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HomeMy WebLinkAbout040-1075-60-100 n U) O 's 9 m m _ z m &T a o� T II I B C F v N c J N O IP C 1 3 = N : :3 Cc N 0) O O N o U7 0 O W O <-r ' 3 IA U7 O O C Cf D (o v m O. D a .► 0 o w CL o N o o 1 n r C) Q N O c CD U7 c ? O O O h� Z cr -3 N N 0 0 z m v G v m N E v o tr _ N Lrl N z o y o Q m o S c " 1111 CD 0 c o m N A a co � D O CL m _ O � h co c _ M CL 3 -.J O 7 1 rt Z CO o� 3 a Q C/) c m I a N Z O A cQ A 7 � � O v v c CD Z p N O .i N � L I � � N GS- X � � N O a CL N o =r o O v c a I 0 I � CD r O CJ O Ofi Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: S t. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 487947 0 GENERAL INF611MATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy taw, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Florek, Zane I Troy, Town of 040- 1075 -60 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 18.28.19.285F10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. vepcto'Alrintake ROAD DtInlet Septic / Dt B ttom 6 Dosing He er /M . Aeration ist. Pipe Holding Bot. Syste 1' Final Grade PUMPISIPHON INFORMATION Manufacturer D m d St Cover G M Model Number TDH Lift Friction Loss System Head TDH t Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) L Length Dia Spacing 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 Bed/Trench Edges Topsoil Yes No I Yes � `j No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 335 County Road F Hudson, WI 54016 (NW 1/4 SE 1/4 18 T28N R19W) NA Lot 5 Parcel No: 18.28.19.285F10 1.) Alt BM Description = 2.) Bldg sewer length = amount of cover = _— Plan revision Required? jYes No � _— Use other side for additional information. _!__ Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) a r �- Safety and Buildings Division county r 201 W. Washington Ave., P.O. Box 7162 • �G /U ,(� I Madison, WI 53707 -- 7162 Sanitary Permit Number (to be filled in by Co bonsln �s q ] Dep of Commerce (6 � Plan I.D. Number 1?� �y, S V g 7 9 � to Sanitary Permit Appl><ca ion kV In accord with Comm 83.21, Wis Adm. Code, personal it ation you provide may be used for secondary purposes Privacy Law, s .04(l)(mi P oject Address (if " different than mailing address) I. Application Information - Please Print All Information I CP 1 :i' 3 Property Owner's Name // arcel ;l t Block Property Owner's Mailing Address Property Location oY6 -l6 -art -, tl o City�State I Zip Code Pho a Number �1' Sect�on f � , � - !d t- d circle nc O fL J�J . 7 ��' �J�.. �� r N: R l I ir o I . Type Building (check all that apply) J� C�l or 2 Family mily Dwelling - Number of Bedrooms � Subdivision Name � i3jvt ?+luln�/ D Public/Commercial - Describe Use _ _ _ ❑ State Owned - Describe Use _ _ -� ❑City_ ❑village of 1II. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' New System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only D Other Modification to Existing System + B. C] Permit Renewal D Permit Revision El Change of ❑ Permit �Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Own` er IV. Type of POWTS System: Check all that app ! T N - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil [I Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter D V Constructed Welland D Pressurized ln- Ground EJ H+rldmV Tank E Peat Filter ❑ Aerobic Treatment Unit 3 Recirculating Sand Filter Recirculating Synthetic Media Filter & i eaching Chamber rip Line ❑ Gr vel-less Pipe Other (explain V. Dis ersaVrreatment Area Information: �_ C _ _ D ow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requ red (sf) Dispersal Area Proposed (sf) Syste VI. Tank Info Capacity in Total Number I Manufacturer Prefab Site 1 i c Gallons Gallons of Units I Concrete Constructed Glass New Existing 'ranks Tanks Septic or Holding Tank w i1 r I Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for iqoqlktion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signa re PRS Number Business Phone Number -7 .'� ?PQ Plumber's Address (Street, City, State, Zip Code) l D �(� �Q Gr c �'z`�'/E'�o/- /`��s'�`.,rJ �1. � ,S �r'dl� ---•- j � VIII/County/Department Use Only Sanitary Permit Fee (includes Groundwater Date Issued Is ng Agen ign ure tamps) Approved ❑Disapproved Surcharge Fee) ! D ` D Owner Given Reason for Denial ` O / _ _ _ IX. Conditions of Approval/Reasons for Disapproval VIA/ Cdr �/t G�7 STEM OWNER: G� 1 Septic tank, effluent filter and 2o03 4 ?