT 1, S. _, VOLUME_ 5 I CSM _PA GE 1_4 08, - _,DOC. Y392275 VOL. 6 awWN I °' ^ 1 PAGE 1710 LOT 12 5.068 ACRES Q 220,776 S.F. r�U/ R =BOC3 \�\i.� 'SETBACK :n "Mn � �OKp R0 2 - IX COUNTY o � 50 LINE d 1 arming Zoninu and Parks Committee / °f `� Q I ^ JUL 2 3 2002 ul 3 rn IPS 87 ^10' 16" E W z 290.38' ne! rued Irt�Odays Of U w O ~' 78 I 1 �PPro al date a�t shall be N I "' I null a o f W Z Q � e 238.09•• W i 1 / /t^ 3 FENCE I °NOD ( -6 1 CD 50. �N �I v I lr 0 DECK cn 0 P\ ?, ` 7 TANK Q1�1 o s LOT 8 LOT 10 I C S. M w LOT 1 1 `� O �. \ 4.379 ACRES ri = o O rn I VOL . 8 o' - °; 4.021 ACRES �: Q ` 190,746 S.F. ° PAGE 2269 � c 175,139 S.F. \ to l — J w C7 ' DOC X462079 \ BOG I X/S/N APPROVED 8Y TC WOVEN o� 3 T W F KINNIC I WIRE FENCE ` KINNIC ° �` OAT �, - !8' -3oa Y _-il EXIS MOU1M'7 33 I I SEPT/C SYSTEM 3 _ W 1/4 CORNER - +'- - E 1 /4 CORNER SECTION 23 Q ,n 12.60' T28N, R 18W °o o °n o o b SECTION 23 3 {ALUMINUM M wiI o o h 228.70' $ (MAGNETIZED ■ - CAP) W k $ $ 2 16.10' M P.K_NAIL) T r o i M _ t ICATED H PU LIC ti z N 8! SG' S5" W �i t 3 2 -401 N 89 °56' 55" W 672.68' �� I 647.79' EAST -WEST 1/4 SECTION LINE N 9° 856' S5" W 5292 .8 BEGINNING (PREVIOUSLY OA _ _ K DRI VE �J RECORDED AS 647.47 UNPL A T TED LAND THIS INSTRUMENT DRAFTED BY ROSS A. COLLINS PAGE 1 OF 3 Vol. 16 Page 4338