HomeMy WebLinkAbout024-741-30-5415-SAN-2022-292 [ndustry Services Division C��jY �
' = 1, - 4822 Madison Yards Way � w ��' �"
-, � 0�� Madison,WI 53705 Saoitary Pennit Number(to be fillul in b} �
` j � P.O.Box 7162
- � Madison,WI 53707-7162 � �� '� �� �
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Sanitary Permit Applieation State T'ransactirin Number ,
—
In accordance with SPS i8�.?I�2),Wis.Adm.Code,submission of this form to the appropriate governmental unit �
is reyuirod priur tu obt;iining�san�tary permit. Note:Application fortns Cor state-owned POWTS are submitted to Ptoject Address(if different than mailing� �
thc Dcpurtmeut ol S,itcty an�1 Professional Scrvices.Personal informati�m you provide ntay be used for secondary
purposes in accordancc with thc Privacy Law,s. 15.04(l)(m),Stats.
L Applicafion Information-Please Print All[nformation �O/ �t/ i _
Pr�,�cm�()wncr�.N:inic --- Parccl#
L u/(�d_Ki�tii•✓_ L4/Yfo.✓_ �ii%7�?/1 f�//�
Pruperty Uwncr'<M.�iling Address PropeRy Location
'191y 6�sXfto,v�r_ c;���.���c�_
Ciry.Statc Zip Code Phouc Number
'ia. 'i4, Section�O
----- --_-- - -
H w � � 9/ ---
II.Type of Buildin�;(chcck all that apply) � �-��" T �/� N R_ 7 _G o� w
�l or2 I�amily Ih�cllin,<� - Numbcrofl3cdrooms_Y ______ SubdivisionName
— - --- _ ___
Block!t
�'ubliciCommcrcial Describc Use
❑City of __
�State Owned I�escribe 1!,c_ ____ -- CSM Number illage of _
�To�m of_1SOJL.�I����'t. __——
III.Type of POW1'S Permit:(Check either�"New"or"Replacement"and other applicable�on line A.� Check one boc on line B.Complete line C if
a licablc.) ------- — ----- —
A� New S stem Rc lacement S stcm ther Modilication to Lxistin�S stem �ex (2m Additional Pretreatrnent Unit(cx I�in
� Y-' � P Y � b Y ( P� ) ❑ P� )
�� �Holding�1 ank �In-Ground �At-Gradc �Mound lndividual Site L)esign � Oiher�fype(explain)
(conventional) 6eo��
,ist Previous Peimit Number and Datc Issued
��• ❑Renc�l�,il Ref�,rc �Hc��ision �Change of Plumhcr �Transferto New Owner �� � ��� � ��� �
F.xpir.i[ion
IV.Dispersalll'reatment Area and Tank Informa6on:
I�c�ign I'low(gp�il T Ucsiitn tioil A�plication Rate(Rpd/s(1 Dispers.il Arca Required(s� Dispersal A�ea Proposed(sf� System F,Ievation �nt.p
i Y
0 ioo .�6 �'� �
-- _(oo _ ,__ -- '�-_ - -
Capacity in �T�l�otal �of Manufacturcr
GalLons GalLo�s Units ;; � b �
Tank Inli�nu.�tiun II � � U �
New"laoks Existing Ta�ilcs � o ;; � � .� �a ro
I G. l� V1 f J: - .L C% CL
_-__- ____. _. _ ._ _..__--__ —_— _._ —__—__. .._.__—_ —
;eE�ii�ur I loldin�• I-.r•,k ' � � �� /L �
Aoo oos
� -- - -- - 0
Uusink Chambcr i, � �
V.Responsibility Statement- 1,the uudersigned,assume�responsibility for installation��af the POWTS shoR n on-the attached plans,� __
Plumber's Name(Prnul Plumbci's Signalure M r?NPRS Number Business Phone Number
f,�fUCt vlT�,rviy- �.�d y�� 7i3-91'3-a>Fr
Plumber's[Addre�s 1Strrct.Citv.Stntc,7_ip Codc)
/ 7 y,�✓JT �./Y Y U L' ,v w
VI.C untv/Ucpartment lJsc Only � � �� � �� � �
�y Permit Fec Datc Issued Issuing Agent Signature
�App 17�L7 L Ui�upprc,c�d $ O�
❑(l�cncr(�i��cn Rcason forDcnial ��• � � ( ���� � �'t�r��.
