HomeMy WebLinkAbout032-2160-00-000 Wisconsin Department of Commerce
PRIVATE SEWAGE SYSTEM county: St. Croix
Safety and BuildircfJivision ,
INSPECTION REPORT Sanitary Permit No: 463069 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
P.C. Collova Builders, Inc. I Somerset Township 032 - 2160 -00 -000
CST BM Elev: Insp. BM Elev: BM Description: n nn. Section/Town /Range /Map No:
160 166 rJ l G5 c` K �� 12.31.19.1378
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM 106 Z_
Aeration Bldg. Sewer
Z ,Z T$ e
Holding St/Ht Inlet
3:45 T 7,35
TANK SETBACK INFORMATION St/Ht Outlet '�{ �S 7G • 95
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic �j Ft ^ LfZ i 4Z Dt Bottom
Dosing Header /Man.
•7.95 9 3 . 6'5
Aeration Dist. Pipe (o • Y. o5
. - 7-95 9 .65
Holding Bot. System 7.� 3 • /
9.a gZG
r!
PUMP /SIPHON INFORMATION Final Grade Z '�}•7� Y
Manufacturer Demand St Cover
GPM
Model Nu
TDH L Friction Loss System H TDH Ft
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 'Z / - Z- 7Te „`V,&11 L ��
SETBACK SYSTEM TO `G P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
l
e
Gon���. kid 17— L7 �
DISTRIBUTION SYSTEM
Header /Manifold ; Distribut ir Intak
ion x Hole Size x Hole Spacing Vent to Ae
01, 1 L4
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 Mulch
Bed/Trench Center -3 . I Bed/Trench Edges \ Topsoil \ Yes [7] No es E] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 728 224th Ave. Somerset, WI 54025 (NE 1/4 SW 114 12 T31N R18W) Wild Turkey Retreat Lot 10 Parcel No: 12.31.19.1378
1.) Alt BM Description = s"O-”' c_ C. GU, � - `� 0'` *
2. Bldg sewer length= S O V'
- amount of cover = 3 S
P�U
Plan revision Required? Yes L No
Use other side for additional information. _ l6 U J
_Date — � Inse tors natur Cert. No.
SBD -6710 (R.3/97)
% oy
i
a
�Q
FD
Safety and Buil tngs lvlsion County �� C 1
201 W. Washington Ave., P.O. Box 7162 ' � 1
W vsc onsin Madison, WI 53702 - 7162 Sari Permit N (to be filled in by Co.)
N� (608) 266 -3151 3 lNJ 1
pe artment of Commerce
State Plan I.U. Number
Sanitary Permit App ED , //'('�
In accord with Comm 83.21, Wis. Adm. Code person nfo �1Vd proms Address (f di t than matting address)
tray be used for secondary purposes Privacy , al S. ) 4
Application L A Information — Please Print All Information ��� °` ` ./ 7,A-
pP C ��NTY
propertyOwner'sN �DNINGO Paroeltf Loth Btocktf
, , 611, ,,, / / 3
property Owner's Mailing Address rr'o'
City, State Tip Code Phone Number
TR— N:
!P W
II. Type of Banding (check all that apply } Sutxlivi :ion cs
2 Family Dwelling - Number of Bedrooms �,
/ pubtklCommerr ial - Describe Use
i
State owned - Describe Use Gty Yom/
III. Type of permit: (Check only one boz on line A. Complete line B if applicable)
A ystem Replacement System Treatment/Holding Tank Replacement Only Other Modification to B>;isting System
List previous permit Number and Date Issued
B. Permit Renewal Permit Revision Change of Permit Transfer to New
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that appW
C -p =urizod In4jmund Mound _> 24 in of suitable soil Mound < 24 is of suitable soil At -Grade Single Pass Sand Filter
O C Coastm a and Pressurized La-Ground Holding Tank Peat Fitter Aerobic Treatment Unit Recireulatiog Sand Filter
Recirculating S nthetic Media Filter Dri Line Gavel - Pi (CXP )
V. Di tment Area I on: L> (a G p mpo ( System El on