-00S sorb ! e 0ris. V!;-z �� � v( � ? dispersal cell must all be serviced /maintained t2S1l�h 9�0J � #� ���� I as per management plan provided by plumber r l i 2. All setback requirements must be maintained Llxlck &kJ eh /tdf -7 !!k as per applicable code /ordinances S 4e S CLtlwl h � � Attach complete plans (to the County only) for the system on paper not tras than 8112 x I I inches in size SBD -6398 (R. 01/03) a U 4 � Cs �o w YC 0 r Ua 0. i "i v i wQ a� h w Vs 0 SY PTIC: :Af1lC t E lll1Y : 2 CR S S FC,TX 4v AND SP ECIF:CATZGNS 4" CI VENT PIPE 12" MIN. ABOVE GRADE £ WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INI"AK£ WITH CONDUIT MANHOLE CC```'ER W/ PADLOCK & FINISHED GRAL WARNING LABEL 4" Cl RISZR 18 I M IN, 5" MAX. ISLET ! I ' I WATER TIGHT SEALS CAS y i `G APPROVED SEAL ' JOINTS WITH APPROVED �--- ALM APPROVED PIPE 'IPE 3' .� ON 3' Otero 1NT0 SOLID } I � SOLID SOIL C ;OIL PUMP OFF ELEV . FT. € I OFF RISER EXIT `--� � PERMITTED O D IF TANK 1 _ MANUFACTURER HAS APPROVAL 3" APPROVED BETIDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC ! DOSE ! TANK MANUFAC JN.BER DOSES PER DAY 4/ TANK SIZES SEPTIC � � C3 GAL. NOSE VOLUME INC LUDING ____� DOSE $rye, GAL. F'LOWBACK: I� 9 GAL. ALARM MANUFACTURER: ", -��,. �r,r� CAPACITIES:w A = , INCHES = q6a, GAL. MODEL NUMBER: Lv SWITCH TYPE; B 2 INCHES = GAL, PUMP MANUFACTURER: G C : INCHES = GAL. MODEL NUMBER: V -P a SWITCH 'T'YPE: me.0-C_ D = INCHES = G AL. REQUIRED DISCHARGE RATE '40 GPM PUMP & ALARM WIRING AS PER i LHR 16.23 WAC '!ERTICAL DIFFERENCE BETWEEN PUMP OFF ADD DISTRIBUTION PIPE . FEET +MINIMUM NETWORK SUPPLY PRESSURE . . 2.5 FEET + _ FEET FORCEMAIN X zj MjF T /100 FT. ` FACTOR . w 7 FEET TOTAL DYNAMIC HEAD _ FEET iNTERNAL DIMENSIONS OF PUMP TANK: LENGTH ✓ ; WIDTH r---' 51AMETER �'-"- L1QUID 5— E=. &AL pout 1 SSGIS%D: : r =( sue•'.' - LICENSE NUMBER. flATF ' 1/88 i MGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 ����•IA�I�I"11 IAMr�••Iw��s�r�i����� �riw APPLICATIONS • Fully submerged In high ■ EPOS Impeller: Thermoplas- • Bearings: Upper and lower Specifically designed for the gra de turbine cxl fur tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. heat transfer. 10 Casing atld Base: Ru • Effluent systems gged • Homes Avafiable for automatic and ttiemr. p6* design provides AGENCY LISTING • Farms manual rata Aut1r s s and corrosion Crtadtaa s tandard: Assodaron i Qrt, • Heavy duty sump manic models iN44010 • Water transfer MedumkAl Flout Svi "ch a Motor Housing Cast iron (CSA listed model numbers end • Dewatering assembled and presot at the fer efliclent heat transfer, In "F" or "C "J facto ry strenyjth, and durability. SPECIFICATIONS IM MO Cover: Thermoplastic Gourds P=Ps is 50 9001 ilellistuw. FEATURES to"r wo integral handle and • Solids handling capability, loBt swltO attachment points. 3 /4 " maximum. 0 EPO4 Impeller: Ttl er mopias- j Power :Were duty • Capacities: up to 60 GPM. cc Semi -open design with rapid oil and water resistant. • Total heads: up to 31 feet, pump out vanes for mechanical • Discharge size: 1 h" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA -N elastomers. • Temperature: 104°F(40 continuous METERS FEET 1401(60°C) intermittent. • Fasteners: 300 series stainless steel. e 30 ^� • --- ' _ Capable of running _. * 25 tr _ _ dry without damage to $ components. 25 Motor: i • EPO4 Single phase: 0.4 HP, el 20 I 15 or 230 V, 60 Hz, 1550 RPM, built in overload with 5 automatic reset. a 4 r I I S Single 1 s� EPOS • z,1550 RPM built in overload with Evoa automatic teset. z • Power cord: 10 foot I 5. standard length, 16/3 , I _ SJTOW with three prong grounding plug, Optional 20 ° 0 0 t0 20 30 40 50 GPM foot length, 16/3 SJTW with three prong grounding plug (standard an EPOS )• o x a s a � o t z mr /h cA PAtm G [ o � ulds Pumps Z 2060 Goulds Pumps </ �,/ ITT I ndustries 00 � Effective February. 29 B3671 C k STANDARD CHAMBER Cluick4 Standard Chamber (EFFECTIVE LENGTH) r I A , _� -lu SIDE view SECTION VIEW MulfiPort End Cap �^ J 12" i 16 � � l ��� �1 1 � � � � !� � � � �� � �� __� i ii 34 SIDE VIEW TOP VIEW FRONT VIEW OMNI 0 P P, Rort In CW orninarzoeclucatlons n ar, Of- InalSp Opp 0 SK�v' Stan dard t M t! m�� d'i 34 x 16" x 12" Effective Length . 