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018-1067-60-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Hawkins, Jeffre & Ericka Hammond, Town of :ST BM Elev: Insp. BM Elev: BM Description: / oD ~ 1®ri ~'m z. GS TANK INFORMATION TYPE MANUFACTURER ,~ , CAPACITY Septic Dosing ~r ~ / C~ ( JCJ G,• ~ ~ ~ ~ a ~ Holding TANK SETBACK INFORMATION TANK TO ~ P! WELL BLDG. Vent to Air Intake ROAD Septic ~w , ~j~, ~ /v' 3~ i ~~ Dosing ~~ ~ f i~r`' 3(~~ ~ ~ .._. Aeration Holding PUMP/SIPHON INFORMATION f~ ~/ Manufacturer // //~~ ~ Demand j C.7o cJ` ors GPM / Model Number ^~ ~' - ~„ TDH Lift ~ 3`} Friction L3sZ System Hea TDB ~~ Ft i f Forcemain Length Dia. ~ ~ Dist. to well 9 // S Z ~ /~/ SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CroiX Sanitary Permit No: 515243 0 State Plan ID ~:~ Parcel Tax No: Q ~~ Section/Town/Range/Map No: 30.29.17. STATION BS 3 HI ~6 .9 FS ELEV. /zsa. ~~ Benchmark 3.8Z /a~ S 1 ~ on . ~5 Alt. BM l Go.h.~,, ~1. 77 ~ ~ Bldg. Sewer ~3. ~ ~~ 3 SUHt Inlet 53 g9 • ~4 SUHt Outlet ~ ~ Dt Inlet ~_ -~ Dt Bottom ~g 3 ~S ~ ~ Header/Man. z •9 `f /a/-b5 Dist. Pipe Bot. System Final Grade l` 4, / `t /ot.o5 St Cover ,1~.w C~ ~j 7-~ CJ ~ Z h.~~u +~ L 5• ~ ~ C ~~ .J BED/TRENCH Width / Length / No. Of nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /Q 7 5 ~e _- ~ SETBACK SYSTEM TO P/L BLDG WELL LAKElSTREAM LEACHING Manufacturer: ~ INFORMATION CHAMBER OR Type Of stem: Zy ~~ ~~ ~~ UNIT Model Number: ~ O ~/ h.. DISTRIBUTION SYSTEM E.~es(^- Header/Manifol~d7 ~ ~~ G • ~0/ ~. ~ Distribution ! / ~ i Pipe(s) `]~3. Ji~ ~. ~ .3 33 x Hole Size ~~~0 x Hole Spacing ~ / /f~ Ve,~to Air Intake / / ~~~a Length Dia Length Dia Spacing ~ SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ i 1 `7 ` Bed/Trench Edges Topsoil I ~-~' es ~ No es ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /~//]/ ~6 Inspection #2: / / Location: 1520 70th Ave Roberts, WI 54023 (SW 1/4 SW 1/4 30 T2/9N R17W) NA Lot 1 Gl~ i StJG Pao..., Parcel No: 30.29.17. 1.) Alt BM Description = ~ G Z C.~J~-OO ~~dl 1//ow a~C 2.) Bldg sewer length = 3 J v~.f ( S c•few S - amount of cover = / i ,, n (,~ ~, ~a 1,... 7 a ,~• a.~'C~ Plan revision Required? ~ Yes No ~ a Use other side for additional information. ~~ ~ _ __ SBD-6710 (R.3/97) Date Insepctor's ignatur 4i a--. ~ y_ s Cert. No. Cafnt»el'Ce.w.gaV Safety and Buildings Division County ~, G ~Z 201 W. Washington Ave., P.O o 1 f ,Q /'t/a'~ n ~ / /~ Madison, WI 5 7-2~~ D Sanitary Permit Number (to be filled in by Co.) Depar~tm/enVt aaf C^omtnearces ~ '~ ~ Z ~ 3 Sanitary Permit Application state Transact`°° Number submission of this form to the appropriate governmental Wis. Adm. Code (n accordance with s. Comm. 83.21(2) , , unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (i different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for second u oses in accordance with the Privac Law, s. 15.04 1)(m , Slats. /5~ L A lication Information -Please Print All Information Property Owner's Name Parcel e ~ f w ' G i~. lv Property Owner's Mailing Address Propert Location ~ ~ ST. CROIX COUN' ~ttpgp~L t City, tat Zip Codep Phone y,, --~ ~/., Section }~ih 1, r ~ V t` vl! (y D ~ 6 / ~~ O { $ ~ C) ! 1 (circle one Eo 1~ T~~N; R~ II. ype of Building (check all that apply) ~ Lot # _ ~! or 2 Family DweNing - Number of Bed; Dome Subdivision Name_ ~,~.t~ ~Jty~,~ ~~w/L stock # ^ Public/Commercial -Describe Use / ^'~^ ^ City of ^ State Owned -Describe Use ~ CSM Number ~ ~ `~j ^ Village of /~ 'own of ~: ~'itl~i 11~ 11 rJ,Q k O ~ ~/ j III. Type of Permit: (Check only one box online A. Complete line B if applicable) A. ~Alew System .~~---.. ^ Replacement System ^ Treatment/Holdin Tank Re lacement Onl g p Y ^ Other Modification to Existin S stem ex lain g Y ( P ) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and d Before Expiration Owner IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ~ Mound > 24 in. ofsuitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) /! V. Dis ersal/CreatmentAraa Information: Design Flow (gpd) Design Soil Application Rate(g t) Dispersal Area Required (s L J, ~ Dispersal Area Propos (sf) 2' System Elevation r j ? .