Conditions of� ���.�liR �asons for Disa proval � � � •� � �
-..� �_..�►o���J aa ` ,,i ,.--- _�-- -
�� I�'�� . �-- OCT 0 6 Z��2
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:._�k#�u_� �-1 S ��___._ ----
.��.�';:'�`y��ic:t-�i vC.i._- ,
C �� �� _ �'� , ,t4'/V.Q,Ur wo r (� �'3�3� ZONING ADNIf��l�STRrI iC;iJ
1'Vl i�
A[tad�to complete plans tor the sys[em and submit to the Co+mty only on paper�wt less than 8 t/2 z 11 inches in size ^/_O �(�
o�.�Q -r
NO R�FJNDS AFTER
ss�-63<�s�a.o3i2 i i ISSUE O�PE��MfF
GeoMat IN GROUND AND DOSING DISTRIBUTION COMPONfNT DESIGN
Residential Application
INDEX AND TITLE PAGE
Owner n o _ _ _
Project Name: Carlson
Ow�er's Name: Luke&Kirstin Carlson
Owner's Address: 4974 Greystone ST
Hermantown,MN.55811
rOp� f1O
Property Address: 10141 N Filter Bay RD
Legal Description: prr b.�i.c.�y_ S 30 T 41 N R 7 W
Township Round Lake County: Sawyer
Subdivision Name:
Lot Number: Block Number: CSM#:
Parcel I.D.Number 24741305415
Plan Transaction No.:
n ex
Page 1 Index and title Page 9 Filter specifications
Page 2 Data entry Soil test
Page 3 GeoMat dist.cell drawings&calculations Soil test
Page 4 Lateral and cell cross section Soil test
Page 5 Management 8 contingency
Page 6 Maintenance&specifications
Page 7 Distribution media
Page 8 Plot plan
A-1 Plumbing License Number: M.P.220498
Date: 10/01/22 Phone Number: 715-943-2382
Signature: �' '
Designer Stamp: State of Wisconsin Approval Stamp:
Desgned Pursuant to the
GeoMat In Ground Component Manual Ver.June 26,2018 Version 1.�
Page 1 of 10
In Ground and Dosing Distribution Component Design
Desiyn Worksheet
Site Informallon
R' Residential or Commercial Design N ' ISD Required7
400.00 Estimated Wastewater Flow(gpd)
1.50 Peaking Factor(e.g. 1.5= 150%)
600.00 Design Flow(gpd)
6.00 Site Slope (%)
90.10 Prop. System Elevation (ft)
84.00 Depth to Limiting Factor(in)
1.60 In-situ Soil Application Rate (gpd/ft2)
93.80 Lowest Original Grade Ele. In System Area(ft)
95.30 Highest Original Grade Ele. In System Area (ft)
88.10 Limiting Factor Elevation (ft)
3.70 Depth Below Grade
s on e a on
325 Cell Width (ft) 7 Number of Cells
2.00 Dispersal Cell Design Loading Rate (gpolft2)
2 Influent Wastewater Qualily(1 or 2)
s on In rima on _ _ _
C Center or End Manifold, Dist. Box or Drop Box
� Number of Laterals System dosed N
0.00 Lateral Spacing (ft)
System not dosed
an c rer rmafion
Treatrnent Tank Information Effluent Filter Information
1250.00 Septic Tank Capacity(gal) jOrenco Systems Filter Manufacturer
Skaw Precast Manufacturer �8" FT085436FT0854-36A, Filter Model Number
Project: Carlson Page 2 of 10
in Ground Plan�ew
Il � cC�llIl C����I�.�
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c ons
I 1.00 ft A 325 ft Basal Area Required 375 n`
K 1 ft B 100 ft Basal Area Proposed 525 ftz
S 0.00 ft L 102 ft
W 525 ft
Basal Area Calculation GeoMat Dispersal Cell Basal Area Calculation
GPD Loadin Rate GPD Loadin Rate
600 1.6 gaUsq fuday 600 2.00 gaVsq tvday
Total 375 ftz Total 300 ft2
Pro osed 325 ftZ
Number of Celis 1 GeoMat Width 325 ft
Cell Length 100.00 ft Lineal Feet of GeoMat Required 92.3
Min. Cell Len th 92.3 ft Lineal Feet of GeoMat Pro osed 100
Celi S acin 0.00 ft NOTE:Min S dimension= 1'
S stem Elevation 90.1 ft
Limitin Factor 88.1 ft
Se aration 2 ft 2•Min
Directions
Play with cell length to get desired cell spacing. length and width Remember system SHOULD be longer than it is
wide. It must also Satisf basal loadin rate and GeoMat cell loadin rate.