48' Invert Height 8" or 1.25" Invert Height 8l' IN-FLL-TR-MB-aY--$T-EM% INC -aTA�WLIMITED WARJIMYY ) Thto sun "Iv al Kcvay of aech 1,harnber. 914 plate, jyyjge ar L)ton, , ti rsswv U) loolual f 'Undsi. when stau& a rd ("rated in a ileacrdiolici or an or Site sPpiic lirvern in accordance win) In'.1114101 1n I U . ions, iS yva airtea loo P, 4iqooal ,ochase, rl•woowlr bgaiw detective ; ;:,,lenai,, told colle vear from the (late that Poe sKii:L Paola i,� rois � tw the sopic syosldrn (,waloing sus , units: we,,,joad, ho:ovovaver. -f at a mpl. penrooll 1% not ieq:;ked toy witcabia law, the wananl,, pfeW will bagi-,Rlll t1b data thar!st,lAWtion of Ina Mtw, .,stem wn,rj&ol T> ex-ose its warranty 4 Il aljet watery or vritina at its C WJuo tiealikplxlolrs in 0 Coroi wftiv weer ms) dllyf of the alloyed dva t, iniiitialoo, wii akip tc unrits ter Un tz. deplaned Ly L. by this L110110d Wall0i'lly II ftilial,-,r n idbillily spt1.CAo;a1tv eloclul the cost of rentl and/)r lnoiiaiijt ,n of the Units, IL 1141 wAnf.AN1 *AY IARF, E.XCLUSIVE 1 1 PI ftl'MiL N Oil IrA WARRAN AE.� volinvi HESPEUC SYSTEMS INC lr 1 tl 1 Mall W t 1 S':. II IKy Vvd it ally pail et ',lie J - tk VS an td 'Uld'!r. rg 1 L y - .r alt lr+dn lnl HI'IIUr. 'ihe L IIr3<1 NJarfd'xy Jttis sl-clly"llizol. 'p—d nr indwA 'Onrovu. Inh r in n o 110t tl , lbhll, lrorD.lallio,l ,,, tIyatdatmi ckding toe' of Environmental onsite Wastewater Solutions'" "orAwron .:ad p'ofits. Law ai)J,ylwerzls, olarhaad Cons. a Ohl IWeIiOr ep,arrsu lru;Fad by the Hlildllf Ur any Iril(daally SpMjfialy —C,okle,j lrwn Lin"' the We I.,)IdV,t.ry weiill sins lea, allerawa avkisrof misuse, abuse a, nogfecl of (hP 0n,I&: the Units b eing s, bjanjo toveh. old ilaff,C or ripthe, wprj,joanl w,.rn.­ ixi, ,ei!ni1edtry tnia 03talial alStWWS: failure to rnienlan the 6 Business Park Road lot P.O. Box 768 mponljor ground covers set kett in the installation insloi0om We plamitani orrDrrrlrp( materials into the system containing 111, Units; lattwre of 7 Olds 11 The llwrlti, ,yst— &,, It IV rig, eXcesWa Ili gr3EM (fi l or irlproW operation; or Old Saybrook, CT 06475 ri�ly othq. event no: caused by inoplt;z�:Iar. - ,,IL be void f into hoULr !ail- it) ixinply with all of the lem set forth in this tamped WarraFity 860-577-7000 - FAX 860-577-7001 Kidt", in roo ulit blo all all Infi tx �) lltal refiWitsibla for any [ O� uooillalfs 1 the 1h9 Units, or ia p&rky rewifing from in-.,tallatonor slnip• ,nAnj . , born any product lawil, claims of many tlood party. ��, J_;-I,>J li"atianky to appy. the Units must be 111swit'i n acleldaMw 800-221-4436 ,ol,.th all site —drflonr, nrqi I, an d local codes; W! other -iipplkabie Layls alld IoWilla(1011 0 1, I,os the -1 1 ,, --go, ., W,— In., L-,lod Wil—Illy. W ..noirIly apple, to —y part ,n ton tr. .,go- nai Hnkira- Tho aWvoo -P-eallt,, the Stands d Lornotel Warranty ffe!oij by lrolitilalOr A 1.111u,ri , wo( -I Ili stales and have d6leroonj wan-3,Ay require - meals. Any pl,rrt)ae, 01 Units should Wrill Infiltrator`6 C�orpeirele Haaacluaritars, in Oki Swobnxik, UjkrwXjj�ut, raor 10 SU p(o copy of Vile applicable warranty, a should Orefdly lead that Warranty lni�r to the pl ill of Ljrols h Ilisa. to obtain a Patents 4,159 ,661; 5,01 7,041; 5,156,486; 5,336,017; 5,401,11 !C; 5,40 5,511 tr 3 5,716,163; 5,588,778; 5,839.844 Canadian llalentS. 1.329,959; 2,004,564 Other patents pending Intiltralor Equalizer and SideWw1der are registered trademarks 01 ItjiIttEti)r Systo,-InS Inc . Iii fill , cilcor Is a tbg(Sleretj trademark in France. Inlidratof Systems Inc 'OntoUr, Gorttaojl Stiltivei COnr.rxfion. loo Pntyluf!., Snapl-ock, CharnbelSpacer, Psis Lock, . WckOut WckPlay i a !egstored tiadernark in Mexico- (, RECYCLED PAPER arid Guick4 are trademarks of InIdtiratcor Systems lr<;. 