~ d X5 VI. Tank Info Capacity in Total # of Manufacturer ~ Gallons Gallons Units ~ ~ ,~, U New Tanks Existing Tanks ! ~ ~ ~5 ~ c V ~ ~ ~ H ~ rn °~ ~ 'w' C7 `~ a h/ /d a. Septic ar Hglding Tank p, _~~l=i_~ Dosing Chamber ~ ! VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum er's Signature MP/M~PtL9 Number Business Phone Number ~C ~ ~ Z Z ~ 7is' z ~ i~SL Plumbe s Address (Street, City, State, Zip Code) '~L t~o~2-~ tv j D ~ VIII. Count /De artment Use Onl ~, pproved ^ D' Permit Fe e Date I sued Issuing A Signature ^ O er en Reason tQeenial t $ ~ ~ 7 00 ~ ~} /6 IX. Condi ' easons for Disapproval ~ t'~~ ~ Go.~,~ ; ~-: o..s , .. k. ra~ ~.e r are. 1. Septic tank, et'tluent fitter and t dispersal calf must al! tee servtces /maintained / as per management plan provided by plumber. 3. All setback requifements must. be maintained "~ r" '"r'rYlF~L"11'Fo'2614FtSfelNlff51SS'tbl°Phe system and submit to the County only on paper not less than s to x I 1 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 _c North property line ~' 0 ~. a N Jeff & Ericka Hawkins Nfi780 County Road E River Fatis, WI 54022 SW 1/4, SW 1/4, S 30, T 29 N, R 17 W Hammond Township St. Croix County BM = 100.0' top of 1/2" pvc pipe BM2 = 100.69' top of 1 /2" pvc pipe Weiser 1000/650 tank Scale 1" = 40' 2" force main 0 Z 4"pvc Weli ° B1 0 3 bedroom E garage house B3 0 4'' o s', O~ 98.0' 99.0' B2 ,,-~' Bi~~ 100.0' ,, South property line 70th Avenue page 8 of 8 _~ E a w c f'~ ~. O fl. North property line Jeff & Ericka Hawkins N8780 County Road E River Falls, WI 54022 SW 1 /4, SW 1 /4, S 30, T 29 N, R 17 W Hammond Township St. Croix County BM = 100.0' top of 112" pvc pipe BM2 = 100.69' top of 112" pvc pipe Weiser 1000/650 tank Scale 1" = 40' 0 z 2" force main 0 a Driveway 4"pvc Well ° B1 0 3 bedroom Garage house m _c ~' ~. a ea w B3 0 ~ ~ s~o '~, 98.0' BA~~ 100A' `i South property line 70th Avenue 8of8 commerce.wi.gov i ^ ~scansin Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 Contact Through Relay www. Comm a rce. wi. gov/s b/ www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary Apri120, 2010 CUST ID No. 226497 ROGER D NELSON NELSON PLUMBING 122 E SUMMIT AVE ELLSWORTH WI 54011 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/20/2012 Identification Numbers SITE: Transaction ID No. 1784321 Jeff & Ericka Hawkins -Dwelling Site ID No. 755812 70TH Avenue Town of Hammond, 54015 Please refer to both identification numbers, St Croix County above, in all corres ondence with the a enc . SW1/4, SW1/4, S30, T29N, R17W, Lot: 1 FOR: Description: Mound Object Type: POWTS Component Manual Regulated Object ID No.: 1262585 Maintenance required; 450 GPD Flow rate; 29 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.01/O1); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This- ystem into be constructed and' located inaccordance with the enclosed' approved plans and with the'component manual(s) referenced above. ~ ~ The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code ~ ~~ requirements. ~• ~?ar~ e ~•`" , ~`` No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, gt ;; ; scats. t1i'Yl5 - i i A copy of the approved plans, specifications and this letter shall be on-site during construction and open to ---• -- inspection by authorized representatives of the Department, which may include local inspectors. All permits ~ k._ required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. ROGER D NELSON Sinc re , ~ ~! Peter E Pagel Private Sewage Pla eviewer ,Integrated Services (608)266-2889 , M - F, 0600 - 1430 Hrs pete.pagel @wisconsin. gov Page 2 4/20/2010 Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 WiSMART coder 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce.wi.gov/SB/SB-BuildinaContractorProgram.html Note: Effective March 29, 2010, we are consolidating our Shawano full-service office with our Green Bay office. Please address all plans, correspondence, mail, etc. related to previous Shawano services, for delivery after that date, to: Division of Safety & Buildings, 2331 San Luis Place, Green Bay, WI 54304. If calling moved Shawano staff after that date, call (920)492-5601. .