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Rev 3/86 PUTNAM;COUNTY DEPARTMENT OF HEALTH
Divleton of Environmental Health Servtcea, Carmel; MY 10512 ,
�* Provide
1 PJ H D Pe'
RTMCATE OF CONSTRUCTION COMPLIANCE FOR SE AGE 6AiSYSTHM - �! �/>C1t
Loin C�� T4 MaP ►_' Block Lot 2'
/,�
Owner/ cant Name . �,d c Formetly Sabdivislon Name Subdv: Lot N
Malling Cl G ~ Zip f� �7 Date Permit Issued
^/
Separate Sewerage System built by O. t Address
yy! � .
Consisting of Gallon Septic Tank and OfJ /.1 - -F . -fi 2,4' W 1�
Water Supply: Piibllc Supply From Address
vt'Sapply Drilled by—
/y.
AddressG��! 0
Balldmg Type ' • . /7 L'%f Has Erosion Control Been Completed?
Number of Bedrooms 4f Has Garbage Grinder Been Installed? ,y v
Other Requirements
/'EClr06r"✓" ..2 l .i'7 L�Clc°..� dFf. �•. f7v5P %!lSf� e' ,i�+•.pz"/
I certify that the system(s) is listed serving the above premises -were conetrucE a eil�iall ae'� `',the plans of the completed work f copies
of�which are attached), and in accordance with.the standards, rules and regulat s, h ac a filed plan, and the.permit issued by the
Putnam Count 'Department Of Health. H i . �.
'i
Date �� a►tiflsd by ) P.E. R.A.
Add reu / License No'
A y
Any person occupying premises served by th above, system(:) shall promptly faQ such ac Wlag i6il teary. to secure the correction of any unsanitary
conditions resulting from such usage., ;Approval of the separate siweragq- system shall beeo d.va, id as soon as a pubt : unitary sewer becomes
availetile and the.approval of t6a private watts. supply shall become null.and void when a public watts ,supply becomes available. Such approvals are
subject to modification change when, in the Judgment of .the Commissioner_ of Health; such revocation, modification or change Is necessary.,(1�
Oats ?J / �� B � --�� T itle
k
ti
Yorktow.p Medical Laboratory, Inc.
f 321 Kear Street
Yorktown Heights, N. Y. 10598
.(9 -14) 245 -2800_
Director: Albert H. Padovani k T. (ASCP)
T
Joseph Hayes.
50 Trail of Hemlocks
Putnam Valley, NY 10579
LA B
Date Taken: 6 -14 -91 Time 10:151
Date Re' d : -6-14-21 Tim'60-10:3101
Date Reported: 9991
PO /Client. # 5-
Referred By:
Sampling Site: Kitchen tap: `
Phone ( )
L -�
REPORT ON THE QUALITY OF WATER
INORGANICS (mg /L) MICROBIOLOGICAL
Alkalinity
® Chloride
_ Copper
_ Detergents, MBAS
Hardness, Calcium
— Hardness, Total
Iron
_ Lead
_ Manganese
Mercury
_ Nitrogen, Ammonia
—
Nitrogen, Nitrate
_ Nitrogen, Nitrite
Phosphate, Total
_ Silver
_ Sodium
Sulfate
..Sulfide
_ Sulfite
_ Zinc
PHYSICAL MISCELLANEOUS
_ PH (S.U.)
_ Color (Units)
Conductance (uhms /c)
_ Odor (TON)
_ Turbidity (NTU)
_ Standard Plate Count `
(CFU /1°0 mL)
Coliform & Related Organisms
Circle Method: MF MPN P/A
Total Coliform
Fecal Coliform
Fecal Streptococcus
E. Coli
KEY FOR
TERMINOLOGY
LT =
<
= Less Than
GT =
>
= rr@pter Than
NA =
Not
Applicable
SA =
See
Attachment(s)
TNTC =
Too
Numerous To Count
P =
Present (Positive)
N =
Not
Present (Negative)
=
Also done because To-
tal
Coliform Positive
REMARKS C01`PENTS Lab Use
(For Lab Use);r
SAMPLE TYPE: 4r<
(Check One)
Potable
_ Non- potable
OUTGOING:
(Check.Each)
HNO
HC13
_ H004
_ NaOH
_ ZnOAc
Na2S203
Other:
INCOMING:
(Check Each)
t
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS (WAS NOT) (NA) OF A
SATISFACTORY.SANITARY QUALITY ACCORDING-TO THZ PW YORK STATE PUBLIC DRINKING;.