Project: Carlson Page 3 of 10
c«�. ���•m
O �...,. .,._.�..� ,. ..�_ _ , .� .... .__.__P....... . _
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Hole spacing is every 12", V2"hole at 4 8 8 O'cbck,starting 4 O'Gock 6"from end antl
8 O'Gocic Hdes at 72"fmm end.
Lateral Spacing 0.00 ft Plpe Diameter 4.00 in
... Of1 IOSS ` .. . . ... . . . . _. . . .. . . . . . . .
95.3 fl F:ni<hed f_.nAc �'v ��V `N'`7
�
. .L.. . '-... �m
I,'�:. � .. 12'LS MNf� . �.i�1��.eR�
3.7 ft— ��R��
4 : , _T..
bin —► pQtlht..'. ^ �"u . F�
. � no. �__
. ... ' . ' _ `.�
Topofgeoma[robeato ��. _ _ _ � - ��: � � GfAMAT
below original grade I � I 1 � I ����M.33�'�' . � � I , I � I � I �
in5lu�tive Sticfice
` I ___NATIVE.SOIL.�=cy_�
84R _y
� f-- ---��__�__—_.__ Gnn'veFrur
On p05_ . . . . . - .. . .. . . . .. ..
.�..�wo�
95.3 ft �0i°�'°°
I
.�rm. �
12"Mia . � \I
48"Max. ��
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i�.i n„���. � n n
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IIDisY � � �
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;�-'-;,�;s;'�;;'�`!�i;i;i;i;i;!;i'',!;i!i;'!;!i',;''!;;I;i'','
90.1 ft
Prol�'. Catlsm Page 4 of 70
Notes/ Maintenance Requirements
MANAGEMENT PLAN
This private onsite wastewater(POWTS)has been desigrff.W,afW is to be installed and maintained in acmrtlance with SPS 383,Wis.Admin.
Code,the in-GrourM Soii Absorption Component Manual for Private Oreite Wastewater Treabnent Systems Version 2.0 SPS70705-P
(N.01/01). GeoMat in grourW Cwnponent manual Version t.
1.This POWTS has been designed to accommodate a maximum daity Flow of 60 �ons of wastewater per day. The quality of
influent discharge fnto the POWTS treaVnent or dispersal component shall be equal to or less than all of the folbwirg.
A monthly average of 30 mglL fats,oil and grease
A monthty average ot 220 mglL BODS
A monthly average of 150 mglL TSS
Wastewater sha�l not discharge to the POWTS in quantities or qualities that exceed these limits or that resutt in exceeding Ne enforcement
standarEs and preventative adion limits specified in ch.NR 140Tables 1 8 2 at a point of standaMs application,except as provMed in DSPS
383.03(4),Wis Admin,Code.
2.The owner of this POWTS is responsible for system operation and maintenance.
3.Defects or maHunc[ions iUentified durirg maintenance descnbed above shall be repaired in wnfortnance with SPS383 ws.Admin.Code,
and the pertaining county Private Sewage Systems Ordinance- The use/s manual,provided to the owner of the POWTS inGudes the names
and telephone numbers of the properly licensed individuals to wntact for such repairs.
5.No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Dept.
of Commerce in accordance with SPS.384,Wis.Admia Code.
6.If the POWTS is rep�aced,or its use discontinued,R shail be abandoned in accordance wRh SPS 383.33,Wis.Admin.Code.
NOTES
Two Effluent FiRers to be installed where possible 1 to be installed in ST,and o�1 in pump tank fn
order to insure particle size less than or equal to 1/8". Fitters should be cleaned once in spring,and once in fall. Also,straine2 in sinks in
the building shall be maintained,so thal wlids and fats are minimized to flow into system.
A minimum of 2 observation pipes per cell shall be installed. These pipes shall be located approximately at the end of each cell.
The plumber,or county shall see to il that a copy of these plans inGuding this page,maintenance folder,and maintenance agreement is
given to the homeowner.
This system may watain a dose chambec If a pump,float,e�ec[ricat outage causes the dose tank to fill,the homeowner should see to it that
the effluent level in the tank is brought down gradually and not all dosed to the system at once. One large dose could cause damage.
Contacl a pumper or your installer if this problem occurs.
The homeowner is responsible for formulating a water conservation plan that will ensure the system is rarely overbaded. I.E.spread laundry
out over time,not 6 loads in 2 hours,while everybody showers,and uses the toilet,ETC.
CONTINGENCY PLAN FOR COMPONENT FAILURE
A. Septic Tank.Any strudurel failure resukiog in crecks or leaks in the tank must be corcected by replacement of the septic tank component.
