HomeMy WebLinkAbout018-2009-41-000
Wisconsin Apartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
`Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 515296 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:
Cutting Edge Four LLC Hammond, Town of 018-2009-41-000
CST BM Elev: " S Insp. BM Elev: BM Desc 'ption: V /7 Section/Town/Range/Map No:
'j. 52? , 04.29.17.1025
TANK FORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benclmarl
32 aq- dS C/5--
~ J
D ~ Alt. BM 0I
Aeration Bld r -307 2 /
Holding Inlet (~J Q 1'4 d /
TANK SETBACK IN ORMATION SvH et 011 y yd -7-1 Z.
TANK TO L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic
n
4U J / q-- Dt Bottom
-7 i-
Dosi o I ri-sx- Z I !!!!5 Man. ' 1~~ Ar
Aeration a-Lj Dist. Pipe ~,~6 p7 ti y
Holding Bot. System + y0
0
21 1~
Final Grade
P"
PUMP/SIPHON INFORMATION J-
' a 'f , 9
r~ / S
Manufacturer GP and S( Cover u ~ C -S
Model Numbe
TDH Lift F ion oss S m ad TDH Ft _ L~1 l0
Forcemain Length Dist. to Well
SOIL ABS PTION SYSTEM Z 3 a
BEDITRENCH Width Length ' No. Of Trench s PIT DIMENSI No. Of Pits Inside Dia. quid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHIN Manufactur ry.
INFORMATION e AMBER OR
Ty Of System: / UNIT
Model Number:
DI IBUTION SYSTEM -rvA(- S ---n Sa :5 6
Head anif Id Distribution rr Le-- x Hole Size x Hole Sparing ent it Intake
h s) - 1 CAp4
Length Dia Pipe(Length~_ D Spacing a-
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only C
Depth Depth Over xx Depth of xx Seeded/Sodded xx Mulched
B rench CentBed/Trench Edges Topsoil Yes 0 No Fw~ Yes No AA- - ij i
COMMENTS: (Inclu a code discrepencies, persons present, etc.) Inspection #1:1 Inspection #2:
Location: 1162 178th Street Hammond, WI 54015 (SE 1/4 NE 1/4 4 T29N R17W) Hill id Heights Lot 41 Parcel No: 04.29.17.1025
1.) Alt BM Description v~~~J '(TVVI• W&d am, ~~~j~,/~ I
2.) Bldg sewer length = 3 Lj 4 LN
~ S ~c,%h cy O~ r11r2 -W ` 5 _L" tj-
- amount of cover = I 0
J
Plan revision Required? Q~ Yes
Ne'
Use other side for additional information.
Date Ins p is Signature Cert. No.
SBD-6710 (R.3/97) rl / n n / , , 54 / q rC
ll 0 tticJ l~ lam' ' l/ 4,0S - r. IrV Ot
F2~c~
Lo~'C:c~rh~✓
PLOT PLAN
PROJECT Cuttina Edae 4 LLC ADDRESS
SE 1/4 NE 1/4s 4 /T 29 N/R 17 W TOWN Hammo COUNTY ST. CROIX
MPRS Shaun Bird 226900 ATE 0 BEDROOM 3
CONVENTIONAL )00C IN-GROUND PRESSURE ON TIONAL LIF HOLDING TANK
MOUND SEPTIC TANK SIZE 100 gallnos IFT ANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 AB RPTION AREA 00 # of chambers 46
,BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVA ION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as B ch k
Plans Designed Using SY EM EVATION 90.0/40.4 4' below grade
Conventional Powts
Manual Version 2.0
Well is to meet all
Pro 3 setbacks required by
Bedroom ;J Road WDNR
House
B-2
23' Road
56
liv
pe 79,
6%Slo
-L-4 L
2-3'X 94' cells 57'
with >3' spacing" 1 / .;...e
Vent it fUZ
Sysf~ rn.
44' h„ { r %
B-1
1
c~'k B.M.*
A-D 6111
10,
Road
y t' A~~
t
Safety and Buildings Division County
commerce.wi.gov
201 W. Washington Ave., P.O. 1 - il I x
Madison, WI 5370 .1 bV nary Pemut Number (to be filled in by Co.)
isconsin sz9
eparetrraent of Ceanmaroa
State Transaction Number
Sanitary Permit Application mental
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this forin to the appropriate governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS arc Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
Of H-
1. u oses in accordance with the Privac Law, s. 15, I rot rgablon
A tication Information - Please Pri parcel #
property Owner's Name / Z L / ~ I
T , ' 1 I Property Location .
