HomeMy WebLinkAbout024-741-16-3104-SAN-2023-203 _ Department of Safety �°"°ty� �A''
• - & Professional Services, - �
_ ; Sanitary Permit Number;to bc filled in by 1.
�: , Industry Services Division
�S 1 ly ��� �
,.. . �
State T�ansaction Numbcr �
Sanitary Permit Application �
In acwrdance with SPS 383?1(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �-
is required prior to obtaining a sanitary pemut.Note:Application forms for state-owned POWTS are submitted to Project Address(ifdifferent than mailing ai dJ�1
the Department of Satety and Professional Services.Personal information you provide may be used for secondary ' ` Q 1 Q� �l� �r- �.
purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. �
I.Application Information-Please Print All Informallon
Property(?wner's Name Parcel#
e
�.Q,c� S�.�►,,�n,;C�,,Pa'- 4 � �t=1 � �I �v 3 l0�-
Property Owner's Mailing Address Property Location
OO"''1� •
City,State Zip Code Phon�e7Numbe
�,►T^ �� //�� � ��O^�' ��Q� �`- '/<,�� '/�, Section_��
Wy �ti��L (�
II.Type of Building(check all that apply) Lot# �� T _l � N R � E or
�1 or 2 Family Dwelling-Number ofBedrooms � Subdivision Name
Block# �'
❑Publie/Commercial-Describe Use �
❑City ot�
❑State Owned-Describe Use CSM Number ❑Village of _
•��� �Town of �� �
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
A. r-��
❑ New System Jo•iceplacement System ❑ Other Modification to Existing System(explain) Additional Pretreatment Unit(explain)
B' ❑ Holding'I'ank .� In-Gmund ❑ At-Grade � YP P )
❑ Mound ❑ Individual Site Desi Other T e I ex lain
(conventional)
C. ❑ Change of Plumber ist Pre��ious Permit Number and Date Issued
❑ Renewal Before ❑ Revision ❑ Transfer to New Owner p
Expiration 1��I�� � �jl�b ��
IV.DispersaUTreatment Area and Tank Information:
Design Elow(gpd) Design Sofl Application Rate(gpcL'sfl Dispersal Area ReqUired(s� Dispersal Area Proposed(sfl System Elevation
�j �n , � 2 � 7 _
Capacity in Total #of Manufacturer Y
Tank Information Gallons Gallons Units p � o � `_'
� ^ V � � N ��
New Tanks Existing Tanks F ° ,, Y y ,fl ^, co
a, U in � cn i�. C7 fs,
Septic or Holding Tank " O �y0 � („�'��' e r:✓ �i � .L � �
DosingChamber O s O � � � /r
r
V.Responsibility Statement- 1,t6e undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number
- - — �s Q� 7�s -��"l�i�
Plumber s Address(Street,City,State,Zip Code)
5� I� T �� 5�8�l
VI.Count /Department Use Only
�Ap ro� O Disapproved Permit Fee llate Issuccl Issuing Agent Signature
❑Owner Given Reason for Denial $ l O�'� 8��8 r`�3 .'' i��"u'i'��/I""""""
ConditionsofApp�roval/Reasons�foA isapproval � �n��
� , � J Z
� �; � �
r v��� 1� uw7i� �at@ �' �� 0�-3� i
al�� AUG 2 5 2023
cs� z3- � 3 � �h�# -
L,`' �`��Y�-�-�� �AVIYER COUNTY
� _.._ ._ _ .--..z- ZONING ADMINISTRATION
Attach to complete plans for t6e system and submit to the County only on paper not tess MAn S v2 a 11 iuches in size �S 33 �
SBD-6398(R.03/22) NO R�FUNDS A��TER
l�3U�UF PER�411'
PAGE 1 OF 5
In-Ground Dosed-GravitY Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 5 Index & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-SG�tion & Plar� View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s):T�� 4��t.c�.1,� _. �C�'lJ'�G~C�� Phone: �- �(�- 0��
Owner Address:�� �� la-�Og �U`k¢�"7�� � Zip: `�J� ��
Project Address: �� � � g I v� t�(,i C.�/� �
Govt. Lot: _1/4 of _�1/4, Section�(�, T�_N-R �7E ❑or W,�
Township: '�t�]i�lQ �,Q-�'� County: ���11-/ ,P-o'-
ProjectParcellD #: (�vkQ `Z� � �f��_d
Designer Information
Designer Name: ��,�.V1, c:�'t'1' G�.l' �k�` Phone: �I�S -SS� ��D�
Designer Address:�05?//�� ��_ �Q�l�-�,_ Zip: �
- cv w�
E-mail: � ,
License Number: 7"� O �Q �
Remarks:
Signature:
� Date: ��'o�-���'�
riginal signature required on each submitted copy.
