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HomeMy WebLinkAbout032-2135-30-000 w' Department of convnerce PRIVATE SEWAGE SYSTEM Count Swety and Buildings Division St. 6 INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita Permit No.: Personal information you provice may be used for seowdary purposes (Privacy Law s.1 5.04 (1)(m)). 384282 Permit Holder Name: ❑ City ❑ Villa Town of: State Plan ID No.: R ndeau, Casey Somerset Township CST SM Elev.: Insp. BM Elev.: 8 Descripti n: Parcel Tax No.: 0 4 C_ 032 - 2135 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic l2, Benchmark a 5-p O� Dosln A t. BM 0 5� Aeras-;? tion Bldg. Sewer Q ( & S Holding t /Ht Inlet 0� TANK SETBACK INFORMATION / Ht Outlet , TANKTO P/L WELL BLDG. Airi to ntake ROAD Air I Septic' ' p NA A Header/Man. A on NA Dist. Pipe O Holding Bot. System L 1 zrt , PUMP/ SIPHON INFORMATION Final Grade M urer -- - -_ mand t Cover 2 �� Model Number G TDH Lift Friction tem TDH F LOSS Forcemain Length Dia. owell SOIL ABSORPTION SYSTEM BED / TRENCH Wi , length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS DIMENSION Manu adu er: SETBACK SYSTEM TO P / L BLDG WELL LAKE/ STREAM LE!P►C ! ,. INFORMATION Type , HAMBE Moe um ec System: � 36 `� S` DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s)_ x Hole Size x Holes pacing Vent To Air Intake Length 7 r Dia. % / length 1��y 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 C] Yes Q No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present JoUllection #1: /j / 3 /0 / Inspection #2: / Location: 677 207th Avenue, Somerset, WI 54025 (SE 1/4 NE 1/4 23 T31 N R1 9W) - 2331191199 Whitetail Trails -Lot 20 Y -1u� Wcl/ of 3C'w 1.) Alt BM Description = r of 2.) Bldg sewer length = Z 3 - amount of cover = '` 3.) 0� � an aa, re f`rv- apes . No � l r � 'Plv sl fir Ir '_] Yc ✓ Use other side for additional infor awn. / Cert No 1 SBO - 6710 (R.3/97) Oat Inspectors Stature k. i 0 ���i r • r o Sanitary Permit Application Safety & Buildings Division AN E . 201 W. Washington Ave. In accord with Comm 83.21, Wis. Adm. Code ® ®S�r ®���n See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(ru - --�. (Submit completed form to county if not I 1 state owned.) Attach complete plans (to the county copy only) for th stem, on of less than 8 -1/2 x 11 inches in size. County V r D l� Stattee SS 'tary �it Number ❑ C `i r£visio to Ievious applicatipn State Plan I. D. Number L Applic Information - Please Print a ll Information rD Location: Property Owner Name I CD I r� Property Location - 2 G/ C?u °� tiI� c , v .. 1/4 /4, ,N, R Property Owner's Mailing Address j c� G f Lot Number Block Number City, S to Zip Code Ph n _ Subdivision Name or CSM Number II. Type of Building: (check one) as w ❑City 1 or 2 Family Dwelling -No. of Bedrooms :- �Qw�s • /�) *own llage ❑ Public /Commercial (describe use):_ _ of ❑ State -Owned moo (3b) r Nearest Road / Parcel Tax Number(s) . 31. . #17 III. Type of Permit: (C heck only one box on line A. Check box on line B if a pplicable) a "aZ l s — - - 00 O A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Okf on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ' P ressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6.,{stem Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) J� '" J =',� Elevation zo'a s-0j�q 5 O / a Z /� , q) �- VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (print) Plumber' nature (no stamps MP/MPRS No. Business Phone Number Plumb s Address (Street, City, StaTe, Zip Code 10-07 '000�� IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued sw g Agent Signa re (No stamps) Approved ❑ Owner Given Initial Adverse Surch a Fee) Q9 , Determination 22s; 7 S X. Conditions of Approval /Reasons for Disapproval: r� SBD -6398 (R. 07/00) PLOT PLAN O PROJECT �� ✓�' ty �1 C�� ADDRESS �✓� K/ �X O/7h Gh 6 �G 4 ��/� �. ✓� ��� 1/4 1 /4S /T N/R W TOWN .�, „� i�OUNTY rC MFRS Byron Bird Jr 220527 DATE BEDROOM CONVENTIONAL XXX 4 6-Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE /aE © LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE 2ABSORPTION AREA — <10# of chambers 3 � ,BENCHMARK V.R.P. ASSUME ELEVATION 100'�f ❑ BOREHOLE O WE / LL v *H.R.P, Vent SYSTEM ELEVATION V 7, a � -,Z.