~
Owner's Maili dress ~U 4 1'r
Property
LINTY Govt. Lot
-
9 7
City, State Zip Code NNG0 Section
le on
12?[ - T N; RE W
A-e Ii. Type-of Building (check all-that apply Lot Subdivis' n N -
2 Family Dwelling - Number of Bedro o per, ,p r U~
6k l l~~ B v Gam/
❑ Public/Commercial - Describe Use ❑ City of
CSM Number ❑ Village of
❑ State Owned -Describe Use Town of -
CQ- w Z3*2 &-m-
III. Type o Permit: (Check only Is box on line A. Complete line B if applicable)
❑ Other Modification to Existing System(cxplain)
ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only
List Previous Permit
B. Permit Renewal El Permit Revision Number and Date Issued
1133 Change of Plumber 13 Permit Transfer to New
❑ Owner
Before Expiration
IV. T e of POWTS System/Component/Device: Check all that a 1 _
on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain)❑ Pretreatment Device (explain)
l Di !Area Pro (sf) System Elevation
V. Dig ersal/Treatment Area Information:
Dew Flow (gpd) Desi n So' Appication g pdsf} Dispersal reaRequite
- D t ~ # ~ k ~ d~ f✓
VI. Tank Info Capacity in Total of Manufacturer
Gallons Gallons Units c
New Tanks Existing Tanks d
All Q F'• i r i in v, i.. c~ a
U r
Septic or Holding Tank
Dosing Chamber
VII, Responsibility Statement- udersigned, assom ousibility for installation of the POW17S/~ Nhe attached plans. Business Phone Number
Plumber's Name (Print) Plumber's re
Plumber's Address (S et, City, State, 'p Code)
II. Coun Me artment Use Oul
Permit Fee Date I ued Issuin gent signature
Approved =:I!r. O6 /r
Reason for Denial
IX. Condit' ",sons for Disapproval 3, L J
'~npl ~g P `O~1 •
DJt1d~ f /~C
1. Septic tank; effltiant filter and yH.Q~~. ' tGetiw/~lA. t ^Ica
dispersal cell must all be services / maintained yJ ►as per management plan provided by plumber.
2. A0i0iat ;ftgt#9meft must ,be hair aine~
Attach to complete p as or a system and submit to the County only on paper not leas than 8 M/2 x t 1 inches in size
SBD-6398 (R. 01/07) Valid thru 01/09
PLOT PLAN
'PROJECT Cuttina Edae 4 LLC ADDRESS
SE 1/4 NE 1/4S 4 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/15/10 BEDROOM 3
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 100 gallnos LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 46
BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Plans Designed Using SYSTEM ELEVATION 90.0/90.4 4' below qrade
Conventional Powts
Manual Version 2.0
Well is to meet all
Pro 3 setbacks required by
Bedroom Road WDNR
House
10' B-2
ST 23' Road
10'
56'
6% Slope B-3 79'
2-3' X 94' cells 57'
with >3' spacing
Vents
44'
B-1
75'
B.M.*
10'
Road
P y
- _ 1513
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings Viii cco nce with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc.
County
Attach complete site plan on paper not less than 8'% x 1 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal refe point (BM), direction and -
percent slope, scale or dimensions, no on and distance to nearest road. Parcel I.D. -6(ti
Please print all infonnation. Reviewed By Date - _
Personal information you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)).
Property Owner Property Location
Cutting Edge Four, LLC Govt. Lot n/a SE 19 NE 1/4 S 4 T 29 NR 17 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
E976 170 TH Street 41 n/a Hillside Heights
City State Zip Code Phone Number _j City J Village 1I Town Nearest Road
Hammond WI 54015 715-796-2793 Hammond Cty Rd T
M New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
I Replacement J Public or commercial - Describe:n/a
Parent material Ground and end moraines, pitted glaical drift Flood plain elevation, if applicable n/a
General comments
and recommendations: Conventional system, system elevation 91.65ft. Trenches spaced and depth to code 4.00ft below grade.