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IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
_.___-�`---�' , ----�` ___.�� ,�---�
""" '?" TYPICAL TRENCH
I�YPical)
soi�covEH -_ CROSS SECTION VIEW
�?" (No Scale)
min.trench
depth
(�YPical) � "
-- c
_ . __ . .. ;. _.._ a .. . .d �a.
3$" a .. .
�— �ryK�icaq , Pravide minimum 3 ft
� � separation between trenches.
System Elevation =� /�.��
(typical)
(�uiCk4 Slandard-W Observation Pipc
w�End Cap (Show location of inlet/ outlet pipe connection on plan view.) <<Y�"��''> TYPICAL TRENCH
----- (typical) Install pc:r manufacturer's
instructlon;;. PLAN ��E�
� — — — — — — — �f- -- — — —,�+�.�u����-r������s� -
(No Scale)
���� �,�����,��y����a�s+��-� — � � �
' 4 I I � I ;I A= 3.Oit
��nkrr�,�k'��i�lk'�+�it=�l�i�iMii��tti�� - — — — .— — — — — — �it ���Y��xax�tra��aai��
(�YPical)
� /
L_ _.. , — �_ _ � ._ _ -��-- — �� -` - -- D
�--- -- --- --- B = �v � ft -- -- ----�-�-� G�
� (typical) Quick4 Standard-W Chamber (Tl
(typicai) W
INSTALL PER TRENCH: (rnfd by�niiltratorSystems,Inc.) O
-- --- Insta�l pursuant to manufacturer's inslructions.
� Quick4 Std-W @ 20 ft' EISA/chamber= ,� ft' �
I --- - — Ul
-}- _�_ Pairs of end craps @ 6 ft'EISA/pair= � ft2
� = Proposed EIS/� per trench= 3 �� ft' Required Infiltration Area= �2,�,� ft` Distribution Method:
x 2_ trenches = Proposed Total EISA = ��Zft' �,,rc�-s��`�, rt��.�r.'����
� �S�T._
�
PAGE 4 OF 5
GRAVITY-DOSED -
SEPTIC / PUMP TANK SPECtFICATIONS
(No Scale)
4'�Ven�Rpe .
>70 ft from
Building Eleclnnl mus[wmpty wilh
1 T Min.or 2.0 ft above SPS 316 and NEC 300
Establishetl Flood Elevalion W����� EMand manhole riser as necessary,
(�i�l) Junclbn Box
Approved qpp��Lodcing Manhole
IMPORTANT: ve1"j�p w�u�wam�rg�aoei u�acned
� (bwm0
Anchor tank(s)as necessary �u�i
pursuant to SPS 383.43(8)(g) 4'M�n.or 2.0 ft above
Established Flood Elevation
ltypicaq
�Avlighl Seal
Finished Grade - �
�uick Disconnecl
18"Min.
CAPACITIES @ gaUn , .- �'��'>
Depth(in) Volume(gal) �
3 3 * 1
A � �i weeP '�APProved,ldnlswilh
Hole Appoved Pipe 3 ft onto
B `L,Q A Sdid Ground
(typiml)
�C] l� 7� � !
� _Alartn
� / 3 /o� B —�
1�C� Pump
� PUMP-OFF
'kPump Tank Liquid Level= �—S" in —�— �—� ELEVATION= Q.�Ft
I
° INSIDE BOTTnnn
Force Main Diameter= Z., in �°"Ofe`e
�� 81a� ELEVATION C� ft
Fo�ce Main Length= / �� ft 3'Appioved Beddirg Matedal Benealh Tank
Force Main Void Volume=�gal
[C]Total Dose Volume TDV = � 3_ � gal/dose
(<0.2X design Oow+force main void volume)
Vertical Lift= ��,C9�' ft
PUMP TANK: SEPTIC TANK(S):
Volume= G���gal Total Volume= /� �G gal
� ��
Manufacturer. T d/{���.>�c�✓, Manufacturer(s): ti� � ✓ �'��-
Pump Manufacturer. Z aQ ��f'✓' —
Install approved effluent filter at the septic tank outlet
Pump Model: 9� (Seeattad�ed pumpcurve.) immediately u�stream of the�ump tank iniet.
