HomeMy WebLinkAbout032-2149-30-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TC,1 PERMIT) 453209 0
GENERAL INFORMATION 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:
Grand Properties L.P. I Somerset Township 032- 2149 -30 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
02.31.19.1299
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. beqgr
Holding SUH I
TANK SETBACK INFORMATION t ttlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inle
Septic Dt B om
Dosing He er /Man.
Aeration Di . Pipe
Holding Bot.
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Deman St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to 71
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSI S No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM \ HING Manufacturer:
INFORMATION Type Of System: OR
IT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distributi x Hole Size x Ho Spacing Vent to Air Intake
Pipe(s)
Length Dia 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 Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 2336 61st St Unknown (NW 1/4 SW 1/4 2 T31N R19W) Grandview Estates Lot 3 Parcel No: 02.31.19.1299
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Use other ls q
lan de foruadditional Yes No - - -� - -
information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
N visconsin Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7082 Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.)
.Department of Commerce (608) 261 -6546 Zd
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address (if different than mailing address)
I. Application Information - Please Print All Information • 2 330 i S{ S� •
Property Owners Name I
Parcel # Lot N 1 3 Block q
i 2004
—
Property Owner's Mailing Address 1
i
Property Location
11 Sill L_ tON WG OFFI(,E
City, State J1r w '/4, S0 '14, Section & I-_
Zip Code Phone Number
SY�� �� /dv ce o
T N; R _j irclE o
II. Type of Building (check all that apply) p„d 5
0 1 or 2 Family Dwelling - Number of BFdroprnk 3 e ubdivision Name CSM Number
❑ Public/Commercial - Describe Use 1t 'y2 ) �(/Q /�� t�s ALt
❑ State Owned - Describe Use 2 I i o ( []City ❑Villa e
g lllll'l'ownship of S_0&L�LSE
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) O -000
A. �y
Ilr New System ❑ 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 appl
19 Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersanreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispe Area Proposed (sf) c Elevation
LSD C
6 -5-3 9G 7
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site tcel Fiber Plastic
Gallons Gallons of Units W 7 Q _ p�� Concrete Constructed Glass
New Existing
Tanks Tanks "C'l ITS
Septic or Holding Tank j '
Aerobic Treatment Unit
Dosing Chamber
i
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plu e s Signature PRS N Business Phone Number
LvA G - ,5 - Y,9 - to
Plumber's Address (Street, City, State, Zip Code)
VIII. Coun /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu' g Agent Signatur (No Stamps)
Surcharge Fee) 2� `
❑ Owner Given Reason for Denial
IX. Conditions of ApprovaVReasons for Disapproval
SYSTEM OWNER:
1 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 the County only) for the system on paper not less than gl/Z x 11 lathes to size
SBD -6398 (R. 08/02)
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1051
Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt
Attach complete site plan on paper not less ' x 11 County
tingh e. Plan must St. Croix
include, but not limited to: vertical and 11 ret�r9nsh pQ ), ion and
percent slope, scale or dimemsions, a and location a� to nearest road. Parcel I.D.
Please ❑ in
R �• \, 0 3 Z -
7 1,49_ 30 I 9 4
iewed By Date
Personal information you provide sed for purposes (Pri xy l @N? s`�5.04 (1) (m)).
Property Owner ,� roperty Location
M & G Inc Govt. Lot na NW 1/4 SW 1/4 S 2 T 31 N R 19 W
Property Owner's Mailing Address 5 _, alN���Gti Lot # Block # Subd. Name or CSM#
1359 Awatukee Trail o / 3 na Grandview Estates
City State i� one Number' _j City _j Village 16 Town Nearest Road
Hudson WI 1 5 � 554 71 Somerset Cty.Rd.I
16 New Construction Use: 01 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash Flood plain elevation, if applicable na
General comments
and recommendations: Suitable for a conventional system with a 0.7gpd /sqft rating. Possible system elevation for Area I, step
trenches, (high trench) 96.07 (low trench) 95.11. Based on a 8% slope.