'I Boring # I Boring
❑ sm Pit Ground Surface elev. 95.65 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-12 10yr3/1 none sit 2msbk mfr cs 1vf .6 .8
2 12-27 10yr4/4 none sicl 2msbk mfr cs n/a .4 .6
3 27-51 7.5yr4/4 none sl 2msbk mfr gw n/a .6 1.0
4 51-96 10yr6/4 none sins 2msbk mfr n/a n/a 6 1.0
Boring # I Boring
1 Pit Ground Surface elev. 95.65 ft. Depth to limiting factor 100 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-12 10yr3/1 none sil 2msbk mfr cs 1f .6 .8
2 12-25 10yr4/4 none sicl 2msbk mfr cs 1vf .4 .6
3 25-41 10yr4/4 none scl 2msbk mfr gw n/a .4 .6
4 41-100 7.5yr4/4 none sins 2msbk mfr n/a n/a 6 1.0
* Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <.30 mg/L and TSS -s30 mg/L
CST Name (Please Print) S' nature: CST Number
David J. Steel 248956
Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number
994 200th St., Baldwin, WI 54002 9/7/2004 715-6845680
Property Owner Cutting Edge Four, LLC Parcel ID # Pending Page 2 of 3
3 ] F Boring # I Boring
If Pit Ground Surface elev. 93.85 ft. Depth to limiting factor 100 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 10yr3/1 none sil 2msbk mfr cs 1f .6 .8
2 12-25 10yr4/4 none Sid 2msbk mfr gw n/a .4 .6
3 25-100 7.5yr4/4 none sl/Is 2msbk mfr n/a n/a 1.0
it
Boring # J Boring
F-1 Pit Ground Surface elev. ft. Depth to limiting factor 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
❑ Boring # J Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod 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
* Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 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
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
Page 3 of 3
STEEL'S SOIL SERVICE INC.
David J. Steel 994 200`" St.
CST-POWTSM Cutting Edge Four, LLC Baldwin, WI 54002
Lic. #248956 SE1/4,NE1/4,S4,T29N,R17W Bus.(715) 684-5680
Town of Hammond, St. Croix Co. Fax.(715) 684-3449
Hillside Heights, Lot 41
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your
use.
Legend
1" = 40'
♦ =Benchmark Ele. 100.0017t N
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 100. 1517t
03 Top of 3/4" pvc pipe
= Borings
Boring Elevations
B I = 95.65Ft
B2 = 95.65Ft
B3 = 93.85Ft
B4 = OO.OOFt
P-3( .
3,
AD
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715-246-4516
Date: 7/15/10
Owner: Cutting Edge 4 LLC
Location:SE1/4 NE1/4 S4 T29 N,R17W Lot 41 Hillside Heights Hammond
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbti
on system version 2.0
(version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-5. Maintanance and ntingency Plan
6. Filter Specificatio eet
Signature
License n er #226900
PLOT PLAN
PROJECT Cuttina Edae 4 LLC ADDRESS
SE 1/4 NE 1/4S 4 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/15/10 BEDROOM 3
CONVENTIONAL XXXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 100 gallnos LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 46
BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Plans Designed Using SYSTEM ELEVATION 90.0/90.4 4' below qrade
Conventional Powts
Manual Version 2.0
Well is to meet all
Pro 3 setbacks required by
Bedroom Road WDNR
House
10' B-2
ST 23' Road
10'
56'
6% Slope B-3 79'
2-3' X 94' cells 57'
with >3' spacing
Vents
44'
B-1
75'
B.M.*
10'
Road
Cross Section of Quick 4 Standard-W Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard-W Leaching
Chamber with 20.0 ft2 of Area per
Chamber 5.8ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 94.2'
Vent Grade Vent
4' 4" 4'
,Ai30/34 Septic Tank
4' Long 119 5' 4' Long 1
34" Grade at System Elevation 3T' Grade at System Elevation
Spacing 5'
2-3' X 92' Cells
Same on other end Observation tubeNent
9.5'
A
B
23 chambers per cell
System elevations:
A__90.4
B__90.0
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.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
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
ntinge Plan
Option #1. If ystem fails, determine cause of failure, use alternate area and install new
system i ested replacement area.