0 2008 Infiltrator Svsei It; Ina " in U.S.A. pi)l IlMlip...) Wisoonsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 2 Division of Safety and Buildings in accordance with Co qty ST. CROIX Attach complete site plan on paper not less tha41x 1 Plan must include, but not limited to: vertical and horizonte point (BM), direction and s Parcel I.D. 040 - 1075 - 60 - 100 percent slope, scale or dimensions, north arrowLion and distano® to;r"ixst ro Please print all iion. Re ' Date Personal information you provide may be used for seposes (Privacva -Ik'k - Ilii 6) ( -))- Property Owner zv ,aoperty Vocation ZANE FLOREK Govt Lot ----1 1/4 SE 114 S 18 T 28 N R 19 E( ❑ ) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 8587 Morgan Lane 5 -- CSM Vol. 17, Pg. 4575 City State Zip Code Phone Number Dity village JDTown Nearest Road Eden Prairie, NM 1 55347 ( 651 ) 775 Trov i C.T.H. F New Construction UseEj Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Pubes or commercial - Describe: Parent material outwash Flood Plain elevation if applicable _ 4 ft. General comments Conventional In -ground Trenches -- 0.7 loading rate -- to be designed by installer and recommendations: Additional pit added to original test dated 03 -31 -03 to add more area for system.` R� �Ca ate. S�taw� � `'t '8 1 �t 7 . d v S 1— Bori # Boring M Goa Q Q pit Ground surface elev. 93.29 ft. Depth to limiting factor 84 in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 *Ef1#2 1 0 -10 7.5YR2.5/1 - sil 3fgr mvfr cb 3vf-co 0.6 0.8 2 10-26 7.5YR3/2 — sil 2fabk mfr I as 2vf-m - 0.6 0.8 3 26 -30 1 10YR3/4 - si 2fsbk mvfr as 2vf-m 0.6 0.8 4 3048 10YR3/6 s Osg dl as 2vf-m 0. 1.6 5 48 -84 10YR4/4 — s Osg dl -- -- 0.7 1.6 Sy Boring # Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dormant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff 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 CST Name Pease print) re CST Number Mary 7o Hollister 224832 Address Dabs valuation Conducted Telephone Number W9975 690th Avenue, River Falls, WI 54022 09-30-05 (715) 426 - 1775 • I mama vAM L— 1 1D - 16VAD' I�� b�� _ 66o3 .G . Ott PQZPFjzry u Nle N. 4a+ s� Oa 3 _ s c.onE ER . 1'Uc{ Y�u� c �i� _ I T\ECHVE Wisconsin Department of Commerce Ais 0 A REPORT Page .�_ of _� Division of Safety and Buildings in acco ance �? �6iu Wttm, C do +,[ p IN OFFICE County tYRO�F= Attach complete site plan on paper not less than CL- M include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. '� / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Re Date Please print all Information. L Por30021 WDrrnahOr: you provide may be used far secondary purooses (Privacy Law, s. 15 04 (1) lm)) Property Owner Property Location T LA�18 A 1/4 5_ 114 S tq T N R Sq E )W Property Owner's Mailing Address Lot Block a Subd. Name a CSMtY 3 � C•T+I, - City State Zip Code Phone Number 0 City 0 Village Town Near st Road Nuzso1J� _� I S40 tto ! t`llS) 3$� - q z9� _T C.T.Q. 5 GPD New cons:rudion User Residential / Number of bedrooms S_., Code derived design flow rate - -- 0 Replacement (] Public or commercial - Describe: � Parent material Flood Plain elevation on if a - iota General comments R � R 0 �� .LOe'F't0/J OF Lai CA 'J9 and recommendations: CoNVEnl�ton�At_ SN—Co20�1D 'TrZ�►dC`11Gg C F10L gplitN LJOT t_•!NE NOT d. l_Oftb1>`IC� RA�rc fit '�t{15 'TtME> PVLOFIL- D lL4W 1�►G, M raHr AE v trc a { 5MR'�OA SMA r q Np M Re UIKr—D• TN �—] l_ Bodng 7 in. I5 EA)oUUGM A for, A 5 U Boring p ROOM I+Vft IQ[ pit Ground surface elev _��! �� Depth to limiting factor � � Sal A lication Rate Nodzon Depth T Dominant Color Redox Des Texture Structure Consistence Boundary Roots GPD/fP in. Munse l +Du. Sz. Cont. Color Gr. Sz. Sh. 'EfEIt1 'Effa2 1 0 -t0 k'40 "- Z 10 -z5 rte -msv< ' cb c 0.4 O,L zs- OYIc 3 J3 tl _ s G� kco d.Z 0.3 �{ -410 ( y�5 r L 2 - ab J MI rn 0.5 •B 5 l01K4 /q 12 o �o �caz 0.1 1, z t Wo Cue 0 Boring Boring # v �J A pi; Ground surface elev �.9 � � Depth to limiting factor 7 l D 'n. Solt A IlcaUon Rata ! Horizon Depth Dominant Color Redox D cription Texture Structure Consistence Boundary F;oois GPD /fP n. Munsell Qu. Sz. Cont. olor Gr. Sz. Sh. ' 'Eft#t Etftl2 3 rS 1 D.S i 0- O�rc i '- � _ o•b Id`EK 5►� CL zY� -m ►, r 1 as >M � - 0 YK-4 � � •- h r 7, l. tJ -S6 yRy /'f �� aS v 1. Effluent p1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent = B _< 30 mg/L a nd TSS :S 30 nrg/L CST Name (Please Print) ignature CST Number mA so N — Z 83Z Address Date Evaluation Conducted Telephone Number 987s �90 { `�Ade,�R(vEP�FAUS�WI 5022 03 -22-03 `�t5 yob - 117S �Ey�s�' 03- •�1 -03 E DING � 3 Property Owner t-�� 1 -- Parcel ID # A N T - - -- Page of ❑ B L Boring # g Z - In.1 llcetion Rate Boring Pit Ground surface elev. _ � dZ • D� n Depth to limiting factor -- Roots GPDIff Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 1 EO#1 'Eft#2 in. Munsell Co. Sz. Cont. Color Gr, Sz. Sh. 51 24 J r +i -Ca .5 9 2 is - 5b r _0 1,2 1 cg v -YY` qq 2q-4! 