Leaks in the joints beM�een manhole risers or covers shall be repaired by replacing faulty seals wdh approved materials to make joints water-
tight.
B.Outlet Filter.The outlet fitter shall be replaced or iepaired when it is either no longer capable of preventing the dischar9e of particles larger
than 1/8 inch or when it has become permanentty degraded by Gogging so as to interfere with the desgn flow out of the septic tank.
C.Dosing chamber and pump.The dosing chamber shall be replaced if any struc[ural failure is found.Leaks in joints between manhole
nsers or wvers shall be repaired by repladng fauky seals with approved materials to make joints water-tighL The pump and wntrols shall be
replaced when they are no longer capable of functioning according to the design plan.
D.Pressure Distdbution Piping.Partial clogging of the distrfbution nelwork may resutt in unduly long dosing cyGes.The ends of the
distribu[ion laterals may be exposed and the threaded end caps removed.The piping can be disconnected on the outlet end of the pump.
The distnbution piping may then be back Flushed to cleanse any accumulated matter from the piping. It is recommended that the dosing
chamber then be pumped by a licensed plumber.
E.Soil Absorption Cell.The discharge of sewage or wastewater to the ground surface is slrictly prohibiled due to the human health hazard
created by the effluent.All failures created by surface discharge shall immediately be reported to the appropriate county.The pump shall
then be immediately disconneded to prevent further discharge to the ground surface via the soil absorption cell.The exis[ing septic tank and
dosing chamber shall be used as a temporary holding tank until the necessary repairs to the soil absorptfon cell can be achieved.The
replacement shall be initiated only after any necessary plan approvals have been obtained from the
appropriate plan review authority and the requi2d sanitary permit is obtained from the wunty.
Project: Carlson Page 5 of 10
In Ground System Maintenance and Operation Spec�cations
Service Provider's Name'�A-t Plumbing Phone 715-943-2382 �
POWTS Regulators Name�Sawyer County SPIA-Zoning Administration Phone (715)634-8288
Svstem Flow and Load Parameters
Design Flow-Peak 600 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow-Average 400 gpd Maximum BODS 30 mg/L
Septic Tank Capacity 1250 gal Maximum TSS 30 mg/L
Soil Absorption Component S¢e 325 RZ Maximum FOG 10 mg/L
Type of Wastewater pomestic Ma�cimum Fecal Colrform t0E4 cfu/100 mL
Service Freuuencv
Septic and Pump Tank Ins ct and/or service once eve 3 ears
Eifluent Fiker Inspect and clean as necessa at least once eve 3 ears
Pump and Controls Test once eve 3 years
Alartn Should test periodical
Pressure System Laterals should be flushed and ressure tested eve 3 ears
In Ground inspecl for ponding and seepage once every 3 years
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap
and are secured in as shown in the GeoMat In Ground Component Manual Ver. March 20, 2017.
2. Dispersal ce�l media wnforms to GeoMat products approved for use with the GeoMat In Ground Component
Manual Ver. March 20,2017. Media is covered with an approved geotextile fabric.
3. All gravity and pressure piping materials conform to the requirements in SPS 384,Wis.Adm. Code.
4. Scarification of basal area is accomplished with a rake or other tool.
5. All disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration.
Lateral Tum-up Detail
� 6-8"Diameter Finished Threaded Cleanout
��, Lawn Sprinkler Grade \ Plug or Ball Valve
Box y
lateral Ends at Last Orifice Where
Long Sweep 90 or Two
�45 Degree Bends Same
Diameter as Lateral
��� r Distribution Lateral �� Lateral Cleanout �
90.1 Feet
Project: Carlson Page 6 of 10
GeoMat Distrib�ution Ceft MedTia Layout
325 Cell Width (ft) 2.63 Sidewall to Lateral (ft)
Distribution Cell Cross-section Amangements
_ __ --- � -- _ _ . _ _
ompo _... . . .
O DisVibution Pipe
GeoMat is covered with approved geotexti�e fabric as per the their product approval.
Distribution Cell Plan View Layout - Typical
3.25 Cell wdth-A(ft) 100.00 Cell l.ength -B (ft)
Center Connection Laterai Layout Diagram
- - - -- - - — - _ _ _ _ - - -
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pipe D'�s, -- • . ~ � �h� ..��; . .. F�
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Infil�ve Surface
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-NA`TIVE�SOIL- =
— — — — � � � � � � � � '" ._ � � L�^.i�v.Facsa�
See detaiis on page 4 for number, s¢e, and spacing oi laterals.