Design Plow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Rapircd (sn
as to Total Number Manufacturer Prefab Site Fiber Plastic
VL Tank Info Gallons Gallons of Units Concrete Constructed Caiass
New Existing
Tanks Tanks
Septic or Holding Tank `
i Aw*icTidtatcotUnit
Dosing C%am6a
VD. Responsibility Sts ent I, the assume bility for installation of the POVM shown on the attaehal
Plu Name (Print) PI s Signatu Number N
��� J r- ,
Plumber's Adders (Street. City, State,
L I Jc
VIII. qgibpEa Use Only u Agent nature )
Sanitary Permit Fee tncltrd�es
App Disapproved Surcharge Fee)
J v' �� D
Owner Given Reason for Denial �p /
nL Conditions of Approval/Reasons for Disapproval „ , fL `0/7 / d
d s S 1 � & /��d'
y ,�
Attach coatpiete plats (to the County only) for the system on papa' not less tban i12 z 11 inches in sine
Soi Test and System PLOT PLAN
PROJECT P.C. C ollova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
E 1/2 SW 1/4S 12 /T 31 N/ 19 W TOWN Somerset COUNTY ST. CROIX
�- �
MPRS Shaun Bird 226900` DATE 10/7/04 BEDROOM 3
CONVENTIONAL XXX IN -GiUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.1/92.0 4 `below grade
Well is to meet all Plans Designed Using
setbacks required by Conventional Powts
WDNR Manual Version 2.0
Vent
>6 » Standard Biodiffuser
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
6' Long 11 "
3 4" Grade at System Elevation
owi i Road
Pro 3 B -2
Bedroom 30 ' 226' Property
House
2 -3' X 69'
35 , Cells with >3
40' spacing
20' B -3
5
10' 12' 8% Slope
Huffcutt ST
10'
Pro e Line B - 10'
Survey iron found, 678' Property Line
lot corner for
adioinine lot
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. d j
Please print all information. Reviewed by k Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
P. e Q t/[D C,, i 1 Govt. Lot E 1, L014 4 2 T 3 I N R E (or
Property er's Mailing Address Lot # I Block # I / ubd. Nam or CSM#
City State Zip Code Phone Number City ❑ Village 2STown Iffearest Road
New Construction Use: esidential / Number of bedrooms Code derived design flow rate 'i�u� GPD
❑ Replacement Pub i or mmerclal - Describe:
Parent material ��,�i, fpm ✓ Flood Plain levation if applicable
General comments
and recommendations: s y� JGGiL/ (] V
Boring # R 7ring ? L Ground surface elev. ft. Depth to limiting factor / in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. , 'Eff#1 - Eff#22
Z -
�
® Ong # ❑ Boring c-1 2, �g7� l
it Ground surface elev..�� Depth t limiting f
ft. epo mng actor /!/C.�. Soil Applicafion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2
/7lZ ��
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Cond t Telephone Number
1008 192nd Ave, New Richmond, WI 54017 O— - -� 715- 246 -4516
Property Owner_ Parcel ID # Page of
Boring # 9 Boring
it Ground surface elev. 0 ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 4*Eff#1 `Eff#2
a Boring # ❑Boring
❑ Soil lication Rate
Pit Ground surface elev. ft. Depth to limiting factor in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
Boring # ❑ Boring
Cl Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/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 mgA_ and TSS 130 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (8.6/00)
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
Madison, - 7162 Sanitary Permit Number (to be filled in by Co.)
