HomeMy WebLinkAbout022-1042-95-500St. Croix County Planning and Zoning Monday, Jane 11, 2012 at 2.55:08 Ply
Detail Sanitary Information Page 1 of
Computer g:
022-1042-95-500
Sub/Plat: >35 acres
Section:
15
Parcel 0:
15.28.18.232A50
Lot: 5
TN/RNG:
T28N R18W
Municipality:
Kinnickinnic, Town of
CSM: Vol. 22 Pg. 5459
114 114:
SW 1/4 NW 1/4
Owner:
Agronomics, Inc., cJo John W. Bradley 1232 Cry. Rd. J River Falls, WI 54022
State Permit:
224651 Issued:
08/18/1994 POWTS Dispersal:
Non -Pressurized In -ground
Permit* New
County Permit:
0 Installed:
08/18/1994 POWTS Detail:
Trench - Seepage
Bedrooms: 3 WI Fund:
POWTS Pretreatment:
NA
Notes
Issuer/Inspector
As Buifl
Plumber Other Reauiremenis
Additional Notes Money Owed
Tom Nelson
Yes
Wang, Tom
built new house after CSM 16/4288 recorded. $0.00
Mary Jenkins
Signed Off: Yes
Bradley has 2 locations licensed by DNR 028465
8 29067 for land application of septage on fields
Maintenance
Notification
Scheduled Pump
Date Pumped
Not cation
8/182005
11/11/2006
04/20/2006
11/112009
8/12011
8/152011
8/152014
AGRONOMICS INC./Bradley,
309 N. River Rd.
River Falls, WI 54022
0zz-/05/�)F6 - .231A
John SE'k, NW;, Sec. 15
T28N-R18W, Town
Kinnickinnic
Address of Site: 1232 Cty J
River Falls, III 54022
Permit No.: 224651 8-18-94 Thomas Wang
New - Trench
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08/05/2011 10 49 AM
PAGE 1 OF 1
Alt. Parcel #: 15.28.18.232A-50 022 - TOWN OF KINNICKINNIC
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
09/20/2007 00 0
Tax Address:
Owner(s): 0 = Current Owner C = Current Co -Owner
O - BRADLEY, LOIS G
LOIS G BRADLEY
1232 CTY RD J
RIVER FALLS WI 54022
Districts: SC = School SP = Special
Property Address(es):
= Primary
Type Dist # Description
' 1232 CTY RD J
SC 4893 SCH DIST RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres:
6.064
Plat: 5459-CSM 22-5459
022-2007
SEC 15 T28N R18W PT SE NW BEING LOT 5
Block/Condo Bldg: LOT 05
---
CSM 22-5459
Tract(s): (Sec-Twn-Rng
401/4 1601/4)
15-28N-18W SE NW
15-28N-18W SW NW
Notes:
Parcel History:
Date Doc #
Vol/Page
Type
08/18/2008 880154
QC
09/20/2007 860927
22/5459
CSM
09/20/2007 860926
EZ-DR
04/18/2005 792453
2785/105
EZ-U
more...
2011 SUMMARY Bill #:
Fair Market Value:
Assessed with:
0
Valuations:
Last Changed: 09/0712010
Description Class
Acres
Land
Improve
Total State Reason
RESIDENTIAL G1
6.064
85,000
294,000
379,000 NO
Totals for 2011:
General Property
6.064
85.000
294,000
379,000
Woodland
0.000
0
0
Totals for 2010:
General Property
6.064
85,000
294,000
379,000
Woodland
0.000
0
0
Lottery Credit: Claim Count:
1
Certification Date:
Batch #:
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 900
l 9d
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
Fee /ls lz�), .
SUBDIVISION / CSMJ!r LOT f�_
SECTIONN-R_,( 6 W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
ica.p ieP ���
P; e e
u�W
0 -/1
30 (IAW--
5 x(Vo
5 X q0F
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
if
BENCHMARK:
ALTERNATE BM. /
r
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: i'jWe%j VI'PSf�S� Liquid Capacity:
Setback from: Well >"�Q House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Loca
SOIL ABSORPTION SYSTEM
Width: �o Length Number of trenches
Distance & Direction to nearest prop. line: 1 �QQ
Setback from: well: (/Ob House '>/!�O Other
Building Sewer
PC inlet
Header/Manifold
Existing Grade
ELEVATIONS
ST Inlet.