10 rts13 s ''� Z 14 t -71 0 \4 (h tQi 0 �f► s1y s 7- " ❑ Boring # Boring 3oU icatlon Rats Pit Ground surface elev. A00 ft. Depth to limiting (actor } I� m. GAD/tF Horizon Depth dominant Color Re lox Description Texture Structure Consistence Boundary Roots •Eff#1 •Elf #2 In. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. � �. p , ! 0 -9 10 1c z " — l 5 O.9 Z q -1 0 3�3 jS Z nt �bK d r s 3v - 0. 1 1.2: U C Z4-co - f IOYfC -L4 JY� 5 CS O ' (o V7 -1 ❑ Boring ❑ Boring # Ground surface elev. __�__ K• Depth to limiting factor _ In. ❑ Pit Sol A ication Rate Roots GPD/ff Horizon Oepth Dominant Color Redox Description Texture Structure Consistence Boundary *Etf#1 *Ett#2 j n, Munsell Qu. Sz. Cont. Color Gr. 5z. Sh. 'Effluent #1 a BOD, > 30 ,220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BOD, _< 30 mg/L end TSS c 30 mglL The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or nccd material in an alternate format, please contact the department at 608 - 266 - 3151 or TTY 608 - 264 - 8777. SOD -4330(R 1 pAGE�� �IZOpEC�ttY OW1�1ER: � t (.EGENJ: � �r y0 ` • PAVcF-t- Lo aM- -T of eVc P I PS Z14' A50 1 T E ' HE 5E4 Seo. 1$ T2$ ROW.To \ U N - O spiKa ' Z' 4 GK,pu�D -1 .00' 50L BODING W/ a NO COMM 65 5F MACK PROOLEM5 V l- YV SO RT �P Z�o 5� � � s l i <avPU.ox. yoc 70 C.T. H • 1 (pc °�s „Kel 0 4o t 2� t op. x 516NEP C5f 2 Z Z � 483 �CV��cD�• 03 -31 -0�, FROM :SCHUMAKER PLUMBING FAX NO. :7153263121 Sep. 06 2005 01:15PM P2 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer T Mailing Address Property Address FVerific lolf required from. Planning &.Zoning Department for new construction.) Cite /State JC *.-j U" l Parcel Identification Number _ ©VJ 0 75'GO- 6(s _ LEGAL MCRIPTION Property Location '/4 , �L� Y , Sec. /, , T �_N. R _j.,q_W, Town of Subdivision r2 / Volume , Page #S7. —,_• Certified Survey Map # _ � J � `'1� ....._----- ._.._.,..: .._�_..�_ Warranty Deed # y , Volume 2 , Page # Spec house yes Lot lines identifiable nn SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could re..3ult in its prrmature failure to handle wastes. Proper maintenance consist% of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into a e in the waste d isposal system. owner maintenance ct' of the septic tank as a treatment at I� Y the system can affect the t' uts ton p 8 responsibilities are specified in § 83.52(1) and in Chapter 12 - St. Croix County Sanitary ordinance. The property owner agrees to submit to St. Croix County Planting & Zoning Department a certification form, sit ?ncd by the owner and by a master plumber, journeyman p1r4s11i er, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after utspeoion and pumping (if necessary), the septic tank is less than 113 full of sludge. I /we, the tutdersigned have read the above requirements and agree to maintain the private sewage dicltosal systein with the standards set fotih, herein, asset b y P the D of Commerce and the Department of Natural Resources ni State of Wisconsin. Certification stating that your septic system has been maintained must be completetl and returned to rite St. Croix County Planning & Zoning Department within 30 days of the three year expiration date, I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(.c) of the properly described above, by virtue of a warranty dtecl recorded in Register of Deeds office, Numb of edro SIG ATVItE Or APPLICANT(Sj DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & 7A>ning Department. lnclude with this application a recorded warranty deed Born the Register of Deeds Office and a copy of the certified survey map if reference is nuide in the warranty deed. (REV. 08/05) I —_ PQWTS OWNER'$ MANUAL. & MANAGEMENT PUN page /- of Z� FILE INFORMA N 0Y$T4M SPECIFICATIONS Owner �,�� So ptia Tank Capacity Permit Sept lc Tank Manufacturer C3 NA DESIGN PARAMETERS Effluent Filter Manufacture �� „� 0 NA Number of Bedrooms �{ 0 NA Offltent Filter Mods 0 NA Number of Public Facility Unite, Q NA Tank Capacity i f al 0 NA Estimated flow leverage) O