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HomeMy WebLinkAbout026-1119-08-000 'Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y- Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary o: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City []Village ❑ T n of: State Plan ID No.: Ligtenberg, Kevin Richmond Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: y .4 026- 1119 -08 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W r k S CJ Benchmark Alt. BM Aeratio '` Bldg. Sewer 3 /p ?, 7 3 1 folding M/ Ht Inlet 00Y TANK SETBACK INFORMATION (9/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD nfet ir Septic DSO 7 7 NA o om Dosing - A Header / Man. (, ZS 0 y Aeration—­ eration - NA Dist. Pipe MZ yz rroy 31 Holding Bot. System w7 7 7}s PUMP/ SIPHON INFORMATION Final Grade 3_ Z M acturer Demand St cover 7 Model Number _— � 3 z O loth TDH Lift 'N Friction S stem TDH Ft Forcemain Length Dia. Dist. SOIL ABSORPTION SYSTEM ;--7 C� BED / T E Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME . ZS u• DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu acturer: SETBACK INFORMATION Type Of �/ MBER y e Numb ✓ System: DISTRIBUTION SYSTEM Header / Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake to&(2� Length Dia. Length ioo•o Dia. Spacing stC-5 /v- 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/Tr nch Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: q 12210 Ins #2: Location: 1274 146th Avenue, New Richmond, WI 54017 (NF: 1/4 NE 1/4 22 T30N R18W) - 223018703 Pondview Meadows - Lot 8 `���� tak►��q�ro� ug" 04 a 1.) Alt BM Description= 2.) Bldg sewer length= '= � � < < < G k �^a� \ -am ount of cover= w, � ,,,j tr y Plan revision required? ❑ Yes P No Use other side for additional information. F7. SBD -6710 (R.3/97) DA Inspector' Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: .... _T 577 £ , £ 3 t t V S , I a � F 4 g 1 y £ i 1 3 .-,vA »»...,. 4'"' .'.-•-- P"..««,<., �.......&,. .�.,.- ,,�,....1.....�.�«.�...., d�..,. �. ®�®.�1m ®.«...,.«.W... 'g .. „�, ®.tea .«....,... «...« _4...- ...«.v.£ -«.- .mom. —> ......o... £ -.�.. ...a. F y E Sanitary Permit Application safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 � seon in Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department Qf Commerce (Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned. Attach complete plans to the county copy on paper not less than 8 -1/2 x 11 inches in size. county State Sanitary P IN r, if to previous application State Plan I. D. Number s-r CR ©iu I. Application Information - Please Print all In ton Location: Property Owner Name 1 ����`.. i v� Property Location k'jEV I N L IGT F IJL� E RLr� � r. i AL NE 1 /4, SZZ T3D,N, A or Property Ownees Mailing Address N I t i Lot Number Block Number �b2? t- 1bt\� STEAD Met- sr c��x City, State Zip Code " ,. Subdivision Name or CSM Number II. Type of Building: (check one) [3 city o ; ❑ Village I 'L' 1 0 1 or 2 Family Dwelling - No. of Bedrooms : � - Q7!I'own of An Mh, ❑ Public/Commercial (describe use):_ ❑ State - Owned Nearest Road -f H N v Parcel Tax Number(s)� b III. T ype of permit: Check only one box on line A. Check box on line B if applicable) Zl l 1 17# _ 7 - 6 � 22 , '�o •t$- a3 A) 1. I nI . New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary ermit was previously issued TV. Type of POWT System: (Check all that apply) ,KNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • pressurized In- ground ❑ Holding Tank ❑Single Pass ❑Drip Line • At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other. V. Dispersal/Treatment Area Information: A app -ZAIaEL 4 VT 1. Design Flow (gpd) 2. Dispersal Arm 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Ra y /sq. ft) (Mintnch Elevation © ISdn )AS� B5`7 . q `� /oZ- 97 10L VII- Tank Capacity in Total # of ufacturer Prefab Site Steel Flier- Plastic Information Gallons Gallons Tanks Con - Con- glass New I Existing crete structed Tanks Tanks SEPTIC 12�� IZZ D I W, EKS --T- ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibW#0m tffe PUW on ttached plans. Plurbees Name (print) betas lure o. Business Phone ber Num JEFF Fix ZZ3Z4Z 715 - ZqL] -31`11 Plumber's Address (Street, City, State, Roy, 29 CRESS I S yoo9 IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Feel ' oo sl D O j� l Determination �1 F 0�� X. Conditions of Approval /Reasons for Disapproval: K Re_s D R salaln -W �,�a­e G b� to� CrA a.. �- Lcd iti+vv+� In cK