PC bottom
ST outlet
Pump Off
Bottom of system
Final grade
DATE OF INSTALLATI-C4A: (/0 �) �/
PLUMBER ON JOB: /y'Z
LICENSE NUMBER: 3 0 3I/
INSPECTOR:
3/93:jt
Wisconsin Department of Industry,
Labor and Human Relations
Safety and Buildings Division
GENERAL INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Permit Holder's Name: ity Vi age Town o
AGRONOMICS, INC.
CST BM Elev : Insp. BM Elev.: 8M Description:
TANK INFORMATION F1 FVATIAN nAl
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANKTO
P/L
WELL
BLDG.
Ventto
Air Intake
ROAD
Septic
�/
/�
-)-J '
y 2 J
NA
Dosing
NA
Aeration
NA
Holding
PUMP / SIPHON INFORMATION
Manufacturer Demand
Model Number GPM
TDH I Lift I Loss Head
Friction System TDH Ft
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
County:
ST. CROIX
Sanitary Permit No.:
State Pla
Parce Tax No.:
4
STATION
BS
HI
FS
ELEV.
Benchmark
JS
C1 U
Bldg. Sewer
St/ Inlet
Stif Outlet
40
Vic/
Dt Inlet
Dt Bottom
Header/Man.
ao
s sf
Dist. Pipe
%
�-
Bot. System
�0
Final Grade
,;
BED / TRENCH
Width r
Length !/ ,
No.Of Trenches
PIT
No. Of Pits
Inside Dia.
Liquid Depth
DIMENSIONS
DIMENSIONS
SETBACK
SYSTEM TO
P/ L
BLDG
WELL
LAKE/STREAM
LEACHING
manufacturer:
INFORMATION
CHAMBER
y e . t ,.
model Number:
System:
1
!
OR UNIT
DISTRIBUTION SYSTEM
Header I Manifold
Distribution Pipes
x Hoe Size
x Hoe Spacing
Vent To Air Intake
Length Dia
Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over -1
alp
Depth Over �1 l
��
xx Depth Of
xx Seeded I Sodded
xx Mulched
Awl Trench Center
Bed/Trench Edges �`
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Kinnickinnic.15.28.18W, SE, NW, C.T.H. ^Jrt
110
/',:LL ji�,J C - o
Plan revision required? ❑ Yes []No
�1
Use other side for additional information.
SBD-6710(R 0"1) Date Inspector's Signature Cert No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
'60x _ QAKIITA12V DFRRAIT ADDI If_ATinki
In accord with ILHR 83.05, Wis. Adm. Code
C
STATE So #
-Attach completA plans (to the county copy only) for the system, on paper not less than
11051
8'h x 11 inches in size.
❑ chadcHrevisiontoprevkwsapplication
-See reverse side for instructions for completing this application.
STATE PLAN I.D. NUMBER
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY CZER % C
roil 6A 10,3 ,4 , o .b�
PROPERTY LOCATION
S E'i. P %, s 5 TVQ , N, R W
PROPERTY R'S AILING ADDR SS /tl
LOT $
BLOCK per»
D vrr
CITY, STA
jiir,
ZIP ^
NE
PRONUMBER
5
SUBDIVISION NAME OR CSM NUMBER
el'utr S
s!
pt 5
II. TYPE OF BUILDING: (Check one) ILL t NEAREST ROAD
State Owned VILLAGE
/ I T
4244 /
❑ Public 1 or 2 Fam. Dwelling-{�of bedrooms L A �
III. BUILDING USE: (If building type is public, check all that apply) r> a +)' _1p y 2 - 9 5 - 0 v0
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B If applicable)
A) 1. RL New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit #.' Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 K Seepage Trench 22 ❑ In -Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. BY TEM ELEV. 7. FINAL GRADE
L ATION
12.