�rsconsi►n
Department of Commerce (608 ) z66 6 3151 [/ (a j
Sanitary Permit Appli j(WCEI �E State Plan LD.N
In acrwComm, rd with Com 83.21, Wis. Adm. Code, nal inf tmation on de
Pew Y pm
vide
be used for secondary purposes , 15.04(1 E .l Q l) 4 j 'j Address diffemnt than mailing address)
I. Application Information - Please Print All Info
T. CRuIX GOU�� :
net's N ZO ' Parcel # ,Lot # Block #
Pro is M ' g Address perty Location
s
J L"� 4, Section 13
City, State r
Lip Code Phone Number
,s --4, a � d'
lQ. ype L al ng (check all that ly) T N;
or 2 elling - Number of Subdivisio d ame CSM umber Pub rc/ - Describe Use ► �t�G�r,t,✓
State Owned - Describe Use - Z bl 51 COV L I --egCA City_ Villag
o
. 11L Type Permit: (Check only one boz on line A.Xomplete line Irif applicable)
A- System Reptacenmetht Systenm T t/Ho ng Tank Replacement Only
t odification
B •
us Issued Permit Renewal Permit Revision Change o Permit Transfer to New v
Before Expiration Plumber Owner
I
IV , ffne of POWTS System: (Check all that apply)
Non - P ressurized )n- Grou Mound> 24 in of suitabl/Dip Motmd in. of suitable soil At -Grade Single Pass Sand Filter
Constructed Weiland Pressurized Holding Peat Filter Aerobic Treatment Unit Recirculating Sand Fil
Recirculating Syndx.fic Media Filter .Leaching Line Gra Pipe )
V. Dispersalff reatment Area I ormation: 1() 6 1 ?D. ZZ
Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Rogaircd (af) Di Pro sets S m
J f ; ,
VI. Tank Info Capacity in Total A4umber Manufacturer Prefab Site ted Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Hel&ng Talc
Aerobic Treatment Unit
Dosing awnber
VII. Responsibility Stat t- I, the and - ed, assttrae responsibility for installation of the POWTS n the attached
Plu s Name int) Plu s Signature MP/MPRS Number Business Phone Number
- Z , ✓ZY4 s
Plumber's Address (Street, City, State, Zip )
VIII n / De rtment Use C OW
�rov Disapproved Sanitary Permit Fee (includes Gramdwater Issued Signature (N tamps)
Surcharge Fee)
Owner Gives for 1)etmial � ZS ,
IX. Conditions of App ons for Disapproval
Y M O c `�w�.1
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by nlumht?r_( /fyW12'i a 3
2. c requirements must be maintained
as per appXable code /ordi ?erne
9 4 V 3 _ /
r Attach co-plete plans (to the County only) for the system on paper not less than 81/2 111 inches in sine
M
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,t
�'� .w
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,, . �-
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9
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P 4RESS N
PROJECT P.C. Collova Bldrs. Inc. P.O. Box 489 Somerset Wi 54025
E 1 / 2 SW 1 /4S 12 /T 31 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9 BEDROOM 3
CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
IL BENCHMARK V.R.P. Top of2" pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 97.9/97.5'3' below grade
Alt. BM Top of 2" Pipe @ 100.2'
Well is to meet all Plans Designed Using
setbacks required by Conventional Powts
WDNR Manual Version 2.0
Vent
ALo Standard Biodiffuser
Leaching Chamber
with 31.1 ft2 of Area
1 "
Grade at S ystem Elevation
34"
Pro 3 Bedroom
House
owi i Road
20'
N 226' Property
ST
20'
35' B -3
30 Vents
B -1 70 ' B -2
20' 7%
Slope
150' Alt. B.M.
5' 678' Property Line
I
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
t inspected via the inspections i
3. Once every 3 years, cells are o be spec ed es at the ends of p pipes
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
in cy Plan
Option #1 If system fails, determine cause of failure, use alternate area and install new
s st i tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715- 246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �, �� i 1 rn�Q I.1 i e( - 3
Mailing Address p o q (,� 0
Property Address - 7a
�i� (Verification required from Plamung Department for new construction)
City /State c�C)Li}r U Parcel Identification Number U 3 - a / (o 0 06-46b
LEGAL DESCRIPTION
Property Location '/,, Sec. l . T N - W, Town of
Subdivision L J1 , 1 A Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # _ ��� �¢ -` Volume ��,S , Page .
Spec e [IYyes (] ] no Lot lines identifiable ® yes ❑ no
SYSTEM MAPti TENANCE
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
masterplumber, 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.
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
of the three year expiration date. P. C. COLLOVA BUILDERS, INC.