j y bQ_ + Pump Tank Manufacturer I eS Vol ,, O NA Design flow (peak), (Estimated x 1.5) ���r g el/day pump Manufacturer 0 NA Soli Applloatiwn Rate a /ftt pump Model O NA Standard Influent/Effluent Quaky Monthly everagA• Pretmtment Unit NA Fats, Oil & Grease (FOG) 530 mg /l. 0 %nd/lGraval Filter ❑ Peat Filter Biochemical Oxygen Demand 11300 5220 m,91L 0 NA 0 Mechanical Aeration 0 Wetisnd Total Suspended Solids €TSS) !160 mg1L Q Disinfection 0 Other: Pretreated Effluent Quality Monthly average Qlspa/rsal Cells) d NA Biochemical Oxygen Demand (800 530 mg /L Q 1n (gravity) I't In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L C NA OA;—Grade 0 Mound Fecal Coliform (geometric mean) S D�, u1100ml 17 grip -Line 0 Other: Maximum Effluent Particle Size Yi In die, Q JN4 fir' O NA Other: 0 t?ah, � NA "Values typical for domestic wastewater and septic tank Affluent. ' O NA MAiN'i 0KANCE SCMIXILE Event Service F roqusn aY rl Inspect condition of tank(&) At least once every{ ,3 e e tMautimum 3 years! C] NA Pump out contents of tanks) When combined sludge and scum equals one-third (Y of tank volume 0 NA Inspect dispersal cell(&) At isW once every: 3 a j tsi (Maximum 3 yam) 0 NA —k Clean effluent filter 14 :5' h/eg every : 13 At least Once ev: i ts) 0 NA Inspect purnp, pump controls & alarm At least once every: mortthis) 0 NA Flush laterals and pressure test At !seat anco every: mon (s1 0 NA C9 s) Other: 0 month(&) 0 NA At leas# once every: --- C7 lei Other. 0 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following license or certifications: Master Plumber; Master Plumber Restricted Sewer, PAWT"a inspector; PQWTS Maintainer; Septage Servicing Operator. Tank inspections must include a vievel inspection of the to nk (s) to identify any misaing or broken hardware, identify any oracks or teaks, measure the volume of combined sludge and scum and to shook for any Lack up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected ected to check the offlvent levels M the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the Mound 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 eg4al& one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septapa Servicing Oper a tor and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. I Page _ 12-16f Z START UP AND OPERATION roducts or other chemicals For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting p that may impede the treatment process and /or damage the dispersal c ell($). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior ii' yes:, System start up shall not occur when soil conditions are froxeh 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 cellist in one large does, overloading the oellis) and may result in the backup or surface discharge of effluent. To avoid this situation have the content's of Vial pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintalner to assist 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 -grade soil absorption area. Reduction or elimination of the following from the waasteweter stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vege ;able peelings; gasoline grease; herbicides; meat scraps, medications; oil; painting products: pesticides; sanitary napkins; t4roo'c is; And water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chalptcr Comm 80.33, Wisconsin Administrative Code: s All piping to tanks and pits shall be disconnaated and the abandoned pipe openings sealed. e The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. r After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space fitted with soil, gravel or another inert solid material CONTINGENCY r AN If the POWT�faiis and cannot be repaired the following mass roe have been, or,must be taken, to provide a code compliant replaoeme system: A suitable replacement area has been evaluated end may be utilized for the location of a replacement soil absorption system. The replacement area should be grotacted from disturbance and compaction and should rot be infringed upon by required setbacks from existing and proposed Vtrugture, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evalualtion to establish it suitable replacement area. Replacement systems must comply with the rules in effect at that time. D A suitable