Controls/Alarm Manufacturer. . T= /2l:,,��-/�,,s Filter Manufacturer. vrP� � ��r�� ����<_._ _
Controls/Alarm Modei: i c�/ � !�/.�.-.-. — Filter ModeL ��� � Z.�—
Float switches containinc�mercury are orohibited.
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-gravity system shall be responsible for its perpetual operation and maintenance
pursuant to requirements of SPS 382384,Wisc.Admin. Code. Pursuant to SPS 383.52(2),Wisc. Admin. Code, this
system shall be considered a human health hazard if not maintained in acwrdance with this approved management
plan. Furthertnore, alI inspection and maintenance ac[ivities shali be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc. Admin. Code.
Maximum Dispersal Area Ooeratinp limits:
Design Flow= ���� gpd; BODS 5 220 mgL-'; TSS_< 150 mgL''; FOG <_ 30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o matenal fatigue(i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution/drop boxes)
o neglect or improper use(i.e., exceeding design capacities, prohibited activiGes, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities-if applicable (i.e., pump re-cycling,float switch settings, etc.)
o electrical components-if applicable(i.e.,wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure—compare to design specification)
c surface discharge of effluent or sewage back-up into structure served
Maintenance Checkiist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank/sl shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (1/3)the liquid volume of the tank(s)or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filterlsl shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufadurer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Nameofindividualorcompany:�`J�n �,Xryr,(JVJ� Phone: /�S� J�����
Vp'
Local government unit: Phone: /�S�D��'g��o 0
Locat govemment unit address:�lJ�CV 1I u.u�.71 � ��l.G `�7 ��ZIP: S�p `L 3
uJ�
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc.Admin. Code.
Continaencv Plan
In the event that any failed treatment component of this POWfS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc.Admin. Code.
20130 � 92 /-�
infdtrator iM-SQa Tank _
Volume as a Function of liquid level In 1-Inch Increments
Uquld tevel Above Bottom oiTank Valume
Centimeters Gailons Llten .
Inches 0
p p 0
1 3 3 li
� g 30
7 53
3 g 74
G 10 21 80
13 ?9 109
� 1� 37 140
. ' � — 173
� 18 46
� z0 SS zo�
H 2M13
9 �} 64
25 74 279
70 317
11 2H R4
12 30 34 35G
13 33 105 396
3� x1G 437
lA 480
]5 38 127
16 41 138 57.3
1� q3 150 566
18 q� 161 Gil
G 1� qS 173 GiG
20 51 186 702
21 i3 198 749
7.2 iG — _�i 71Q 796
7.3 58 2T 843
6 ZQ �1 2a5 A91
25 G9 2qR 939
Zg r6 261 988
27 69 D4 1,03A
2g 71 ZN7 1,088
Zg /q ?00 1,137
30 7G 3t3 1,185
31 79 326 1,233
32 B1 338 1,281
33 A4 351 1,378
3q gG 363 1,375
35 89 375 1,421
36 91 387 1,46fi
37 94 399 q 1,511
3g 97 411 1,555
� 39 'J9 _ 422 1,598
40 ]OJ 439 1,640
41 1G1 44a 1,681
42 107 455 1,722
q3 109 nG5 1,761
� 44 112 _ 475 1]99
q5 114 4ft5 1,835
4G 1ll 494 S,A/l
q7 d19 503 1,905
AR 12.'. 512 7.938
q9 12A 520 1,970
50 17'/ 528 1,999
51 130 535 2,026
52 132 '.i42 2,050
53 135 547 2,OA
5q 13' S51 2,OR7
55 738 552 2,090
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_:: s _ c.a.�ar,s ,o s� �o +o sn eo_�_ �o ea requirements.