REQUIRED (sq. ft.) PROP. SED (sq. tt.) (Gals/djy/sq. tt.) (Min.Anch) Ry
Feet FZ/& Feet
VII. TANK
INFORMATION
CAPACITY
in al Ions
Total
Gallons
ijof
Tanks
Manufacturer's Name
Prefab.
ncret
Site
Con-
Steel
Fiber-
glass
Plastic
Exper.
App
New
isti
Tanks
Tanks
strutted
Septic Tank or HoldingTank
ds0flZ%Vr1E::=E=
F-1
I I
Litt PumpTank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown o ttached plans.
Plum is Name (Print):
Plu 's Signature: ( S ps)
M
Business Phone Number:
�3 rx
�'9S�'
0 4 n
Plumber' Addr@ss (Street Ci to Zip e):� -
IX. COUNTY/DEPARTMENT USE ONLY 77"07-
Approved
F-1 Disapproved
❑Owner Given Initial
San i ry Permit Fee (includes Groundwater
urcharge Fee)
rE u
�/p
Issuing Agent Sig to
AdverseD termin ti n
/
�
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.OM3) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B it permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in #1-7.
VII. Tank information. Fill in the capacity of every new and!or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers, wells: water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
'�gNo»Q>"�cSThQ 1l �ehn B��iC�
See.lc� TAAI Mtj
ffrn4JCk�Vtnl�
01A Fev.ke 1,
Rot m
N�
a9S id,%>
R (t-e f. �rcq
d
ey 63
90.E
89.7
SCd,?e.1,: l/v
�R
3a3 t
$"j 17 jqy
p,ro�e�ea � B�c�rno�
Res.
k i tl r L', h e
Aire Atree
Wiismnsin-ov""nt91Industry, SOIL AND SITE EVALUATION REPORT
Labor ind HuTnan Relations
I)Kilion of Safety 6 Builchngs in nnrnrrf with II u n4_rw_
Page / of 3
----._ ......._.
.- ... nT..
COUNTY
Attach complete site plan on paper not less than 8 112 x 11 i
not limited to horizontal dir
siz PI4►mu t inc t
NCa
11
ST ' Crp1 X
PARCEL I.D. #
vertical and reference point (BM),
dimensioned, north arrow, and location and distance to nea
and jscale o -
ad.
APPLICANT INFORMATION -PLEASE PRINT ALL I
INAXIdN I:i 't
REVIEWED BY DATE
PROPERTY OWNER: _
RTY L --
C .Sohn Brad le
P_
N2MAOT 114 114,S /S T 28 N.R 1 £i * W
PRO RTY N ':S MAILINGAdbRESS
09
LOT a
_
Bt O
—
SUED. NAME OR CSM •
—
CI STATE ZIP CODE PHONE NUMBER
KIVt Falls lJZ 5y02Z (-1)4 -585Lj
_OCITY ❑VILLAGE OWN
_
NEAREST ROAD
I C-TN 3
DQ New Construction Use p( Residential / Number of bedrooms 3 1 1 Addition to existing building
[ ] Replacement 1 ] Public or commercial describe 1 4
Code derived daily flow y S 0 gpd Recommended design loading rate 0.5 bed, gpd/1112_L._!�_trench, gpd/tt2
Absorption area required `f 00 bed, ft2 7,50 trench, I112
Maximum design loa i rate 0 • 5 bed, gpd/fl2 O• � trench, gpolfl2
Recommended infiltration surface elevations) -� Tw%ch.01 , q0. 9 r2 = SQ. b; , g( referred to site plan benchmark)
Additional design / site considerations / 4r- ne_"ea jw. 10 &I
bon ng 1- hon Zoh 3 _
Parent material )V Ar
Flood plain elevation, if applicable N A it
S = Suitable for system
U a Unsuitable for system
CONVENTIONAL
N S ❑ u
MOUND
S❑ u
IN GROUND PRESSURE
S O U
ALGRADE
,®S O U
SYSTEM IN FILL
O S U
HOLDING T NK
❑ S llu
Boring #
Ground
elev.
t1l& h.
Depth to
limiting
n22
Boring #
Ground
elev.
zz n.