-- x... ~• ~- ~-, .. ~ a,.~ .,_ . _ ~''~~ ~ (~ ~~I~ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIQ~N Residential Application INDEX AND TITLE P/-t3E Project Name: Jeff 8 Ericica Hawkins OHmer's Name: Jeff ~ Eridca Hawkins Owrter"s A~lress: N6780 Cty. Rd. E River Fails, WI Legal Description: SW 1/4, SW 1/4, S 30, T 2g N, R 17 W Township: Hammond County: St. Croix Subdivision Name: tot Number. 1 ~ Block Number. Parcel l.D. Number. 01&1067-+60-000 Plan Transaction No.: Page 1 Index and bile Page 2 Data entry Page 3 Mound drawings • ~ r Page 4 Lateral and dose tank " ~ • ~ ~. Page 5 System maintenance speafic~tions `y~v~'~'~~~~~~~~~ Rage 6 Management and contingency plan ,, ~~~ ~ ,~ Page 7 Pump airve and sP~~s ~ ~ " ""~` Page $ Pbt Plan ~,' r ' _ .~; ''~LJ ~~fw~, Designer: Roger Nelson License Number: MP 228497 Date: 04/08/10 Phone Number. 715-273-4444 Signature: ~ ~/~~ Designed Pursuant to the Component t<Aanuai for POV1ffs version 2.0 sDS-1o~1-P tN. o1ro1), and both SSWMP Put~tion g.6 Deaf of Prossure Distributlon Networks for ST-SAS (01/81) and Prossuro Dim Component Manua! Ver. 2.0 SBD-10706-P (N. 01!01) Version 5.1 (R. 06/08) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet (R or C) __ R Residential or Commercial Design b.00 Estimated Wastewater Fkwv (gpd) 1.60 Peaking Factor (e.g. 1.5 =150%) X0.00 Design Fk~rv (gpd) 4.00 Site Slope (96) 16.00 Contour Line Ewation (R) 8.00 Depot to Umidng Factor {in) 0.60 in~itu Soii Application Rate (gP~) Dbtributlon Ceti irttotntatbn 45.00 Disperse{ Cell Length Along Conbottr (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpolil~) 1 Influent Wastewatier Quality (1 or 2) Pntrssun Diaihutlan Information (C or E) E Center or Ertl Manifdci 3.33 Lateral Spacing (ft) 3 Number of Laterals 0.166 orifroa Diameter (in) 3.26 Estimated Oririae Spacing (ft) 2.00 Foroemain Diairneter (in) 160.00 Foraemain LengtFt (ft) 86.00 Pump Tank Elevation (ft} ~% ~5v ~~, .~- 4.5 ~' stem Head (ft) x 1.3 .08 1 lift (ft) t~~ 1.72 Friction Loss (ft) !n-Ikte Filter Loss (ft) Tote! Dynamic Head (ft) taiteral Darmtt.r seNctiom in, die. choice 0.75 1.00 x x 1.25 x 1.50 x 2.00 x 3.00 x Trsu#ntent Tiwnk tntornation 1000.00 optic Tank Capacity (gal) Wieser ~ Manufacturer Dose Tsnk Mbmntlon 650.00 Dose Tank Capactity (gal) 17.E Oose Tank Volume (gaUin) Wieser Manufacturer Note: Sand ~ (D) ddculatbrai sgwns s Table 83-~14-3 in-situ soA tr~abrisnt t~ fecal ooiiform ar <: 36 inches. 10.00 Cell Width (ft) Are the laterals the highest ' t in the disMbution Y network? Enter Y or N If N above, enfier the elevation ft of the highest point. 10.71 (t2/orifice Does the forcemain drain back? ~Y~ Enter Y or N 24.47 Forcemain Drainback (ga!) 26.64 5x Void Volume (gal) 51.11 Minimum Dose Volume (gal} 22.82 System Demand {gpm) MsnMold Dianaar ssiecelan in. dia. tions choice 1.25. x x 9.50 x 2.00 3.00 t3aNondlnctrCak~istor (optional) Total Tank Capacity (gal) Total Working Liquid Depth (in) gaUin (enter r+~uft in tx•Il 849) Effitwrtt Filbeir NNormition Po Loc FHDer Manufacturer 525 Filter Model Number Project: Jeff 8 Erldca Hawkins Page 2 of 8 Mound Plan and Cross Section Views i- 1_ .1! o Pee .® K, ~ ~ . . =~ . , ...~:.:.:..:..r.. •.•.•.• B ::~ :~ L. L - -- Mound Component Dimensions A 10. B 45.00 h D 7.im in E 11.80 in F 9.00 in G 0.50 h 450.00 (h~j Dispersal CeN Ate 10.00 (gpdfft} Ling Loading Rage Fin' Grade l 95 (h,~-~- Dis 1 E s.d ~7'""~ H ~¢.re/ (h) Labored Im~et't .. -:.; (h) Contour Elevatlon Geotextile Fabric Cover 8hsdMg Kell Topsoil Cap ••••' Subsoil Cap .. ASTM C33 Sand ., ~ 1.5 h ~ 0.5 ft r H 1. h z 7. J 4.91 h K 7.60 h L 60.20 h W 22.52 h 792.81 (h~) 8e~sal Area Available 4.50 (h)1/10 B Obs. Pipe Placement ~ ~I See lateral detaik at Pegs 4 tOr ntxt~ber, sine, and sparing ~ . Laterals are equaNy spaced tram the distrtbution celPs certter~Nne in the dxaion ceN (Ax8). y _; _I -j Pn~ject: Jeff ~ Fricke Hawkins Page 3 of 8 Mound Cross Ssctlon View Aggregate Dispersal Area End Connection Lateral Layout Diagram t:'.e(lelf ehe IatMals OVef P AM taea+ais are fderetioai •.