a Boring # I Boring
16 Pit Ground Surface elev. 100.90 ft. Depth to limiting factor >101 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
1 0 -8 1Oyr3/3 none sil 2mgr mfr cs 1f .5 .8
2 8 -19 1Oyr4/4 none scl 2msbk mfr dw 1f .4 .6
3 19 -34 1Oyr4/4 none sl 2msbk mfr gw - - - -- .5 .9
4 34 -42 1Oyr4/6 none cos Osg ml cs - - - - -- .7 1.6
5 42 -101 1Oyr5/4 none ms Osg ml - - -- - - - - -- .7 1.2
� 96•a�/
s� � 93•g6
Boring # I Boring
0 Pit Ground Surface elev. 100.90 ft. Depth to limiting factor >120 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
1 0 -6 1Oyr3/4 none sicl 2fsbk mfr cs 1f .4 .6
2 6 -15 1Oyr4/4 none scl 2fsbk mfr gw 1f .4 .6
3 15 -38 7.5yr4/4 none sl 2msbk mfr gw - - - -- .5
4 38-42 1Oyr4/4 none sl 2msbk mfr cs - - - - -- .5 . ,9
5 48 -120 1Oyr5/4 none ms Osg ml - - -- - - - -- .7 1.2
" Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD 130 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
586 Valley View Trail, Somerset, WI 54025 5/21/01 715 -549 -6651
I
Property Owner M & G Inc Parcel ID # Page 2 of 3
F ]Boring # Boring
Pit Ground Surface elev. 98.08 ft. Depth to limiting factor > 102 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -12 10yr3/3 none I 2mgr mfr cs 1f .5 .8
2 12 -34 10yr3/4 none scl 2fsbk mfr gw 1f .4 .6
3 34 -46 10yr4/4 none sl 2msbk mfr cw - - - -- .5 .9
4 46 -72 10yr5/4 none cos Osg ml es - - - - -- .7 1.6
5 72 -102 10yr5/6 none 1 ms Osg ml - - -- - - - - -- .7 1.2
• S"S
5� o
F-1 Boring # I 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 GPDtft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F-1 Boring # I Boring
I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
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 s 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
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of Z '
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner - f Septic Tank Capacity 1000 gal ❑ NA
Permit # Se tic Tank Manufacturer ❑ NA
O p E S
Z 9
DESIGN PARAMETERS Effluent Filter Manufacturer 2-4134-1- O NA
Number of Bedrooms 3 O NA Effluent Filter Model A -oo ❑ NA
Number of Public Facility Units 0 NA Pump Tank Capacity a l M NA
Estimated flow (average) 0 p gal/day Pump Tank Manufacturer ® NA
Design flow (peak), (Estimated x 1.5) d gal/day Pump Manufacturer 4 NA
Soil Application Rate gal/day/ft'. Pump Model ® NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A NA
Fats, Oil & Grease (FOG) S30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L O NA O Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA
Biochemical Oxygen Demand (BOD S30 mg /L ■ In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L O NA ❑ At -Grade ❑ Mound
l
Fecal Coliform (geometric mean) S10` cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: Oh NA
Other: O NA Other: ❑ NA
'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA i
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: O month(s) (Maximum 3 years) ❑ NA
3 ®
year(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA i
Inspect dispersal cell(s) At least once every: 3 0 mon h (s) (Maximum 3 years) ❑ NA
3
Clean effluent filter At least once every: ■ month(s) ❑ NA
❑ year(s)
O month(s) 0 NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
❑ month(s)
Flush laterals and pressure test At least once every: ❑ year(s) Ii) NA
Other, ❑ month(s) lj NA
At least once every: ❑ year(s)
Other:
16 NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or 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 r
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 3
contents of the tank shall be removed by a Septage Servicing Operator. 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. i
event.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service
L
Page
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.
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, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer 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 wastewater 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 vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; 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 chapter Comm 83.33, Wisconsin Administrative Code:
• 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 area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not 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 and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
• The site has not been evaluated to identify a suitable 'replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
• 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 comply with the rules in effect at that time.
« WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Nam e Name —
/V —
Phone _ �^ _ Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name _ — Name —
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer e AAf/� D L1 S - --
Mailing Address 71 I? . o 27
Property Address 2,33 { 5+
(Verification required from Planning Department for new construction)
�^ 0 - 0
City/State r 1!74!Ff1S, i ./� Parcel Identification Number � 1
Z
LEGAL DESCRIPTION
Property Location _&YA ' /�, 2 %,, Sec. 2 TAN -R_4'? W, Town of 2,, � SET
Subdivision G2Ane CS % Tf =s
Lot # 3
4
Certified Survey Map # , Volume -, Page #
Warranty Deed 4 70 , Volume Page # l a2 7
Spec house ® yes ❑ no Lot lines identifiable N yes ❑ no
SYSTEM IYiAINTENANCE
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 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
mastcrplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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.
I/we, 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&ystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
dawoTthe three veapexpiratil n date.
t"/PLI 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 ,pmpe describe.0 above, by virtue of a warranty deed recorded in Register of Deeds Office.
(CANT DATE
* * * * : . information that is mis representcd 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 the certified survey map if reference is made in the warranty deed
VOL i640PAGE 627
STATE BAR OF WISCONSIN FORM Ea45709 2 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Harold J. Schachtner and Margar J. RECEIVED FOR RECORD
S chachtner, husb and and wife, 05- 16-2001 10:00 AN
WARRANTY DEED
EXEMPT N
Grantor, and Grand Properties, LP, — _ _ CERT COPY FEE:
COPY FEE:
_ TRANSFER FEE: 825.00
- — — RECORDING FEE: 10.00
PAGES: 1
Grantee.
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
W 1/2 of SW 1/4 of Section 2 -31 -19 EXCEPT Lots 1, 2, 3 and 4 of Certified Name and Return Add ss
Survey Map filed November 6, 1985, in Volume 6, Page 1607, and
EXCEPT E1/2 ofNEI /4 of SW1 /4 of SW I/4, and EXCEPT EI/2 of SE1 /4 V
of N W 1/4 of SW 1/4 thereof. ? ��� ` L� OW
VSCCu'�A, W SMvily
Pt 032-1005-20- 100 & 032 - 1 -30 -500 _
Parcel Identification Number (PIN)
This is not homestead property.
04) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
r
Dated this day of May 2001
* • Haro J. Scha to
• • Marge t J, Sch tne
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Harold J. Schachtner and Margaret J. Schachtner, STATE OF WISCONSIN )
husband and wife, ) ss.
County )
authenticated this day of May 2001
Personally came before me this day of
`tip the above named
s Krist Ogland - --
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, _ instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY • _ _ _ -
Atto Kristina Ogland Notary Public, State of Wisconsin -
Hudson WI 5401 - My Commission 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. Informallon Profesaionale company. Fond du Lac. N
WARRANTY DEED STATE BAR OF WISCONSIN
900 - 655.2021
FORM No. 2 - 1999
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QUARTER ALL IN SECTION 2, TOWNSHIP 31 NORTH, RANGE 19 WEST, TOWN OF SOMERSET, ST CR0IX COUNTY, WISCONSIN.
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