ion #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
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n \ ° E 433.511' I
41 \0)
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W 23 LCD I
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42 ' \ 1.50 Ac. I 1 1 0 Ac. O 01 cal
N~ \ 1 II i 11 I P~~~~ 1.5 I N
792 S. F.
t, LBO = 1098.0 ~
.56 Ac. \ I 11 nQ n l L°~,?~ 89°39 39 WJ I 1 N
cli 'Y ~ I - O
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1.50 Ac. I LnI
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' 21
SEE SHEET 2
TOWN. BOARD RES 0`LUTIO N:A
.k-
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer L-L~C-
Mailing Address ? 7 o f-l S-/- n~ m4ncx
Property Address 116 17f 13IC6
(Verification required from Planning & Zoning Department for new construction.)
Parcel Identification Number
City/State
i LQAi DESCRIPTION
Property Location -f~-p %4 V4, Sec. T N R~W, Town of
i
Subdivision Lot #
i • -
Certified Survey Map # Volume , Page #
W'arran Deed # ~ Volume 2-,S-7,,. , Page #3<Q 7
{y
no Lot lines identt5able
Spec house
(~R
SYSTEM -MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its promatum failure to handle wastes. Proper
mainfienaace 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 m the waste disposal syst m. Owner maintenance
responsibilities are specified in §Comm. $3.52(1) and in Chapter 12 - 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 frill of sludge.
Uwe, the undersigned have mad tho above requirements and agree to maintain the private sewage disposal system with the
standards set forth, basin, as set by the Department of Commerce and the Department of Natural Resour ce,% Starve of Wisconsin.
Certification stating that your septic system has been maintained mist be completed and retuned to the St Croix County Planning &
Zoning Department within 30 days of the three year eViration date.
Uwe cartify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
properly described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedr v
SIGNATURE'OF APPLICANT(S) DATE
***Any information that is miarepmesemled 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
refcreance is made in the warranty deed.
(REV. 08/05)
_ U 2 5 7 6 P 3 9 7 763197
EEDS
WALSH
STATE BAR OF WISCONSIN FORM 1 - 1998 REGISTEER R H. OF D
DEEDS
WARRANTY DEED REGIST
ST. CROIX CO.. WI
RECEIVED FOR RECORD
Document Number
This Deed, made between John J. Dalton and Carolyn G. Dalton. 05/20/2004 09:30A?1
husband and wife, Grantor, and Cutting Edge Four, LLC. , Grantee. WARRANTY DEED
Grantor, for a valuable consideration conveys to Grantee the following EREIPT ti
described real estate in St. Croix County State of REC FEE: 11.00
Wisconsin (the "Property"): TRANS FEE: 2952.30
COPY FEE:
CC FEE:
PAGES: 1
Recording Area
Name and Return Address
,ei J e-r jg--k-
P a B ox 7 -If 7
S'-f- Git2dr>< acs ~ 1
S. IV
018100690000 018100850000
Parcel Identification Number (PIN)
This is homestead property.
(is) (Is not)
The East one-half of the Northeast Quarter, except that portion of property described as Lot One of Certified
Survey Map filed In Volume 12, Page 3414, and the East one-half of the Southeast Quarter of Section Four (4) all in
Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin.
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except
lov
Dated this day of May, 2004.
(SEAL) (SEAL)
wJ n J. D046n Carolyn G./Dalton
(SEAL) (SEAL)
w w
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
} ss.
HIV St. Croix County authenticated thisN4q_T'N"f F21 1 RI IC;
STATE OF WISCONSIN Personally a re me this X~'day of
May, 2004 4 the the above ove named
John J. Dalton and Carolyn G. Dalton. husband and wife
* to me known to be the on who executed the
TITLE: MEMBER STATE BAR OF WISCONSIN ore g Instrument a ackno ge the same.
(If not.
authorized by §706.06, Wis. Slats)
fy,
THIS INSTRUMENT WAS DRAFTED BY Notary Public, Stalle of Wisconsin
Coldwell Banker Burnet
anent. (If n
ot, state expiration date:
1301 Coulee Road My commUK
Hudson, WI 54016 4-26689 )
(Signatures may be authenticated or acknowledged.
Both are not necessary.)
Names of persons signing in an capacity must be typed or rinted below their si nature.
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