~ Turn-u p v~f bs l l wlw or of aui~ ouR pl u p k- x --> ~ t+a+fs dnwe on eh• bottom of ehe lac.ral eo~ispaeea LatataFS !~ ioroa main of R+VC Soh •O ~ (pet COIIMiA TabM B{.3Q-6j $ __. ~.___-_-..___ __. _ .r Force makr ootineotlon vla tee or Dross to manifold at aryl poMt. Number of Laterals Lateral Length (P) , Lateral Spacing (S) Lateral Flow Rate System Few Rate Total Dynamic Head Orifice Diameter in Orifice Sparting (X) ft Orifices per Lateret ft O~ Density gpm Manifold Length gpm Manifold Diameter ft Forcetnain Ve~dty Dose Tank IMon~nation EkcMad as pat' NEC 300 and ---- .......,.~ Canm 16.28 WP-C ~ Tank oompoltsttt is praperiy trentsd Wiser Manufacturer 650.00 GaNOns Volume 17.00 ga~irtch Dimension ittc~tes Gallons A 21.28 360.89 B a.o0 3a.oo C 3.01 51.11 D 12.00 204.00 Total 38.24 850.00 A B C D troddnp oovsr with vMarrlitg label and dsvks slid sand want 4 in. mart. E--- IlMsrttabe ou1Nt lotion Fottxma~t diantebr ~t 2 in. Weep tats a attli- siphon dsttios P~eisvstion 87.00 4Does-taM` °4vati°" 88.00 Aim Manuaaacturer S. J. Electro S~st~xn s ~~ Alarm Mode{ Number __ 101 HIN T- Pump Manufacturer ,__ Goulds Pump Model Ntmtber PE 41 Pump Must DeNver 22.82 gpm at 15.36 ft TDH Proje~: Jeff & Etidca Hawkins Page 4 of 8 Senrice Provider's Name (~- ~_ Neon Plumbir~ Prone 715-273~4A44 POWTS Regu~tor's Name (- St. Croix Zonir~ Phone 715-386-4680 Design Flow -Peak 450 gpd Maximum Influent Pattic~e Sias 1/8 in Estimated lbw -Average 300 gpd Maxknum 8OD5 720 mgll. Septic Tanis Capacity 1000 gal Maximum TSS 150 mglL Soli Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of W Domesllc Maximum Focal Colibmn >10E4 cfu/100 mL Septic and Pur Ef+flue Pump and Pressure 1. Observation pipes are sk>t6ed and matsrieds conbrm m Table Comm 84.30-1, have a wa~tight cam, and are setxrred in as shown in the mound component manual. 2. Dispersal ceN ~ conforms m Comm 84.30 (6xi), Wis. Adm. Coda. 3. Ali gravity and pnrssuro piping materials conform to the n3quinementa in Comm 84, Wia. Adm. Code. 4. Til~ge of the tai area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas wNi be seeded and mulched tQ prevent soil erosion and help reduce frost penetration. i.aberal Turn-up Detail Finished • ............. ~. ............... Grime ;,~~...;............,.. 6-8" Diameter Lawn ~.p Threaded t+IeanOUt Sprinkler Valve t3ox Plug or BaN Valve D~tribution Lateral "~i- Lon9 Sweep 90 or Two 45 Degroe Bends Same Diameter as l.aaerai Project Je1F & Fricke Hawkins Page 5 of 8 Mound System Mana~nt Plan Putsuutt iDo Comm 83.54. Wh. Adm. Cade The system shall be opsnMed M aooarda~oe wMh Gomm 82.84. Code, and shatl maiMabed in acoordanoe with its' t~r~aarratt malmuata (SBq-10881-P (N.01/01), SSWAAP PuMicatlon 8.8 (p1181), and Preeeunt Oxon Component Menwi Ver. 2.0 SBD 1pP06-P (N. 01/01)) and loco or eta rules psrtainkip to sysam miNNenanae and nq~nbnana ~epbrtinp. No arcs should suer enter a septic a pump tank since dmgerow a~ may be prsterR 11ad could cane death. Ssptlc and pump tank sbandonmsM shah bs in acoordenoe wNh Comm 83.33. Wk. Adm. Cods when the tanks aro no bnger wed as POYVT8 . Septic or parmp tsnk manhole rises, aarxrse risers end covers should ba inspected for water end sarrraJrrese. Access openk+gs used for service and aessssrr~urt shaA be ssaNd watsrti~t upon the oompietion vt suvios. Any opening deemed unsound, defedtw, or subject to hero must be replaced. Exposed access openings aroaler then 8-incMs in dlarrister shah bs seamed by an she bddrp dsvbs to prevent aocfdenW or ~rtalwtlrorized entry ~ a tarn or oorrgronsnt. The