= �7 O f Sidewinder High of Capacity Leaching ©• °� f� Cov Chamber with 17.2 6" t ^2 per chamber " 1 6e Long 34" Elevation d 1 �J y . PROJECT �Cl L t/`Q u� SS y✓� K/ �XOI7�Glt e / %�G�J 3Oi� `�P ✓ r'1 14 1 /4S a:%o OWN OUNTY MPRS Byron Bird Jr. 220527 DATE BEDROOM _ CONVENTIONAL XXX t - Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE 2ABSORPTION AREA ZO# of chambers 3 BENCHMARK V.R.P. ® � ASSUME ELEVATION 100 ❑ BOREHOLE (DWELL +H.R,P, { Vent >12" S SYSTEM ELEVATION I °f', a � -q ._ Sidewinder High Of f Capacity Leaching of Cov C ©• °� Chamber with 17.2 6„ t ^2 per chamber Long 34„ Elevation nv t 0 l �r 1 f� 1 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 'abor,�nd Human Relations . Divisidn of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix n paper no 8 1/2 x 11 inches in size. Plan must include Attach complete site plan o p p t less than , but not limited to vertical and horizontal reference point ( rLL�L ' ctiprt n f slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance t. = }! pending APPLICANT INFORMATION PLEASE PRI NF RATION:;, IEWED BY E PROPERTY OWNER: ° PRPP TY LOCATION Forest Oaks Condos, Inc. �!� GOVT Lb SE 1/4 NE 1i4,S 23 T 31 ,N,R 19 50or) W PROPERTY OWNERS MAILING ADDRESS L0 - # - BLOCK # SUBD. NAME OR CSM # 11160 190th. Ave. N.W. _'A na Whitetail Trails CITY, STATE ZIP CODE NE NIA; 1T ❑VILLAGE J]TOWN NEAREST ROAD Elk River, MN. 55330 2) <'441- $.. Somerset 207th. Ave * ] New Construction Use [x] Residential / Number orw Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 96.60 ft (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code 3/50' below grade Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U ®S ❑ U ®S ❑ U (� S ❑ U ® S El U 1:1 S CRU SOIL DESCRIPTION REPORT ��1 lam -� } Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -9 10yr3 /3 none sl 2m r mvfr cfw if .5 1.6 S' 2 9 4 7.5 r4/6 none ms Os g mvfr na na .7 .8 Y . - 1-- Ground elev. 1 Depth to limiting facto ` �/ `17 -Z Remarks: Boring # , 1 0 -15 10yr4 /3 none sl 2mgr mvfr gw if .5 .6 2 2 15 -90 7.5yr4/6 none ms Osg mvfr na na .7 .8 Ground elev. 1 Depth to limiting factor Z +90 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200 New Richmo d WI 54017 Signature: Date: 4 -20 -2000 CST Number: m02298 - 1 PROPERTY OWNER Forest Oaks Condos SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # pending « I D Dominant Color Mottle Structure GPD /ft Depth Dom a es Boring # Horizon Texture Consistence Bounck3y Roots in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -12 10yr4 /3 none sl 2mgr mvfr gw if .5 .6 S 2 12 -84 7.5yr4/6 none ms Osg mvfr na na .7 .8 .� Ground elev. 9 8.7 ft. Depth to limiting factor 20 • `f S6 . – w l ( t Z� Uv� � 4" Remarks: Boring # 1 0 -9 10yr4 /3 none sl 2mgr mvfr gw 2f .5 .6 S 4<`< 2 9 -84 7.5yr4/6 none ms Osg mvfr na na .7 8 Ground elev. 96.9 ft. — Depth to -- limiting factor «« Remarks: Boring # 1 0 -6 10yr4 /3 none sl 2mgr mvfr gw 2f .5 .6 .f 5 > 2 6 -15 10yr4 /4 none is Osg mvfr gw if .7 .8 3 15 -84 7.5yr4/6 none ms Osg mvfr na na .7 .8 Ground elev. 9 6.8 ft. Depth to limiting factor +8 4" Remarks: Boring # Ground elev. i ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Forest Oaks Condos, Inc. 1554 200th Ave. CSTM2298 SE S23- T31N -R19W New Richmond, WI 54017 MPRSW -3254 town of Somerset (715) 246 -6200 lot #20- Whitetail Trails / 1 " =40 ✓ ' = �� 1 . - of 1 vc p el. 100.00 p p p p Alt. BM.= top of 1 pipe C el. 95.30' ?) V Z 3h � 1"I�f J 2 lo 61 b 33 I Gary L. Steel 4 -20 -2000 POWTS OWNER'S MANUAL a MANAGEMENT PLAN Page of — FILE INFORMATION SYSTEM SPECIFICATIONS Owner �,� 8/-I �� Septic Tank Capacity p ga l ❑ NA Permit # Septic Tank Manufacturer e_ 6 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 4 ❑ NA Number of Bedrooms ❑ NA, Effluent Filter.Model ❑ NA i Number of Commercial Units 13 NA Pump Tank Capacity gal ❑ NA {, Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ❑ NA Soil Application Rate - c'� a gal /day /ftz Pump Model ❑ NA 1 * Influent/Effluent Quality Monthly average Pretreatment Unit ❑ NA Fats, Oi18t Grease (FOG) s30 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter ❑Mechanical Aeration ❑Wetland Biochemical Oxygen Demand (BODs) s220 mg/L Total Suspended Solids (TSS) s ❑ Disinfection ❑Other: 150 mg/L Manufacturer Pretreated Effluent Quality E3 NA Monthly average" Man Dispersal Cell(s) j Biochemical Oxygen Demand (BODs) s30 mg/L 94p-ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L '❑ At -grade ❑ Mound Fecal Coliform (geometric mean) s10 cfu /100m1 ❑ Drip -line ❑ Other. Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ear(s) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume ! a Inspect dispersal cell(s) At least once every ❑ months ar(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ear(s) ; Inspect pump, pump controls u4arm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ 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 of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate nodflcadon of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one -third (A) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less 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. START UP AND For new construction prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals concentrations are detected have the contents treatment p rocess and /or damage that may impede the p � the dispersal cell(s). if high Page of 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; 6tton 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. ABANDONEMENT 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 ch. 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 falls 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 66m 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 Infiitrative 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 IMMICctRIT. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Q eCc ti Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency _ ev �.� < <v �0 de� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P #t(r'4'a Mailing Addre4s Acnj � C t cS� Property Address 677 , 5cl S YU (Verification required from Planning Department for new construction) City /State Parcel Identification Number �O�"o���� `�� ` ax °O LE GAL DESCRIPTION Property Location C� ' / / Sec., T—jzN -RW, Town of Subdivision .�9 �%<z / � k� ,Lot # Certified Survey Map # , Volume , Page # Warranty Deed # `� a ? , Volume / 6 , page # 23 Spec house ❑ yes 9 no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE 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 master plumber, 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 r septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 Adayso three ear expiration date. l E OF APPLICANT DATE OWNER CERTIFICATION I (w ify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro scrib b e, by virtue of a warranty deed recorded in Register of Deeds Office. IGNA DAT OF APPLICANT 1G E * * * * ** 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 I Yt' t662PAGE 431 10 STATE BAR OF WISCONSIN FORM 2. 1999 648627 Document Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS This Deed, made between Forest Oak Condo Inc. ST. CROIX Co., WI _-- _ - - - -- _ — - - - - -. _.— RECEIVED FOR RECORD - -- _ __ - -- - -- 06 -18 -2001 3:05 PM Grantor, and Cas L. Rondeau , a sin l WARRANTY DEED EXEMPT II - - - -- — — - - -- _. -_. -- CERT COPY FEE: - -- - -- — ----- - - - - -- COPY FEE: _ __ —_ —_ - -- - - - -- —_ TRANSFER FEE: 125.70 Grantee. - -- — _ - — - — — - - -- -- RECORDING FEE: 10.00 Grantor, for a valuable consideration, conveys to Grantee the PAGES. I following described real estate in St. Croix _ State of Wisconsin (if more space is needed, please attach addendum)• Lot 20, Whitetail Trails, Town of Somerset, St. Croix County, Wisconsin. Recording Area DAVID J. ESTREEN 304 LOCUST ST. w 4 HUDSON, WI 54016 0 32 - 2135 -30 -00(1 Parcel Identification Number (PIN) This - is not - -- _— homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. 0K1 (is not) Dated this _day of _June 4Gerold ks Condos, c. �f - - -.. -- - -- Simi resident AU THENTICATION ACKNOWLEDGMENT Signature(s) Forest Oaks Condos, Inc., by Gerald J. Smith, STATE OF WISCONSIN ) President, -- - -- .— —. —. -- -- ) ss. authenticated this v -- — - - -- - -- - -- County ) d , - -_ I fx y of June 2001 - Personally came before me this day of t /tL—� — - -- . Kristina Ogland — _._ - -- the above named - -- - -- — — ------ - - - - -- _.� _ TITLE: MEMBER STATE BAR OF WISCONSIN — (If not, to me known to be the person(s) who Y� executed the foregoing authorized b 706.06, Wis. Slats.) - instrument and acknowledged the same. _ THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hud WI 54016 — - - - - - -- Notary Public, State of Wisconsin -- (Signatures may be authenticated or acknowledged. Both are not necessary My Commission is permanent. (If not, state expiration date: .) 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