(715) 247 -2742
P.O. Box 489 /
Ad
SIGNATURE OF APPLICANT SOMERSET, WISCONSIN 54025 DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
operty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
P. C. COLLOVA BUILDERS, INC. q/1
6
iS;ATU E R OF APPLICANT (715) 247 2742 DATE
P.O. Box 489
* * * * ** SOMERSET, WISCONSIN 54025 * * * * #*
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 the certified survey map if reference is made in the warranty deed
Wisconsin DepaPoment of Cormmerce SOIL EVALUATION REPORT Page of
Diwsion of safety and Bcs *vs
in accordance with Comm 85, wft. Adm. code
Aftsch complete site plan on paper not less than 8 W x 11 in 4M. Plan MW
include. but tat limited to: vertical and horiaontal reference po rd (BM}, direction snd owed I.O.
pwcm t slaps. state or dmerrsions. norm avow. and location mddisUmcelonearestroad. o 3 L
ved
please print all information. by owe
peramul intoma*m you provide m" be used for seoondnY PWPOM Owaw law. s. 15.04 (1) (m)). ' I�
PMpwv rLe, � L d� cc .._._.` GoiiC`txft 1 / 4 S 1- T 3 N R E ( W
Property O s Making Address Lot # # 1 ,9ubd.CSKW
X �/ S1
City State Zip Code Phone Number 0 City ❑ visage own Obarest Road
:2 0 / CeLz
I S S`/ —S9 �°
Nsw Construction Use: Residential / Number of bedrooms Code derived design sow rate GPD
oReplacernard Q Pubic qr cwwWdaI - Describe:
Must min In' � rte-'° l �-� Flood Plain elevation d appkcabla /r/J,S� 8
General oorrmertls , S� 5�,�.u... e %p, vrx���GV�✓ f
a Boring o
Pit Ground surface elev�� . R Depth b irrrsirg factor in. SW Appicadon Rate
Hot= Depth Oomirwt Color Redoic Description Texture Structue Consistence Boundary Roots GPQff
ir. btrxrseN Qu. Sz Cont. Color
Gr. Sz Sh. - MI I •EfM2
Z -ao mss/ ---' = �
36 O
e #
0 eo
® ,iii Pit Grorxrd solace elev.�lt Depth to imitin9 facto Rate
Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots DM
In. Murseil Q L Sz. Cont. color Gr. SL Sh. 77 60M
e
• Emuent #1 = BOD > 30 <_ 220 nrgA. and TSS >30 :150 • Estuent #2 = BOD < 30 nV& and TSS <_ 30 mgiL
csr Number
c (ptea§e Pdrr"
Address D Evakumon Conducted Telephone NWww
property Owner
Parcel 10 # Page of
® Swing # ❑ Pft S wing Ground surface elev. Depth to tirttitirtg factor /.� 6 wl Sot Application Rate
Norhm Depth OombaM Color Redox Description Texture Structure Consistence Bouxtdary Roots GPONI
in. Munsd Ou. Sz Cont. Color Gr. Sz. Sh.
�s K' ,
U Bodr+o # ❑ Boring
❑ pit Gtound surface elev. R Depth b WrOg factor in. Applicat Ram Sol
Moibm Depth Donwunt Color Redox Description Texture Structure CAnsistence Boundary Roots GPOW
in. Mined flu. Sz. Cats Color' Gr. Sz. Sh. T&I
I
F—I Boring # ❑ Swing ❑ pit Ground surface elev. 11. Depth to tirr�ktg factor in
Sad Application Rate
Hottzon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPM
In. Munsell Ou. Sz. Carle. Color Gr. SL Sh. - ER#1 'Eftif2
• Effluent #1 = BCC, > 30 220 mgll_ and TSS >30 < 150 mgll - Effl #2 = BOD, 1 30 mg& and TSS <_ 30 mWL
The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
sao43=(RAM)
w '
Soil Test Plot Pla
Project Name P.C. Collova Mrs. Inc Shaun P . O. Box 489 Address
Somerset Wi 54025 M #226900
Lot 1 0 Subdivision Wild Turkey Retreat Date 9/6/02
E 112 S W 1/4S 1 2 T 31 N/13 W Township Somerset
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 2" Pipe
System Elevation 97.9/97.7 *HRPSame as Benchmark
Alt. BM Top of 2" Pipe @ 100.2'
Please Note: Tested area
may not be suitable for
desired building area.
Check system location
before excavating. Also,
survey was not completed
at time of test. Set backs
from lot lines may
change.
0
c
3
0
H
t~
a�
a
N
N
35'= -
102'
30'
101'
7 7% B-2
Slope
150' A NJRRI B.M.
15' 678' Property Line
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1339.17' 609.22' — — —
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