replacement area is not aveiiebla! due to setbpok and /or soil limitatione. Barring advances in POWTS t re or to replace the tailed POWTS technology a holding sank may be installed ere aA iaalF e t . +•R 'A 13 The h d site e tank D Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must gomply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LITHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT" TANK UNIaiiR ANV CIIICUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY Sir DIFFIC00 Qft IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POW TS MAINTAINER Name `���, �t ! Name Phone ? t r ,p Phone SEPTAGE SERVICING OPERATOR (PUMPER) L O CAL . � QULATORY AUTHORITY Name Name ST: G/cJ J J Phone Phone J S — This document was drafted In compliance with chapter Comm and 83.5411), (2) & (3), Wisconsin Administrative Code. Parcel #: 040 - 1075 -60 -100 10/04/2005 02:55 PM PAGE 1 OF 1 Alt..Parcel #: 18.28.19.285F -10 040 - TOWN OF TROY Current L X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner ZANE M FLOREK O - FLOREK, ZANE M 8587 MORGAN LA EDEN PRAIRIE MN 55347 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * CTY RD F SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.500 Plat: 4575 -CSM 17 -4575 040/03 SEC 18 T28N R19W PT NW SE BEING LOT 1 Block/Condo Bldg: LOT 05 4/1018 (5.000AC) NKA CSM 17 -4575 LOT 5 (2.500AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 28N -19W NW SE Notes: Parcel History: Date Doc # Vol /Page Type 11/04/2003 745648 2449/064 WD 07/28/2003 732441 17/4575 CSM 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 67,000 0 67,000 NO Totals for 2005: General Property 2.500 67,000 0 67,000 Woodland 0.000 0 0 Totals for 2004: General Property 2.500 67,000 0 67,000 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 U 2449' 064 745648 KATHLEEN H. WALSH REGISTER OF DEEDS S fA FE BAR OF WISCONSIN FORM I - 2000 ST. CROIX CO., WI Document Number WARRANTY DEED RECEIVED FOR RECORD This Deed, made between WILLIAM K. LANIER and PATRICIA 11/04/2003 08:080 G. LANIER, husband and wife, WARRANTY DEED EXEIPT # REC Grantor, and ZANE M. FLOREK TRA FEE: 11.00 TRANS FEE: 201.00 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in ST. CROIX County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): Part of the NW 1/4 of SE 1/4 of Section 18, Township 28 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 5 of Recording Area Certified Survey Map filed July 28, 2003 in Vol. 17, Page 4575, Doc. No. Name and Return Address 732441. ,' 11 TOGETHER WITH and SUBJECT TO shared driveway easement as shown on said Certified Survey Map. 040- 1075 -60 Parcel Identification Number (PIN) This is not homestead property. Together with all appurtenant rights, title and interests. pls) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except 30t Dated this h day of October 2003 t r� * * WILLIA,INi K. LANIER X * * PATRICIA G. LA "ER AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. ST. CROIX County ) authenticated this day of Personally came before me this 30th day of October , 2003 the above named WILLIAM K. LANIER and PATRICIA G. LANIER tttltll lllp/ TITLE: MEMBER STATE BAR OF WISCON S (If not, �•`, q� t; • • f 0� ��to me known to be the person(s) who executed the foregoin authorized by § 706.06, Wis. Stets.) Aq •. m�, �4 ;stlument and acknowledged the same. J_ . THIS INSTRUMENT WAS DRAG 'BY * *+ Leo A. Beskar %'t .O Z/ �totary Public, State of WI CONSIN ' RODLI BESKAR BOLES & KRUE ' •• ��1 Commission Is ° nlanent. (If not, state ex iration date •__ ��. Y P P L (Signatures may be authenticated or acknowledged. Both ar�' Cc * Names of persons signing in any capacity must be type{ or iWi below their signature. WARRANTY nEED STATE RAR OF WISCONSIN INFO -PRO (800)655 -2021 •rmw.in /oprolorms com FORM No. 1 - 2000 CERTIFIED SURVEY MAP LOCATED IN THE NW 1/4 OF THE SE 1/4 OF SECTION 18. T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN, BEING ALL OF LOT 1 OF CERTIFIED SURVEY MAP, VOLUME 4, PAGE 1018, DOCUMENT NUMBER 368066. OWNER'S CERTIFICATE OF DEDICATION AS OWNERS. WE HEREBY CERTIFY THAT WE CAUSED THE LAND DESCRIBED ON THIS CERTIFIED SURVEY MAP TO B SURVEYED, DIVIDED, MAPPED AND DEDICATED AS REPRESENTED ON TH CER IED SURVEY MAP. LIAM KE PATRICIA LANI STATE OF WISCONSIN) COUNTY) SS PERSONALLY CAME BEFORE ME THIS a9 DAY OF 2003, THE ABOVE NAMED WILLIAM KEITH & PATRICIA LANIER, TOM KNOWN TO BE THE SAME PERSONS WHO XECUTED THE FOREGOING INSTRUMENT AND ACKNOWLEDGED THE SAME. NOTAR NOTARY PUBLIC. � � OUNTY, WISCONSIN. n MY COMMISSION EXPIRES app F c DATE: MAY 7. 