septic tank shah be meMtaMSd by ar- Nidividuel oertiRed to ssrvbs septic tanks under s. 281.18, 8tals. The oorNerrts of the septlc tank shah be disposed of in aooordares with NR 115, Wls. Adm. Code. The operatMg aonditlorr of Mre sep8c tack aid outlet HMer aheM be assessed at teal onus every 3 yeare bf- irapeotfon. The outlet fAtat shatl bs deuced ae nsoeaery to ensue proper opsrNion. The filter caRridge should not bs rerrwved unless provisbra are made to retell sotlds ~ the tank dull may sough olf the filler when removed from its endoeun. M the itl6er is equif~pad wtlh an alarm, tlwr tilEsr shall be servkxid M the amrm is a+5lvabd contlnuowly. IrtlSrmitlsM t altams may indica6s surge lbws or an br~endfrq oorsiraroue elem. The septic tuck shsN tans ib eoordents renwved when the vokens of skrdip and scum in the fork eoaxeds 113 the Nquh! volume d the tarn. M the contents of the tank are eat rernowd at the time of a trisnr~ asesanrerK, main~nenos pereonraN shall edvMs the owner a when the nerd service needs to bs perfonnsd to mairMain lees then maximum scum and skates aoanwietlon in the tern. Tee sQ~ion of tNobaical ar dwtmlait addKMes to enhenos aeptlc tarNc ~ ie asneraly not required. ttoareMer, N sue, products are wed tl»y shell a epprowd for eeptlc taNc we by the ospartrramt of Conararnos. TM pump (dosing) tuck ahMl bs intpscNd at Isest once every 3 years. AM swNdars, alums, and pumps shah bs Msled to verty proper opsretlon. M an stnua+t fNler is instaNed within the folk k shah be inspected and serviced as nsat+wary. No trees ar shrubs should be piarrted on the mound. may bs made aroar+d the mound's psrirnelsG and the mound chap be s~sdsd and mukr?rsd ae necessary to prevent erosion and to provide some protectbn from frost parstratbn. TraMlc (atha thur for veaetativa maintenance) on the mound is not reoamnotrdsd since soN oompaabn may hinder seralbn of the MMKratlw surface wMhin tM motard and snow corrrpactlon h the winter wW promote frost punAretlarr. Cokt weather oral (October-februsry) dice lhst the mound be h~ mulched as pralersion from MetMp. in8wrd quaNty irdo the matmd system may not a~a~sed 220 myl. t;fODb,150 rrgll. TSS, and 30 mall FOO for ssptlc tank Ntkuait or 30 mgA. t3Ot3a, 30 mpll. TS8,10mall FOG. and 104 du1100 mL for hiatily bested e1lNrent. MArrerrt lbw may not erooeed rraddnNan desbr- Clow spsd(ied in the pemrit for ~ won. The pressure disbibutlon system is pr+avided with a tkretrirrg point at the end of each Fateral, end tt is reoorrarrsnded that esd+ islsnil be thrsirsd of aoarr»uJaled solids at least once every 18 mwths. When a prossuro tact is performed tl shook! bs oompsrod to the iniWt tea when lire system was ira~lled to dslurt~ne M orNloe doppMrp has ocxrurred and M orilbe desrdrp is requNsd to makrtairr equal ~sMbrdfon witltin tM diepereal osN. Obesrvatlon pipes wNhin tho dispereal csN shsN be drscked for sAkrsM pondhp. Porrditra levels shY be roparlsd to the owner, and any Mush attow 6 Nrctres oonsktsrsd w an irnpsndMra lyrdestdc taNuns requiri~ sdditlonsl, more fie4uent rnonMorNra. ttIILP.IiR M the septic tank or any of ks oomponsMs become defediw the tank or oornporwnt shah bs ropairod or tspleoed m keep the system in grope' operadrtg oorrdtliarr. M the doshq tank, pump, pump corrtrWs, aprrm or misted wlrkg beoanres defscWa the defectlre carrrparrsrrt(s) siraN be kranediatNy repaired or replaced with a component of the same or agwd psrfomt.nos. M the mound cortrpar+urt taNs to accept ~stsweter or buns m disdtsrae vgwtewgrier to the arourxl surhoe, it wiN be repaired or -epleoed in its' present iocatbn by irraweirg tasty ass M toe Iesksps occurs or by rarrovirp biobataaMy doaped abearption and dispersal medb~, end reprOpd piping. and replschrg said componsr>!s as deemed neoessuy to bring tM system info proper operatkrg oondltlorr. See baps 5 of this pbn for the rains and tsleptwM number of your bcal POVilTB reau4ror and service provider. Ptt~mti~lr'W~ Ths krtorrnatlon and srtlrsduie d menanapenrsrrt and rtatMrlerrenoe br prMbeafnfsM devbes such ee aerobic Usalrtrarrt uMle or dhori roe attedred as eeperats doaurturb and we cortsiderod pat o-tlre ovendf magigement pferr for tlrie aysterrr. ~ s a>t e -~_ ~GOULDS PUMPS Submersible Effluent Pump PE AIKICl1TlONS dlSlQnld ~Of tll! •• Maund tiil5. nfl Symms • ~~~ METERS FEET i do r _~,~,: • Temperature: ~ 04~ Napq maximun-, aontinuou~ when ~~u~lh~-ysubm~eyr~ged.'L ~ 7VI~W ~II{1N~. 