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION°
THESE RESULTS INDICATE
SATISFACTORY CHEMIC
ING WATER CODES, F
0 raaovan1,-rioT.
THE WATER SAMPLE (DID) (DID NOT) dL5I,. T.THE'
TY STANDARDS OF THE NEW YORK STATE DRINK®" `.` ARAMETERS TESTED, AT THE TIME OF SAM CTION'
7 /87(Rvsd1 /90)RWE :`.
ASP , D— r ctor
GT
4/18 .20PC
_ GT
200C`
LE 2
—PH
._ pH
GE 12
— Other. .
NYS ELAP #10323
t
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS (WAS NOT) (NA) OF A
SATISFACTORY.SANITARY QUALITY ACCORDING-TO THZ PW YORK STATE PUBLIC DRINKING;.
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION°
THESE RESULTS INDICATE
SATISFACTORY CHEMIC
ING WATER CODES, F
0 raaovan1,-rioT.
THE WATER SAMPLE (DID) (DID NOT) dL5I,. T.THE'
TY STANDARDS OF THE NEW YORK STATE DRINK®" `.` ARAMETERS TESTED, AT THE TIME OF SAM CTION'
7 /87(Rvsd1 /90)RWE :`.
ASP , D— r ctor
PLTI'NAM COUNTY DEPARTMENT OF HEALTH
:..,. .... �. _.. _. DISI ERVICES � E „
"G5 , 4 C s
Owner or Purchaser o Building
/f
Building Constructed by
Location - Street J /
Municipality
Building Type
Section Block Lot
Subdivision Name
Subdivision Lot #
GUARAME OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
wor)ananship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has been constructed as shown on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating condition any part of said system constructed by me which fails to
operate. for a period of. two years immediately, following the date of approval of the
"Certificate" of- - -CdnstYuction- -Compliance° for the sewage disposal system! or any
repairs made by me to such system, except where the failure to operate properly is
caused by the willful or negligent act of the occupant of the building utilizing
the system. `
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environinental Health Services of the Putnam County
Department of. Health as to whether or not the failure of the system to operate was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Datedrtbis 12th day of Jul 19 91
o eph yes (Owner)
Gen aL'Contractor (Owner) - Signature
not applicable
Corporation Name (if Corp.)
Signature d�
i4ic6ael J. Amorosano
Title President
50 Trail of Hemlocks Putnam Valley NY
Address
rev. 9/85
mk
The Country Carpenter Inc.
Corporation Name (if Corp.)
373 Church Road
Putnam Valley, NY 10579
WL.LL Lj,)r1rLL11ULN rLEtrVL%1
DEPARTMENT OF HEALTH
ry
rn—VTiftfiri tal 'Healr1i - Servi'c'es
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET RESS: WNIVIL If TAX GRID NUMER:
11� V/ Ile.
_15*0 ., I�All
WELU OWNER
"Alwlt),�.e 1_1 0
-PBIVATE
❑ PUBLIC
USE -OF WELL
1- primary
2 - secondary
101"ESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
Q BUSINESS. ❑ FARM ❑ TEST/OBSERVATION 0 OTHER (specify)
❑ INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY ❑
MOUNT OF. USE
YIELD SOUGHT gpm./NO. PEOPLE SERVED _/ EST. OF DAILY USAGE —gal.
REASON FOR
DRILLING
.[]REPLACE EXISTING SUPPLY EITEST/OBSERV ' ATION DADDITIONAL SUPPLY
C2NEW SUPPLY (NEW DWELLING) 0-DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 75 — ft. I
STATIC WATER LEVEL _� v ft.
I DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING 0 OPEN HOLE IN BEDROCK 0 OTHER
CASING
DETAILS
TOTAL LENGTH l ft-
MATERIALS: 0,STEEL ❑ PLASTIC 0 OTHER
LENGTH BELOW GRADE i S ft.
JOINTS: ❑ WELDED 9-THREADED ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE BOTHER
WEIGHT
PER FOOT Ib./ft.
DRIVE SHOE. ❑ YES CRNO
I LINER: Q YES LINO
SCREEN
rOETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
❑ YES ONO
HOURS
SECOND
GRAVEL PACK
❑ YES'
0 NO
GRAVEL
I SIZE:
DIAMETER
OF PACK in. I
TOP
DEPTH —ft.