d 2 t 97kt, solo," ./X /St' — ( 7 _ ISM X57 ; l ty = So Gln�. tM bc� S Etf 1� 1_ 1Gfi Iv �41 S n T )Q, R. 18 N/ BbZ� _ I''IDIUI A\rg= R1L'fMdNo - 1 - wsP Cb ALOE r MN 5501 �x� AI T: >3 m. 0 0 0 0 0 � 64 _ e' WEEKS IZl CAL 3 TRENCHS WIT .50 tllGH_ SEPTIC_ - MJK L!APPO-% 1 9)ZEWIN0E2 f, rfLTFCAT0ZS A -IDD nc �'i DPD.SFp �I SEORODAA f / ©6E GRKAGC we) I st46 (cs s W I we-l( +6. cod,es l 3FivCN/vI ARI: - TDP o f N- VI 107 57AKE EL. JOD ` AALT 1DP of I " , Wr- Pi PE ae- Iv y, y Gs S01L EaR) NzS SSE 1 yU' _ MeO L ATIONS — ')$D &FU - •7` ' 8577 g5`7 7A/ = SO C- HAMM.4 RE66 iReb AYF- M as ZZaZ4Z ,S Y 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). T able 1: System Design Specifications Sanitary Permit Number 7 V 9 Number of Bedrooms Design Flow - Peak (gpd) (v 00 Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft') S5�7 Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) /yGo zs 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 septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the 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 longer P WT n tank is no used as a O S component. e 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 more intense, and earlier, organic clogging of the soil. 2 II 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 r Wisconsin. Department of Industry SOIL AND SITE E V A L U 0 R P ) R Page 1 of 3 Labor and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.0 . , it '.'Adm. C�de ' F roix r '�� Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz Plan must rnclude �� = not limited to vertical and horizontal reference point (BM), direction and slopalik or P1 dimensioned, north arrow, and location and distance to nearest road.- 50 - 000 y DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATI 1Q.' ^o� � acK- +y 1 A4 ,\ PROPERTY OWNER: 0"ERTY LOcAIM,1 Richard Derrick NE; fi(4� v4,s 22 T 30 N,R 18 XTor) W PROPERTY OWNERS MAILING ADDRESS LOT # UBD. NAME OR CSM # 1310 H 65 8 na Pondview Meadows CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE (MOWN NEAREST ROAD New Richmond WI. 54017 (715) 246 -5425 Richmond 146th. Ave. (�] New Construction Use Residential / Number of bedrooms 4 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .3 bed, gpd /ft •4 trench, gpd /ft Absorption area required 2000 bed, ft 1500 trench, ft Maximum design loading rate • 3 bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevation(s) area A= 102.00/ B= 102.97 h (as referred to site plan benchmark) Additional design / site considerations na Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ? S❑ U S ❑ U S ❑ U ®S ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerch 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 I .6 2 9 -18 7.5yr4/4 none scl lcsbk mfr gw if .2 .3 Ground 3 18 -80 7.5yr4/4 none sl lcsbk mfr gw na .4 .5 10e14_.-Zft 4 80 -84 7.5yr4/6 none fs Osg mvfr na na .5 .6 Depth to limiting Zit factor 3 +84 Remarks: Boring # 1 0 -8 10yr3 /3 none 1 2cpl mfr cs 2f np .2 2 8 -21 10yr4/4 none sicl lcsbk mfr gw if .2 .3 3 21 -60 7.5yr4/4 none sl lcsbk mfr gw na .4 .5 Ground elev. 4 60 -84 5yr4/4 none sl M na na na .3 .4 1 05.8 ft. Depth to limiting , tr factor 84 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -5200 Address: 1554 200th e. New Ricbmmd, WI 54017 Signature: Date: 4 -22 -9 CST Number: m02298 PROPERTY OWNER Richard Derrick SOIL DESCRIPTION REPORT Page 2 t of 3 " PARCEL I.D. # 026- 1065 -50 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTwich 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 S 2 9 -20 7.5yr4/4 none scl lcsbk mfr gw if .2 .3 ,L Ground 3 20 -84 7.5yr4/4 none sl lcsbk mfr na na .4 .5 elev. 1 06. O ft. Depth to limiting 3� factor Y Remarks: Boring # ... .1 0 -11 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 4 2 11 -21 7.5yr4/4 none sicl lcsbk mfr 9w if .2 .3 3 21 -72 7.5yr4/4 none sl lcsbk mfr gw na .4 .5 Ground ` elev. 4 72 -84 5yr4/4 none sl M na na na .3 .4 106.1 ft. Depth to limiting factor 84" Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 5 2 9 -23 10yr4 14 none sicl 2msbk mfr gw if .4 5 y 3 23 -58 7.5yr4/4 none sl lcsbk mfr gw na .4 .5 Ground elev. 4 58 -82 7.5yr4/6 none sl /fs lcsbk mfr na na .4 .5 106.8f Depth to limiting y S -►s- e� factor 1 Remarks: Boring Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Richard Derrick 1554 200th Ave. CSTM2298 NE4NE4 S22 -T30N R18W New Richmond, WI 54017 MPRSW -3254 (715) of Richmond (715) 246 -6200 lot #8- Pondview Meadows This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. N 1 BM-= top of NW lot stake @ el. 100.00' Alt. BM.