'i~ 1TId)~Ip1r11 • AulonuRic rrrodek include a float swlRh. • MtlBNil mOdeli a~labll. • Pu1np11g tangs: see performance chaR or a,ne. P£31.f'ump: • Maidmum capadhe..50 GPNI • Mmdmurn head: 25' TDH '~ apedty: ti0 GPM • Ma,anwm headr 29' 1DH PESt Punk • MsKimum capsdty: 70 GPM ` Ms~rinMan head: 37' 1DM MOTOR • • 60 ~ • 115 vons • BuNEin the+mal aerbW pro- 1~~~ • Cia$ 8 aue~tlon. 311a4~. PE31 Motor. • .33 fiP, 3000 RPM (~~ x641 Motor. • 00 HP, 3000 RPM • 7.5 Maximun amps • ~ PESt Motor; • SO ttP, 3100 RPM ~. .~ .r..a. ,~. _. :.. .1..:..."... .1.. i- .. ,...'t_ r..t._ .t..N.. _ ..*.. MQO[L k PE31. re41, 35 ~...;...... +w .a~ ~ . x.50 t0 ... ... ~...r..a..?... .............. ~ .......:.. ..t... ... ... .:...t.. r .:.:..~, ~ } ;.....~.. ' • y ..p.. .f _ ~ . i.. . .µ.y_ S .. _.... .. .. _ . .. . , ..?..t. d r ~.a H . -; { . .. ..~ . T... }} Y-~ ~ ...~. ~_.. ..Y... ._ .. ~.......~ " a-2.G2 » rs a ioo: coutw wm ~ G f7~ caw-unr li+raaN. rre~+a.-, .oes,a, . carosian rrsistart ~. ^ case iron body. • Thennoplasb'c unpeNer and • Upper sleeve and bw-er Mary duty b.il bearing onr~strucNan. (# Meta IS pelrllilllfMly IubriwEed for eaterlt~d servlCe Ids, ~ Pgvwered br wntirxx+us ope~atian. ^ AN ratings are wNhin Lhe . eht motor. P'~r n"~°eavy a~tys w~, NEMA 5.15P, three prong, 11 S volt grountprig plug. ^ ~ duty, t# Med~erncal seal is carbon. BIMA and stains yy ~steei. tf S ~ . A~NGY .. S~• C US Tiped b to 774 and CSA 222108 Slnrtdud~ t+101Adr /rlllpi klSOti001 ala11e1ed pQ9~~~o~~ Goulds Primps ITT Industries i~~i~~~~w~~iiuq~ 914288 .- -- ::: _._ . ..SIAtEBAl2.OF~~~`1~N,~O,ttM.i-2p0¢ . Darumcm Nwnber WARRAI~ITY DEED I7EfIS D1~D, math between lames H and Dolores A Hawkir~, hnsbffita and wife, Grantor, aad Te>~ey 7 and Fricke A Nawk3ns, husband and wife, C.rrarn~ee Grantor; for a Yaiuable tidtxati~, cmnv6ys ttr Grantee ~ following desctRred real estate in St Croix County, State of WistsonsLt (the `•rtY"): Part of the 36ir % of Ills 3 W % of Section 30. I ownship 24 Nt~tft, Range I? West, Iawn of Hammond, St Croix County, Wisc~sn deserebed as L.ot 1 ofCeataBedSruveyMap? Itoltrme 24, Page 5b86, recorded March 2, 2010 as :.Document N4. 9I2553. BETH PABSr REGISTER OF DEEDS _._ ST. CROI~_Cp,f:RT RECEiUED FOR RECORD ~- 04/O6/2010 03:40pM i ~~RR~rr DEED fXEl~i t B REC FEE: 11.00 COPY FEE: 2,00 PkGES: 1 ~~ Ttatne aad Requn Address: Ttde Ono Prtnaka Group, Inc 706 i4th Street South I~Iudson, WI 3$Otfi Iogatlter with all appwteatant tights, titim ~d inttuesCg Part of t)I8.1f167-b0-000 ideffii5cetion Number C~ - Grantm warrants that the title to the Ios i no homesteadproperty Roa tY ~ goad, indefeasible in f~ simple and flee and cleft of encumbrances excel dways, East'aretrts and Restrictions of record Dated this ~~~' dgy of ,~ _,_, ZOIO ' es . Hawlans-,~~~-~ ~,~,. ---_~_ _ Signatut~e(s) autltertticated Ibis AUTHENIiCATIOPi TITLE: MHMBSR STATE BAR Oi+ WISCONSIN (lfhot, atrthorized by § 7t?6 tiG, Wis Stars ) Irt1SINSIRUAg+NI WA3DRAFrgy$Y Micltaol H. For+ecld, Attorn "-"~- (Signahteesmay 6c auWant[cated or ae¬rledsed Bath am amt °Y) 'Names ofperaoa~ s~ i~t ~3' caPmeitY must he typed erred hefow their signahxa ems` ~•1~~.~ ACKNdWLEUGMEIVI SIAIEOF WISCONSIN } COUNTY ) ~ Personally came before me this 3tiSk ~Y of Do ores A H 2____._SL_ the above named James H and awkins, husband. and wife to me known to be the person(s) who executed the foregoing insiaum~ent aad acknowledged the ~ _ Notary Pub ' ,State of WLsco '~ My co scion is p; ~ ~ state expiration date: WARRAIYIY rlt:BD SIAiIs BAtt DF wrSCONSnv . ~ ~ 'Jv<t ~~ G N~," . `OUB~~ rre r-aooo ertifiec~ purvey ~Ilap James H~ and_Delores A. Hawkins Part of the Soufhwest f of the Southwest % of Section 30, Township 29 North, Range 77 West, Town of Hammond, St. Croix County, Wisconsin. -r~~~~~~~~~i.