BOTTOM
DEPTH — It.
I
WELL YIELtTEST : If detailed pumping
METHOD: dPUMPED 3 tests were done is in*-
O COMPRESSED AIR . attache 1 formation d?
0 BAILED ❑ OTHER i ❑ YES ❑ NO
V more detailed formation descriptions or sieve analyses
'WELL LOG are available, please attach.
DEPTH FROM
SURFACE.
Water
sear-
ing
Well
Dia-
Deter
FORMATION DESCRIPTION
COE
ft
ft
WELL DEPTH
ft.
DURATION
hr, min.
DRAWOOWN
It.
YIELD
gpm.
an d
L urface
e .
C_ 4)" ft
WATER 0 CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? 0 YES ONO
ANALYSIS ATTACHED? 0 YES ❑ NO
-------
STORAGE TANK TYPE X -
CAPACITY GAL.
PUMP INFORMATION
TYPE (3 e-1- ?A) 2 CAPACITY 1112-
MAKER — DEPTH
MODEL 14.4 VOLTAGE 2�12 HIP
2
WELL DRILLER NAME CATE A
AGOPESS 1-111t, SIUMM L A
4 , t, " 'AI Ile
j/69
- s v a V ♦ � . a. rte.- � •.�. -
, y
t�
Putnam County Department of Health
Environmental Health Services
_ Two County Building
Carmel, New York 10512
I, the undersigned, hereby certify.-that the abandon-
and
•
existing S.S.D.S
ment of my water well has been accomplished in accord- b"
ante with the methods described in my application for
a permit to abandon said water well.
• � August 2., ,1991:; _ •
(Date) -
Joseph Hayes
(Print Name)
`7 50 Trail of Hemlocks
Putnam Valley, NY 10579
(Address)
Inset b
STRE:-.� 1CCATION �� �� cyvTlm
PERMIT a �� ° - ° um Q OR . SUEDIVISIM LOT a 'EE
I.
I�
-V.
V.
v2_
u
YES
NO
4 �a. SDS area located as per.atmroved plans
-
b. Fill section - Date of place-nent
2.1 barrier _ LGT$ W--Oym AVG_DPTH
c. Natural soil not striped
d. Stone, brusi-i, etc _ , cry te_r than 15' fro n SDS area.
e_ 100 ft. fran water course/wetlands.
I
I
:. Ss rte' DISPOSAL SYSM4
a. Seotic tank size - 1,000 1,250
o
b. Seotic tank insi=i ed levee
o!I
c. 10' minhm n from foundation
I
d_ No 900 bends, cle=*icut within 10 ft. of 85° bend
e. DIS=Tj --TION BOX
1. All outlets at same elevat- on - water tested
2. Protect---d below frost
3. Y -inim= 2 ft_ cricina soil be-t e--n box and tranches
I
I
f. JUNCTION BOX - vrooerly set
I
{
g. 5
1. i.---igth rezu i red - 4' Len�� instal? e3 V
e 3
2. Distance_ to water- ccurse nEas
3. Instal-1---A accord? nq to plan
4. Distance cell=-- to ce-i =, er i ®I
I a
5. Sloce of t=ench acceptable 1/16 - 1/32 0 /,:cot. I
"
6. 10 feet from urc� Lv line - 20 feet - fourZaticas (
i
7. Depth of tre_ncz < 30 inches frQA sarface i .o
I lAaM
8. Roan aiicwea for expar_sion, 50%
°. Size of cravel 3/4 - li" diame -tar
10. Depth of crave]. in t_ e.*Ich 12" mi n i mm ( v
I
UL. • Pire e_*les capped
h. _ ,. OR DOSE SYSTEMS
1. Size of. v=.chF -rfb=r _.
- - -
_._ ..-- ..__..... _
2. bv6rfl6i tank
3- Alarnl, v? s•_ /audio, I
I
4. Pump eas�Llv accessible ranhole to a de
I
5. First bex baff=led
6. Cycle wit*iessed by Health Dew ment I
I
estinateo flow r cvcle
a. Educe located Derr a:=reved plans.