= top of 1 pipe C el. 104.40 � 0 r ID (P Gary L. Steel 4 -23 -99 Aug -25 -00 08:13A Viebrock Companies 715 294 -4444 P.02 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND O WNERSHIP CERTIFICATION FORM Owner/Buyer ` r1 L; Mailing Address �� Homesb C *1 tit -t- Crowe 44 P'rtS"t) Prop erty Address �o # PW vti 4wo 9V44vt✓s -7 � lo �11 (Verification required from Planning Department for new construction) 'l ew ICf1•'I t� MK� © �c10 - �1oS _ 50 City /State N W.T Parcel Identification Number LEGAL DESCRIPTION Property Location WE %, NE 1 4, Sec. 22 . T 30 N -R I L W, Town of Ris mbael Subdivision fca� /YIP G�a �.✓S , Lot # ty Certified Survey Map # 1�wt�V � a0t✓S . Volume b Page # Warranty Deed # , Volume 5 H . Page It Spec house O yes Vno Lot lines identifiable Oyes ❑ 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 treamient 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 plumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal 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 y expiration date. T / La / S?4AIV70F 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 owner(s) of the pro pe cs!wp above, by virtue of a warranty deed recorded in Register of Deeds Office. S1GNXTLMt APPLICANT DATE 0 t 0 • 4 • Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.' •• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of (lie certified survey map if reference is made in the warranty deed voL 1514 87 to ST ATE BAR OF WISCONSIN FORM 2 - Iyoo 62 37$$ Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., W1 This Deed, made between Richard L. Derrick, in and as RECEIVED FOR RECORD attorney -in -fact for Loren D. Derrick, Rose H. Derrick, Richard L. Derrick, Joan L. Derrick and Robert J. Derrick, under Powe of 05 -26 -2000 10:45 NM Attorney recorded in Vol. 1454, Page 425, as Doc. No. 609877, ypY DEED Grantor, and - Kevin Ligtenberg and Charline Ligtenberg, busband EXEMPT I and wife, CERT COPY FEE: - COPT FEE; -- TRAItSFER FEE: 86.70 RECORDIBO FEE: 10.00 Grantee. — PARES: I Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 8, Plat of Pond View Meadows in the Town of Richmond, St. Croix County, Wisconsin. Name and Return Address S & C Bank P 0 Box 128 New Richmond, WI 54017 026 - 1065 -50 ✓ Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. OE) (is not) Dated this le /I day of May 2000 — _ • Richard L. Derrick, individually and as attorne - in - fact for L L D. I40M H. Derrick, R2d'ard L. Derrick, - - --.— -- -, —_ -- ' Attbtrtey rw. in Vol. 1454, Page 425. Dx. N o. - - - - -— — AUTHENTICATION ACKNOWLEDGMENT Signature(s) , STATE OF WISCONSIN ) ) ss. dte) /,( County ) authenticated this day of � Personally came before me this day of - -- —_ May _ , 2000 1tA Bove named r Richard L. Derrick, in dividual) and a t y or —' - - -- L oren D. De rrick, Rose H. Derr — Derrl Jdpn L. TITLE: MEMBER STATE BAR OF WISCONSIN Derr ck nd Robert J. Derrick, undo Mtt r ey rewin (If not, (v e [ fid Ike for going authorized b instru n and ac nowe the J y 0 706.06, Wis. Stats.) ld d THIS INSTRUMENT WAS DRAFTED BY Attorney Kriatina Ogland Notary Public, Slate of Wisconsin Hudson, WI 54016 My Cormni ion is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _ ,) • Names of persons signing in any capacity must be typed or printed below their signature. id— o„ company, rod du tae, W WARRANTY DEED STATE BAR OF WISCONSIN 8006562021 FORM No. 2 - 1999 LOT 1 NE CEF J °"-------- SECT ID C.S.M. IN ---- - - - - -- ND IN PAR T OF THE SE 114 - v,4 PG 1144 OF RICHMOND, S T. CR OIX OWNED BY ❑THERS NOTE I QA V IRON PIPE FOUND I I N83 "W 2,03' FROM SET CN88 491730 RNER I 3 , N87 °35'23 "W 574.06' ,, 452 68 ' 128.28' 4317 W 115, 36 ,62' q 493,90' I 33 I i I 10 9 ko i i I ) 2.001 ACRES 2.001 ACRES ^ p u�� 87,179 SQ.FT. IQ 87,171 SQ.FT. cl) 8 � : N i �- m 3 2�. I �•' M 2.001 ACRES ' N I i w Z" 87,177 SQ,FT. �� • < I � ,h�` I M9 °43 i-9 "W 5 � ° i I 66.00' �, 7 •Q I I i • 100 •� • • • �� 2.001 ACRES w I I o i i • 'i• 87,172 SQ.FT, 10 i .4.. ......... � • 273,73'! • CD - - 75,92 - N89 ° 4 8 "03� ? . 73' _ 146T A `° i '50': Sa4•SO'29 W '� 346.1' • I i 1 — 50'1 I I (') '•••.i...•••'' LOT 4 OD ; 2. 002 ACRES i 87,188 SOFT, � C,S,M,IN V. 10, PG, 2745 4 o ti`Sfl� s s OWNED BY ❑THERS 'o ON ccv s -- - - - - -- ------------------ - - - - -- - -- --� I-- �_