Project: Carlson Page 7 of 10
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R�ai Estate Sawyer County Property property Status• Current
L-isting '
Today's Date: 2/10/2022 Created On: 2/6/2007 7:55:44 AM
Description Updated: l2/18/2020 Ownership Updated: l2/18/2020
� ..� _.__ �__..__ .._.___.__..___�__._.__._.____________.___---�. _T_�.__ ___.________ __.___ ._._.__.._ _.__. .._ ._.__._._ .._____---
Tax IDc 26029' WKE D & KIRSTIN HERMANTOWN MN
P�N: 57-024-Z-41-07-30-5 05-004- M CARLSON
00015:0
Legacy PIN: 024741305415 Billina Address: Mailing Address:
Map ID: :4.15 LUKE D & KIRSTIN LUKE D & KIRSTIN
Municipality: (024) TOWN OF ROUND LAKE M CARLSON M CARLSON
STR: 530 T41N R07W 4974 GREYSTONE 4974 GREYSTONE
Description: PRT GOVT LOT 4' ST ST
HERMANTOWN MN HERMANTOWN MN
Recorded 0.470 55811 55811
Acres:
Lottery � Site Address * indicates Private Road
CI a i m s: .__.._____._.�.._.___....___�__.___.__...___ ___ _ ______ . ___.._._.
First Dollar: Yes 10141N FILTER BAY RD HAYWARD 54843
Waterbody: Round Lake
Zoning: (RR1) Residential/Recreational property
One Assessment Updated: 7/16/2019
ESN: 404 _ .._m_...,.__.__��._.___...�__.._______ __.. __ _ _____ ___
2022 Assessment Detail
Tax Districts Updated: 2/6/2007 Code Acres Land Imp.
_. _._ _..__ ,_.. _ _.__..___ ._ .___._ .._.__w�._----__�_...--_:___.._____ G1-
1 State of Wisconsin RESIDENTIAL 0.470 311,200 76,000
57 Sawyer County
024 Town of Round Lake 2_Year
Hayward Community Comparison 2021 2022 Change
572478 School District o
- Land: 311,200 311,200 0.0 /o
001700 Technical College �mproved: 76,000 76,000 0.0%
Total: 387,200' 387,200 0.0%
Recorded
Documents Updated: l2/18/2020
___ . ... _._._..__.___..__._.____._.____�.___.___.,�_...______.______�__._____�__..__._.___---...
WARRANTY DEED Property History
Date _._._.__ _�.�:___ ____...____----___ _
___ ___
Recorded: l2/1/2020 4283g2 N/A
QUIT CLAIM DEED
Date 394306
Recorded: 2/9I2015
WARRANTY DEED
Date 29�555
Recorded: 6/11/2001 WD747/226
�'''�""`"" PRIVATE ONSITE WASTE TREATMENT County
/,;=-- ,,^�
SYSTEMS SaW er
i��;�gpS ��i
`��,
J��' ( POWTS) Y
\�� �—,ti�;
��Fly.�_-�ti��.
�-�"'-``'=�'' INSPECTION REPORT sanitary Perrnit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2.d � a�a
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
Lu� a.k;,��, Cq��.so�, r���d c�l�
Insp BM Elev: BM Description: Parcel Tax No:
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TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �j'�.�„�J ��� Benchmark �pp,o�
Dosing
Aeration Bldg. Sewer q j;�5'
Holtling St/Ht Inlet q3,�7'
TANK SETBACK INFORMATION St/Ht Outlet �3 �'
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic f� �1�c� '�' -t-7� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Holding Dist. Pipe �j�,�'
PUMP 1 SIPHON INFORMATION Intiltrative
�
Surface �•3
Manufacturer Demand Final Grade
Model Number GPM � �-33 `T��Y �
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N �� L (�p' #of Cells ( Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate ��(�Q�
INFORMATION P I L Bldg Well Waters ° �GP o Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO �-3" �+02� � .F- ` ❑ Mound � Other
__ _ __ ---�----- -- -- —-------
DISTRIBUTION SYSTEM X Pressure Systems Only
- — --- --- —
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length _ Dia Length Dia Spac I Spacing ❑Yes ❑ No �
SOIL COVER
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges l_Topsoil 1 ❑Yes ❑ No ❑Yes ❑ No l
COMMENTS: (Include code discrepancies,persons present,etc.)
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Plan revision required?�Yes ❑ No '�
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�DITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBEA� � ���o�
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