Depth lo
kmiting
factor _2
SOIL DESCRIPTION REPORT
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Bancl1ry
Roots
GPD/ft
Bed ,Trerch
0-2-4
to YR 2/1
--
5"
2,FsbK
rn 4t-
as
0.5 :0.1,
2.
2q-142.
10y 3 y
—
s1
3
l
j>. 5 YR Lih
-f'
C5
-
o• y a IF
5
In YX S
Remarks:
.
. ,
yea,
,
Remarks:
CST Na= Pri n -' 1_ I I I S�f►' Phone: O/S) y-2 4, - y9 0 — —
AWress:l l l `l S, 6+a4e- S4. lbd, River RL 1[5 Cb! Syo2z
sgnature. rd�q � � L Date D 8 y CM63?07 �/ 'r tom- - Iz-9
PROPERTYOWNER SOIL DESCRIPTION REPORT PagT�. Of
PARCEL I.D. 8
Boring #
Ground
elev.
qq-^7 it.
Depth to
limiting
factor
Boring #
Ground
elev.
97.5 ft.
Depth to
limiting
fa
ctor
Boring #
Ground
elev,
??. 1 ft.
Depth to
limiting
factor
7 (OV "
Boring #
Ground
elev.
It.
Depth to
limiting
factor
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boi-rdary
Roots
GPD/fte
Bed Tivench
0-1tv
1c) M -,/1
5,1 I
M SbK
(nor
6t5
0-tv
J-19
5 Y R 3j2-
Si
2 m 5bK
mTr
s
0.1,
10 YR 3�q
sbY,
M
0, -'5'- 0,(0
7.5 YK
-G
Remarks:
I'
��
r
Remarks:
MM4
®MS
Mo
mm�.,
M
MIMM
Remarks: —
Remarks:
S8DA330(R 05192)
` PLOT PLAN
Property OWner_A rOnOm1cYS-Inc-
Sohn 13 KaA IP- y
Legal Description_ SLAn�47�f, 41WV1-1,
Leo . JS, 72f AU, 21 Y (� -r wry a-P
K,m l IC W),i c
/I)D 4ttre
Pt+r",le(
97•51
O
44
Wk
Q B+A—100."'
Page_3 of 3
Legend:
sM = ,/, ground 5uf-ace a�
III iron �ye �Ic�ggai
a.l5umed 100•�
❑ = soil boring w/backhoe
Np �LH�2 83 • ID St�bAc1C
problems
pile 1 I'� = 40 �excepE na+ d)
c� Qni411 firers
3Jy acres
93j �°�ra Pew, C*;h14*r
qL�tIr e K Pc It
42.0A
agpoxmodely 1lU rrwt- 4. C-r4 .T
Signed CST k4 tln
A 163707
Date AQ 4jws - u2- 199y
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER )/ iP gA 4d f 1 e S
I
MAILING ADDRESS �(l(/1�I°L IV
PROPERTY ADDRESS j
(location of septic
CITY/STATE
obtain from the Planning Dept.
PROPERTY LOCATION 541�:_ 1/4, " 1/4, Section, T 65;2a N-R�W
TOWN OF 1*0 ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP_, VOLUME PAGE, LOT NUMBER
Improper use and maintenance of 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July I, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE: 0 - ? t/
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016
11 /93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
-------------------- I ---------------------------------------------
Owner of property QAA6Ai GCS _/!! ��/QlTG1 .v/✓�%DC�I�%
Location of��ropert��l/4JZU 1/4, Section l`� ,T ;�VN��-R AF W
Township ���'1`%,Cr�1?/��� Mailingaddress :?GSi'/il /(rUPy
Address of site Za 3 a TT
Subdivision name Lot no. �-
Other homes on property? Yes No
Previous owner of property :74/�t {
Total size of property — 0
Total size of parcel /rie) rY
Date parcel was created
Are all corners and lot lines identifiable? k Yes No
Is this property being developedfor (spec house) ? Yes XNo
Volume O ! and Page Number /56 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in t e ffice of the County Register of
Deeds as Document No. �g�/ and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
th 9o(f�� of the County Register of Deeds as Document No.
Aa. T,uf
$Jignature oflYApplicant Co -Applicant
B-t7- 9y
Date of Signature
DAtP of glrtnatiiro