-'. ~'~fll~5~~lt~IIINI~IIIII~IIIN ~1~~5~ BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03J02/2010 10:30AM CERTIFIED SURVEY MAP UOL: 24 PAGE: x686 REC FEE; 13.00 COPY FEE:. 3.00 PAGES: 2. , UNPLATTED LAlN~S N 89°p8'11 "E 274.83' 4 Lot ~ ~~ ~~ JI 8 2.2't78 Acres or 96,190 S+q. Ff 8, ~~ 0 ~ 2.OOb Ames or 87, 720 sq. Ff. o ~ a ~ Excludfng Road R.O.W. ~ ~ ~ ~ F ~ ~ d a> g ~~ ~~ ~ 4 ~~ N;89°09'ii"~ 274.83' 912. p4' ~ _ . - __. ~~ Sc~~!`hwest ~Qr. dec. 30, rz~N, R 17 w, (@ernfsen Naft Founa-j ~_ a __. 274.83' ~ L..~_,,~p TgTH AVE. t ne svv r4 ~ ~,%~ -- S 88°09'11"VY 2700.84' -"'" S©utl! ~ COI: Sec,.. 30, UIYPLATTED LANDS r2g nr, R 17 w, (P.IC IYsIf Fot~rtd} w E {7wner's Addr~SS: 15$2 '4n' ,4vc~. Rvber~s, Vt~l 54023 ~~ Description: That certain parce/ of land located in the Southwest % of the Southwest % of Section 30, 'Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin, more fully described as follows; Commencing at the South % corner of said Section 30 thence S 89 °09'11 "W (assumed bearing on tfie South flee of the Southwest f of said Section 30) a distance of X513.67' to the POINT OF BEGINNING, of the parcel to be herein described; thence continue S 89°Q9'11"W 274.83' fhence N 00°50'49"V~/3b0:00; thence N 89°09'11 "E 274.83; thence S QO°50'49"E 350.00; to the POINT OF BEGINNING, containing 2.208 acres or 96,190 square. feet, being subject to easement over the Southerly 33.40' thereof for town road purposes and also being subject to easements of record.' State of Wisconsin) County of Pierr.~e) 1, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by diction of the Owners, James H. and Delores A. Hawkins, l have surveyed and divided the lands shown hereon in accordance with official'records, Chapter 236.34 ofthe Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a t-ue and correct representation ther~*of. Gene/ Notice Statement: Note: Each parcel shown on this map is sub, ject to State, County and Township laws, mules and regulations (l.e. weflands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County ~oning`Oflfce aril the Town of Hammond. Dated.• November 23, 2009 STATE QF WISCUNSIN) ST. CRQIX COUNTY) SS 1, Laurie Noble, being the duly elected, qualified and acting treasurer of the county of St. Croix do hereby certify that the r+acords in my oifi show no unrede reed tax sales and no unpaid taxes or specie! assessments as of~~C.(r~ o_ ( 2p l ~ affecting the lands included in this Certified Survey Map. ~ Date Treasurer APPROVED err, c~eoix caiarY rya s ~«~xt MAR ~? 2 2010.. tt not recorded w-khir~ 30 daYo ~~ ~ ~ apprtWfd sna-I be n~i and vale SI~fLT 1 OF 2 Vol. 24 Rage 5:686 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ ~~ ~ ~,f"r c~u ~/~~ ~ Mailing Address ~p~i' ~ ~ .- ~~~~ L JCCV~ ~Ll ~,,,~ s'Yd z ~ [5~,a Property Address J~,~,~-'n~ ~~©~ v :~ f~~~ Gr/~ ~"" Q z (Verifica ' n required from Planning & Zoning Department for new constructi n.) City/State ~ ~~ h~~ Parcel Identification Number ©~ ~= f Q ~`7 ~ 6 (~ - Q ~ ~ LEGAL DESCRIPTION Property Location ~ W 1/4 , ~'/4 ,Sec. ~, T ~N R~W, Town of `~~MMp ND Subdivision -' ___ ,Lot # ~. Certified Survey Map # ~ ~ 2~ ~ ~ ,Volume ,Page # Warranty Deed # ~ ~ ~Z ~ ~ ,Volume ,Page # Spec house yes Lot lines identifiable ~ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter ]2 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ~~~ SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 17 Gt' ~ b Q 827 ~q 16 eu 1S Qpl~ 0 i 'R 823 e~ ~2 ~! ! 