u�45 _�.___.�.---___�_ _
`-'� 160 240
o PLOW PER MINUTE
1 --_._ .�- � --�
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f�._..--------- ._f �F..:.-.r--�,,` �_
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NERQ � UNfS3.'MtM :�,-�-'�� �f
� FEET YtTER3 tALS LTRS j • r i � �i
, ,r
. 3 i.52 72 213 ? y �\_..___�
10 3.W 01 711 � ` --, l�-._ }
� 13 4.37 �S /10 1 i i�
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CONSUI.T FACTORY FOR SPEClAL APPLICATIONS
• �i2c,ncai aRernator3, tor duplex systems, are ava��ab:e and • h�ercury t;oat sw;tc:�es e;e avai4abte ior controlt(ng singie'and
suppi:ed wfth an afarm. t�rea phase sys;e•�s �
= h"echa��lcal aRarnators, for dupl8x systams, are avallabla wllh or • pouble piggyback mercuy rsca; swi;ches a�e availahts for
wifho�t a�arm sw4�hes. varlable 1eva1 long cy��e c��:•o+s
SELECTtON GUtOE
Standard att models - ��lQI ht 39 IbB. ' ti. �ntegra!P,oat operateC 2 po-e ?ec^anical switc�+,rto etterna+convot requ�rec
- - -- ----- --j--�--- ' �� }-i•P. 2. Si+tiC1e P�OGYback rnerccry f�oa: switch w douCle P�SBYback mercury. itoat
,- — _- 48 S�r{es Con�rol Ssisetian swlteA. Aefer:o FM047T.
� ' Mxo: �. Yolt�•Pfi Mode� _Arrs.�_ Stm i�x ' Ou I�x �. ►Aechan�caJ a:te�netor t0-0072 e� !.�-b075.
� �';i . 115 1 Aulo � 9.0 r t o• } 6 7 -- ---' �. See fM0)12.Iw corract moda. ot Elecuice;IUternator, `.z•Pak".
• s� � � 5. MarcLry sensor lloal awiic`+ t0-0225 used es s cc.�trct aa�va:a, specih
15 1 Non 9-4 2or236 9or < 35 �
_ _ �— --- duptex(�)or (4)1{oa; system
a3e �2au � AWo I �.5 t or 2 6 T — 6. four(�) ho;e"J•Paic".3unC,;o�bcx i�!waterUght conrsscLan or wired•in s�m•
, �;._ _ _ � --- ---
_�E : 2� t , Non a.5 _ 2 or 2 d 8 : 3 or 4 3 S plex rn dupbc opsrstwn, 10-QQQ2.
7. Twa ;2} t+�;te"J-Pak",too v.e'.e"ig!�t cen�ectton or spfice.
�a r��vm�:,ar,�+adC�tbri Ine��e�pr�C:.G:f�tie;b Gt�Up W1 COrttC:7utiOn�:af.M.F4h:S;�, CA�Ti OM
�'''6vY'�'• �•te•�,;'Y Swtt,:Ms. FU�CJ7; E.�Ct/ica! AhlrnatDl. FMWAE: A{�tlwttl IL`.etM�, A�� inataf4llo+f d scntrW. Rrd�c4on dati�cc� �nd ..rt�np �Awa1C De done by � qwt:.
G1.4i�O5. A:a••-. RK'uC�. `Mb�.� $;:rP'Slw��f $ii�nl. FMSS4a7'i'W $�mp{�x Cd4iiP (wd Iie�nNO �I�NiCl�R AY �Nei�,u7 �nE �at�ty CodH �A�Ould W (ollow�d includ�
� . BnL Inq Ue 1noN r�uM Mu;ona! EMct��e Cm• (NEC} �nE th� Ouuyt:w�at S�i�ry •��d
'�'�`'�� � 4•��hti Ao1 (OSrl�f
RESERVE POWERED DESIGN
For unusuai conditions a reserve safety tactor is eng��eered into the design cf every Zoelier p�ma.