b. Y mina- of bedreans
a_ Well located as rex- arorove3 vlars
b. Distance from SDS area m--sure3 ft. I
(
{ ® vv
c_ F=- ing 18" above grade.I
I
I
d. Surface drainace around weU acceotable. I
I
I
OV RAM WORRY -ASaIP
a. Foxes proper-ly grouted
b_ All ices pa_*-LLiaLy baccill.ed
c. P?1 ires flush wit_'- inside of box
d. '�ckrill material contains stones < 4" in diameter
e. 0 - tain drain installed according to plan
°
f. Ojrta.in drain cutfall vrote---ted & dir. to --vist_watercours
OI
g. Footing drains disc�rce away from SDS area
h. Surface water rotes -ticn ademmte
L tE=osion ccnrro provided cn sloces greater than 15 %_
u
:.. -.., i-; �. S`- ^- `,- �rT'n`�•'7' -T' sn. �S "'T- �`r- .`+y"!�— a ""h"' ,."' L
II.
: a l
PUTNAM COUNTY DEPARTMENT OF HEALTH
,.16t t Dlvlelon�Fwh6amenLll `•HeeMb,Servkmr Carmel:'N:Y 10.512 Hnginewto'ProvldePermitY.
•l/1
on CERTIFI F i
ATE O COMPLIANCE -�
�CONSTRUCnON PE1Zl W FOR SEWAGE DISPOSAL. SYSTEM , Permk aY
7 O
trot" a . �;� f . /�j
.m�.y. =..nw+ ... a- Y a ._ .. w '"_'r"T. v4•e Ao r P Y a -i r a., . -,-. .a r - ti .,.•ter
Sabdlvlabe Name Sttbd. Lot.N Tu Mep. - Bloch W. .:..
. R •
Renewal ❑ • = evlelee.�
Owner7Appiknt Nwmo 5.
Date or Prevloae..Approvol
M1111111018 Addnm :./ jbs✓ / > -. c —S Town Zlp Je-S 7
Balldhr� Type / G' S . d � C'C • Lot Aces' '�! �' FIII Section Ool
Y Depth Volume.
w .G P D �.GG PCHD Notf caltlon la Required en F111 la completed
• t � i DCsallo�a ,. -..:. � . ,
Number of Bedrooms eai Flo .
Separate SewerilRe;Sydtem to cotislat of �— Soptk Tall an �'� F'� its `G' �o!%G
To be conslructed by Address
Water Suppl.Pt c *.PP y From " Address
or: Private Sappy ."ed by — Add. moo,
'
Other Ili
uiremetite
I represent'.that I am wholly and completely responsible for. the design and location of the proposed, system(s):.1) that the separate Sawa a disposal, system
'above described -will be constructed is•shown on,the dpproved amendment there to and in•accordance with e- tand�atrds, rules an regulations o • Putnam
County Department of M•alth, and that on eompletion`thereo ( a ;Ce`rtdicate 'of; Construction Co n spry to the Commissioner of Health will
be' submitted .to the Department and a written, uarantee will be furhisf:ed ;the owner his;uc
y Y nq ,S.P119s r►>f by the build•i, that said builder will
place m 9001 ope►atinq eonditioi) any* of VC f. ruct onsCompllansce of tths:or rrnaltsYStem� ;;a' r�6paUS tliei b tely following theaate of the issu-
Y �' _ nY
once of the approval' of the Ce ,, 19 ) t t the drilled well d•scrib•0 above
Will De o
loted is stigwn on the "approved plan and that said well will be installed;.in accordant it tls ;' a d repu aT ii s of the' Putnam
County Department oil 4"Ith. f L fo-
Oete/ S ned` o P E. R.A.
Addreu �� « - 2, ,.License No y C+js
tom., -. _ � s ` .. J .
APPROVED FOR COtJS*RUCT.ION:7h' approval expires two rs /►om.the'dat issued unle structlo69 tKft uildiny has been undertaken and is
revocable for cause or may be amend cur modified w hen cgnL ►ed necesmry.'bY he. Commisslo 'of- HealtlbT_9 ny' Charlpe or alteration of construction
requires a n w er ityV�� Approved for dispose) of dome rifc r a►y: aye a p ivata w ter supply only -
tev. �. TitleY i
J87 Date
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION- 'TO CONSTRUCT A,.- WATER' WEL -L-- :- ..•
PCHD PERMIT #1 d
WELL LOCATION
Street Address
Tower Vill e City Tax Grid umber
WELL OWNER
--Name Mailing Address
ktr & -
private
O Public .