2003 REVISED: JULY 16, 2003 J ES D. FILKINS S -2246 JOB# 03 -2675 GISTERED LAND SURVEYOR OGDEN ENGINEERING COMPANY 1234 SOUTH WASSON LANE RIVER FALLS. WISCONSIN 54022 JA .40» pftmR. o�. wl THIS MAP HAS BEEN APPROVED BY THE TOWN OF TROY. ? /W A'�b 3 t"--E � 1 A m - � DATE SHARON PROVOS, CLERK Vol. 17 Page 4575 PAGE 3 OF 3 • CERTIFIED SURVEY MAP LOCATED IN THE NW 1/4 OF THE SE 1/4 OF SECTION 18, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN, BEING ALL OF LOT 1 OF CERTIFIED SURVEY MAP, VOLUME 4, PAGE 1018, DOCUMENT NUMBER 368066. N 1/4 CORNER SECTION 18 T28N, R 19W OWNERS & SUBDIVIDERS LOT 2 C.S.M. WILLIAM KEITH & PATRICIA LANIER ROUTE 3, C.T.H. "F" VOL. 6, _FA GE 1697 HUDSON, WISCONSIN 54016 i i z I _4-' 5o' w UNPLA T TED LAND �I — — — — — — — — 111 S2 " 558.75' 525.73' F I I 33.02' o o B 1 ® B3 = '� O to O N - - �) SLOPE >20X ' LOT B2 w I V� _ I o 150' 2.500 ACRES, 108,902 S.F. 'oo 9 I i vi O SHARED. INCLUDING ROAD RIGHT -OF -WAY; 50 °' to DRIVEWAY 2.352 ACRES, 102,467 S.F. rn O � I 'o EASEMEN \ EXCLUDING ROAD RIGHT-OF-WAY I o O azll M; o +��Q�� Z OT 1 C.zm_ V0 � 4 QI Q ) M 50'.4 ,� to w J �I I - I 525.73' v' - Q S 88 058' 52"" E 558.75'' p M W 33.02' DR/ VE'WAY m ICI I of _ _ EX /S TING CI ° * ( ' n EXISTIw SHED o Q "v� II o Z ^ 0 100' EX/S DO_C. Yj&8Oi 6 �' Z) I S t o Tl I o Z Z I ° ol� « LOT 6 , . 5 0 ' J I °' zI� 2.500 ACRES, 108,902 S.F. I EX /STING - _ INC ROAD RIGHT- OF -WA� I (T pr G � TIA 2.352 ACRES, 102,467 S.F. 111111 \ EXCLUDING ROAD RIGHT -OF -WAY I i 33.02' 525.73' i N 88 °58' 52" W 55875' POINT OF BEGINNING I UNP A T TED LAND .I I 3 I I I SCALE IN FEET in _ � �i I .- of C 0 50 100 200 300 q I w O. 1�Y WNmz z 3�� LEGEN ' COUNTY SECTION CORNER MONUMENT, t y in I ,- ALUM I NUM CAP, FOUND. 0 o ���� • 1 1/4 IRON PIPE, FOUND. z m p 1 1/4" x 24" IRON PIPE WEIGHING 1.68/ /LINEAR FOOT, SET. - -- - EXISTING FENCE. B1 SOIL BORING PERFORMED BY MARY JO S 1/4 CORNER ® HOLLISTER ON MARCH 22 2003. SECTION 18 - - BUILDING SETBACK LINE. T28N R 19W * NOTE: ALL IRON PIPE ARE DIMENSIONED AS OUTSIDE DIAMETER. THIS INSTRUMENT DRAFTED BY DANIEL P. KUGEL �IE PAGE 1 OF 3 E 5 203 COUNTY 7 3 2 4 4 1 'S RECORD VOL 77 PAGE 4575 KATHLZIN H. MA `- REGISTER OF DEEDS ST. CROIX CO., VI RECEIVED FOR RECORD CERTIFIED SUR M AP 07/28/2W3 01 :45PH CM?TTFTFin Silpvgy NAp LOCATED IN THE W 1 /4 OF THE SE 1/4 OF SECT ION 18REC FEE: 15. T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCO I03 BEING ALL OF LOT 1 OF CERTIFIED SURVEY MAP, VOLUME 4, PAGE 1018, DOCUMENT NUMBER 368066. N 1/4 CORNER I SECTION 18 T28N, R 19W .L Z SLAL WILLIAM KEITH & PATRICIA LANIER �11 ���� ��vv /f ff ' , Q' I 1/Ol • ..�,_P�G� 1 7 Zwo IONS IN 54016 4 I ST, CROIX COUNTY Plannlno 2onfra and Parks CaTmmee 1' JUL 2 8 2003 �II If n01 teo0rded wiNin 30 days Of g• "E 558. 751 I ` �' I 33.02' 5 81 ® 83 I Z II I SLOPE>20X - - - - - i �- 82 150 2.500 ACRES, 108 S.F. �8 1 SHARED INCLUDING ROAD RIGHT -OF -WAY 50' I a , " EWA 2.352 ACRES, 102,467 S.F. i o, OI I $ EA � EXCLUDING ROAD RIGHT -OF -WAY $ O I oQI 91 C 50,�y�\ LM�.��► .� QI X W �l a J I I O I, QEMrERL /AIE S 86'58' S2'• E 558.75' O I EX /Sr /AC ^ Ell I i� •.r Y 3 33.02' / VEN01 ��� Ex/S C/ _ $ � I Q f EXIST /MC SHED Z y Q "III I _ 100 DO_C. 36 - 66 ` I S EX��rI + 50 , g Z LOT 6 J z 2.500 ACRES. 108.902 S.F. I I I I EX /ST /ABC - _ NC R OAD R OF-WAIf� .f I SEPr /C EXISTING ACEW 2.352 ACRES. 102,467 S.� JJ \ I TM �i M!7 C,IRAC,E EXCLUDING ROAD RIGHT -OF -WAY � � 1 IY POINT OF 2 45 1 ' W BEGINNING UNPLA TTED LAND 1 I I SCALE IN FEET a 0 50 100 200 300 3 LE GEND *^' COUNTY SECT I ON CORNER MONUMENT. . cn ALUMINUM CAP, FOUND. • 1 1/4" IRON PIPE, FOUND. z� p 1 1/4" x 24" IRON PIPE WEIGHING 1.68/ /LINEAR FOOT, SET. 00 — - -- 9 - EXISTING FENCE. SOIL si HOLLISTER ON P MARCH 22,82003.Y JO N S 1/4 CORNER SECTION 18 - - BUILDING SETBACK LINE. T28N, R 19W * NOTE: ALL RON PPE ARE QNP4SIONEO DQ THIS INSTRUMENT DRAFTED BY DANIEL P. KUGEL AS OUTSIDE DIAMETER PAGE 1 OF 3 t Vol. 17 Page 4575 • r`