MAiI T0:PA BOX J63e1
� ta�s�'e, xra0755-D3a7 "fanu�ac►u:ers o�
0 n�/��Q �. SXIPiiD'j3�89KtQ��}�iane Q�,�!/1Y/�u.tI�S �Ntf f��j •�
l.t L ! 1
� T !S'!?; 1'�.i??' • �AC!il??; )v6-.'<^71
�'�IN FI LTRATO R IM-�J4O
�
�
tanks
Features& Benefits
• Strong injection molded
'' polypropylene construction
� • Lightweight plastic construction
and inboard lifting lugs allow for
easy delivery and handling
r • integral heavy-duty green lids that
interconnect with TW'"risers and
pipe riser solutions
�* • Structurally reinforced access
ports eliminate distortion during
installation and pump-outs
• Reinforced structural ribbing
offers additional strength
• Can be installed with 6"to
48"of cover
• Can be pumped dry during
pump-outs
• Suitable for use as a pump tank
or rainwater(non-potable)tank
The Infiltrator IM-540 is a lightweight strong and durable septic/pump tank. ' No special installation,backfill
This watertight tank design is offered with Infiltrator's line of custom-fit or water filling procedures
risers and heavy-duty lids.Infiltrator injection molded tanks provide a are required
revolutionary improvement in plastic tank design,offering long-term ' No special water filling
exce tional stren th and waterti htness. requirements are necessary
P 9 9 • The tank may be backfilled with
suitable native soil.See installation
instructions for guidance.
�� Reinforced 24"
� Custom tit
y�4� structural! - �'— -�� TYV Riser
y - access port i
'��� I .��►
� Reinforced
! watertight /
! mid-seam
gasketed �-
connection �
. �
1�
Protectin the Environment with Innovative Wastewater Treatment Solutians �N F I LT R ATO R'
g water technolocies
'""=`°"��"E�'��`� PRIVATE ONSITE WASTE TREATMENT county
_ � r,
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= o$ � SYSTEMS
- � ps ( POWTS) Sawyer
,;�,� `_—,-��'V
'""v� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � 3 �'2-��
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 Pian Transaction ID#:
� .����.5�-�,���� �►�J� ��/� ^
Insp BM Elev: BM Descriptio�: Parcel Tax No:
loo.a ' �b oF�e�� o�y -�75'1- 1� •3l bY
TANK INFORMATI N ELEVATION DATA .f'.
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic eK��; w:e.�.�$� � S"�(o , Benchmark (0,3 O6. ` (oo.c��
Dosing �,,� \ c-� ST o�`I1 �.?.o`i� b�Y, �
Aeration Bltlg. Sewer
Holding St I Ht Inlet 2„?,b3' 3,6�'
TANK SETBACK INFORMATION St/Ht Outlet �,Z,cr t � .Y r
TANK TO P/L WELL BLDG AIR INTA�KE ROAD Dt Inlet �.3, D ' $3,3'
Septic +� �-�.r +S' ��► NA ot Bottom 2b.6s` ?��?�
Dosin ` � �• NA Installation
9 +10 ,f--�"j� �''S' }�' Contour
Aeration NA Header/Man. ` qc{,��
Holding Dist. Pipe
PUMP I SIPHON INFORMATION Infiltrative �
Surface 1�.� `��?S�
Manufacturer ��- Demand Final Grade
Model Number �(� GPM Ni` � �
. 6 .9
TDH ;�j Lift Friction Loss Sys Head TDH Ft
Forcemain L o� Dia " Dist. To Well
DISPERSAL CELL INFORMATION
DIMENSIONS `N 3 L (o � #of Cells Type of System Distribution Media Manufacturer:
� Conv ❑ Aggregate ��.
SETBACK P/L Bldg Well OHWM of Nav � IGP o� Chamber
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO •1-('�� �� .�- � ❑ Mound o Other Q��
- - - - - ---- -_ ------ - - -- -
DISTRIBUTION SYSTEM X Pressure Systems Only
[ Lengthr/Manifold Dia �L�engthution Pipe(s) Dia _ Spac � X Hole Size ; Spacing ❑Yes atio❑n Ni�pes
SOIL COVER
-- - -- — ---- - —___ _ --
Depth Over �epth Over Depth of Seeded/Sodded l Mulched �
Cell Center Cell Edges Topsoil ❑Yes ❑ No � ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��s}�II� �f f�3
, �� � —�
Plan revision re uired.0 Yes❑ No � �J C�� ��,� ��
p O 3 �-- � -_- _._
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS NO SKETCH
SANITARY PERMIT NUMBEA � ' ���
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