USE OF ; WELL
1 - primary
2 - secondary
SIDENTI
BUSINESS
® INDUSTRIAL
0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP
0 FARM 0 TEST /OBSERVATION
O INSTITUTIONAL 0 STAND -BY
® ABANDONED
0 OTHER (specify.
AMOUNT OF USE
YIELD SOUGHT
gpm /# PEOPLE SERVED /EST. OF DAILY USAGE v V gag
REASON FOR
DRILLING
PIM SUPPLY ❑PROVIDE ADDITIONAL SUPPLY
®REPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL
0TEST OBSERVATION
DETAILED
REASON FOR
DRILLING
WELL TYPE
06RILLED
®
DRIVEN ®DUG ®
GRAVEL
0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES 6� NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Al d
Lot No.
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES. L:�NO
NAME OF PUBLIC WATER SUPPLY:
TOWN /VIL /CITY
DISTANCE TO PROPERTY PItOl�I NEAREST" WATER 'MAIN: "I-,4;14�3"
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON REAR OF THIS APPLICATION ON SEPARATE SHEET
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the
County Health Department attached to this
3. Submit a Well Completion Report on a form
Health Department.
Date of Issue: �J ""� 19_
Date of Expiration: — 19__�j_�
Permit is Non- Transferrable
2/87
requirements of the Putnam
permit.
pr vided by the Putnam County
LjAl"6�6�
ermui�g i�ci al
White copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Orange copy: Well Driller
►• •• 0 01• • •46 ly 0 &k);M : I Y 6-
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
., .- v....>. :.- . " - e..,,,r. y, ,.. •:. .. _ ., - -. - -: a .... ...... o..... _- +�...- .,,.., -, a -._ . . -.,.. ..:,�_: ,, - ... .. • .. _ ... . _
Owner 6 Q -e,—> Address
Located at (Street) �i?v► %i G / tii /oG�if Sec. ; Block �% , lot 3
(indicate nearest cross street)
Date of Pre- Soaking /Z Z
Date of Percolation Test y _
HOLE
NLEM CU)CK TIME
PERCOLATION PERCOLATION
Run Elapse Depth to
Water From Water Level
No. Time Ground
Surface, In Inches Soil Rate
Start-Stop Min. Start
Stop Drop In Min/In Drop
Inches
Inches " Inches
o=
ZL e,> 17 - 3
4V '/_3 3 - y
3 9 f -4-
4
5
1,91y � y >s
39y�ia °� i y �- 3
4
5
1
2
3
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained.at each percolation test hale. All data to•be submitted
for review.
2. Depth measurements to be made from top of hale.
rev. 9/85
PIT
M
WrM APPLICATION
. BOLE NO.
- o
20
R
3°
40
5°
6°
70
go
10°
11°
1a°
13°
04 kN 6) (Wily wmffi:�T) Diem OAT; ROM"fly N;A;o M MA roils
DESIGN
Soil Rate Used O' °'� Min/18 Drop: S.D. Usable Area Provided S�OaO
No. of Bedrocans Septic Tank tpacity gals. Type d
Absorption Area Provided PLO L.P. x 24°° width . tiench /
Other
Nam
Address��
.1 .; j '4 N "'§ 111 _' , i41IDl�0 _ ,1
Signature OF Nfy�
�pNG'1
Q6
W 'f
I
r � r
FO 4a -r-411
4R0RFSSI0t&0
Soil Rite Approved sqoft,/gal. Checked by � Date
b �
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I,
1- ;r
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1
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1¢
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Inspector
TOWN HALL
R, : ;, ;:mod Y ::�•w..: P11.T-NAM - -V-ALL
(914) 526 2377
TOWN OF Pl'JTNAM VALLEY
BUILDING, ZONING, AND SANITARY DEPARTMENT
December 27, 1988
Dept. of Health
110 Old Route 6
Carmel, N.Y. 10512
Re: SSDS Repair or Expansion
TM #PV 29 — 4-
Owner:
Dear Sir or Madam:
The proposed alteration of Sewage Disposal System as
shown on drawings dated have been reviewed
and determined to be in compliance with
1. Wetland regulations.
2< Information on file in Building Department.
3. Separation to adjacent water supplies.
Applicants that receive permits shall advise the Putnam
Valley Building Department when construction is to
commenc -e. -and- again prior to backfill for_ inspection .of
same.
An "As Built" drawing of said work shall be submitted to
the Putnam Valley Building Inspectors office upon
completion of work.
Building -A oning Inspector
14/0. ,"
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