21 SE-NE X077 i esea ate 78di32 SW NE 3848 i 76THA ~ E $E-pJyy - ose -NW 15 ~ ~~ I ' Ni/N1 822 81aA j M LD RES ~ zz °~ I 12 1 ate I 808 14 em atae i azt " Q°' ~ m es6 3956 BOB F 3'Gtt 1 011 n JP a17A 0 ~~ ~ yd ~ I 3 Q$ i a10 I 8778 i 6 E 3v 7 S ~r NE-SE i et3 ate ets b32 4 5 9 e a95n i att ate ate NE NW-SE I -SW 4e5 I 9zvut i I 26 ~ .l 433 I ' 31 3 29 ~ ~ 27 ~ 34 33 ~ 838 837 e3e t>95 a34 ~ eaz eet eao I aa.a i Is L ~' eaz6 I A9~' I i ~y~. ~ SE - SE 3ggA,pS I 2 e i SW-SE SE-SW SW - 3W eea I 4a2D 48?Jl 483 92SMt ~~ vat I 0 SM 18-431 I ~~ ~aA-10 I I I I 1At7 ~ 4898 i I 473a ~°.An. m1 NE-NE I NE-NW NW-NE NW - NW 40BA 558 I 473A e72A a6Y872 I 884'813 984813 I I i 124&387 I 1 2 3 4 5 I 927 i y2p s29 930 93i tn'r3 HIGHLAND H 1 7M~ g A SE-NE ss9B 559A I H A NUE 11 10 6 SW - NE ..a SW - NW 83g o 982 SE-NW 470 i ip72 937 175 ~ 8891892 i 740.-20 47gq-q0 ~ 98Bat3 Croix County 2004 Orthoph Source: St 6" pixel resolution. ography ~ ,m„ 12 9 . , , 934 7 om ~ ~ na-t -.... R 963 . ~- ; - - - - - 5`' ~ ~ I ~ ~"` cnlL EVALUATION REPORT Wisconsin Department of Commerce ' Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information, .Reviewed Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner - Property Location 2198 Page 1 of 3 A.C.E. Soil 8 Site Evaluations St. Croix 2 018-1067-60-000 ~ ~G 'Lf~ i I ~~~~ Jim Hawkins (Jeff & Ericka Haw 'ns) i~ Govt. Lot SW 1!4 SW 1/4 S 30 T 29 N R 17 W Property Owner's Mailing Address ~~ Lot # Block # Subd. Name or CSM# ~ ~ 1 1552 70th Ave. ~,a 1 Proposed CSM (dn City State ip Co a Phone Number yf City ~ Village yr Town Nearest Road Roberts ~ WI 5402 •C -~~QE Hammond 70Th Ave. frf New Construction Use: y_j Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement ub'c o commercial -Describe: Qrt~'rt~ ~ f l ~ 1~ P l l4jtl ~ ' ~~ e , aren m as a G - _ Flood plain elevation, if applicable Na General comments ~J ~~"~-"~ PC Z Sv- 5 . and recommendations: Site suitable for mound system requiring 7" of ASTM C-33 sand fill placed on 9 .50' conto ur. Linear loading rate not to exceed 6.0 gal./day. Boring # J Boring 29" L/f Pit Ground Surface elev. 99.50 ft. in. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fgr mvfr as 2vf,f 0.6 0.8 2 10-20 7.5yr4/4 none sicl 2msbk mfr cs 2vf,f 0.4 0.6 3 20-29 7.5yr4/6 none sl 2msbk mvfr aw 1 of 0.6 1.0 4 29-36 10yr6/4 f2f 7.5yr5/8 `_ fs„__ Osg ml gw - 0.5 1.0 5 36-49 10yr7/4 m1d 7.5yr5/8 SSBR r Om ml - - 0.0 0.0 H#4 is weathered in place sand stone residuim. 5 determined to be sand stone bedrock by resistance to knife penetration. Boring # J Boring Pit Ground Surface elev. 99.75 ft. 29" in. Soil A nation Rate ~ Depth to limiting factor ppl' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlitz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fgr mvfr as 2vf,f 0.6 0.8 2 10-21 10yr4/4 none sil 2fsbk mvfr cs 2vf,f 0.6 0.8 3 21-29 10yr4/4 none sl 1 msbk mvfr aw 1 of 0.4 .7 4 29-44 7.5yr4/6 f2f 7.5yr5/8 Ifs Osg ml - - 0.5 1.0 * Effluent #1 = BODS> 30 < 220 mg/L a d TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/Land TSS < 30 mg/L CST Name (Please Print) Signa re: CST Number ~" a Address A.C.E, Soil & Site Evaluation Date Evaluation Conducted Telephone Number .. 12/1 /2009 Property Owner Jim Hawkins (Jeff & Ericka Parcel ID # 018-1067-60-000 Page 2 of 3 Boring # -~ Boring /J Pit Ground Surface elev. 98.39 ft. Depth to limiting factor 29" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/2 none sil 2fgr mvfr as 2vf,f 0.6 0.8 2 12-23 10yr4l4 none sii 2fsbk mvfr cs 2vf,f 0.6 0.8 3 23-29 10yr4/6 none sl 2msbk mvfr aw 1 of 0.6 1.0 4 29-42 10yr4/6 f2d 7.5yr5/8 Is Osg ml - - 0.7 1.6 ^ Boring # -~ Boring ~ Pit Ground Surface elev. fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P 1 ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # -~ Boring ~ Pit Ground Surface elev. fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 30 mg/Land TSS < 30 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 (R.0~/00) A.C.E. 5011 & Site EvalUationS ~~ ~ • E"x~s ~~ ~~~ elegy' ~ ~-c c~ ~w~a~. S~ I u Ov L3~Ye.~s: J"e{•~'~` E~'~ cXC ~ c,~7,(%hs Lai ~ aF~ro~ose-c/C5n( /ac4.feQ'i° 5 w y~ S~,v/~y Se,e, 30 ~,29/t., ~~ Tu1. 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