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HomeMy WebLinkAbout3586DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.09 -1 -7 BOX 28 03586 PUTNAM COUNTY DEPARTMENT OF HEALTH - - . Permit' �\ Diyis�on of:Environmental °Hale /ili Serwoes, Carmel, N Y 1�1? ,, P ; _CERTIFiWE 'bVb00TR.UCT10W COMPLIANCE F"0' -, R :SEWAG _O.SAL. SYSTEM, r j ` < Town o%r V illage B oca e =�d'� .r.er�jGi a scR i.. r •yam ,w aa.- �u1t i'hipx t.r.� ' tt ,.. /..e .tea - .ry o•.c+,,. +.a . + i ocafed "'at .�:,,�� ' /I/1 GCS .`/ Formerly Tax MfiP Lot # _- s'Subd Lot # 'owner. _ Separate Sewerage System built 6Y Address ;- `a C.1r '. i Consisting of Pal. Septic Tank and Other reQUiremenfs v Water SuPP1Y Public Supply From ti Private :5uPp1Y -Drilled • BY a F1dd►ess Y 6J Building Type �'J- Q - ENO of Bxedrfooma 6i6, Permit Issued'' F1as Erosion, Control Been Completedi rnrd� a 7a I certify that .,the syetem(s)- ae.l- ieted.aervinq the above.premises;wereAco atru ted�esa�n1'K ae,ahown on the plans of fhe completed work (copies i _, ;of, which' are atEached); -and in accordance' with th4e standards rules a>id iQgdl$tioiie king so da' oe wiYi� the filed ^plan, and iheapermit issued by 'tiha 1 f- Putnam County Department Of Health, �Y,�3 ^� ,rG • ,, Date ' Cer fedbby P.E.R,A. Address' �; v Llesilss � Any° person - oceupying premises served by: -the ova systems) shall: promptly taia{e >4ucli attiori as,ma - e necessary to;fsecure tha eorraetlon of any unsanitary .;. ;. �..- ;. w ;conditions resulting from sueW usage ,•Approval,of the ;separate •sewerage, system; ;�i'a�f$becRrr�e hull_and void as soon as a publtc,YnlWy sewer;. becomes a ._ able and: of the. private water. supply shall - become =n 11 and', voW Ywhen s ,public wafer supply., sicomes available Such ipprovals are availg. " subject to modlfi`aat[on or .change-4vv , In ?the :judgment;.of ,the..0 m her:of . ti,;w revocatio . modlflcation or -chanpe'It, necessary, fl,, r Tltb l By � • r• t Rev:9 -81 Owner or Purchdser of Building :z 0 Section Building Constructed by Block •'}'. ... �r'�....�..io 4c�a�u.� .n .:. r. •x .��. r.. ., :.�'. '..p . .-v .�. ...r a.a Location - Street Lot Gj /`7? 'dw Municipality Building Type Subdivision Name l Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, 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 success- ors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to- accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services of the Putnam Co.u.nty Department .of .Health• as to whether or not the- .ail- iire �f.� fire -sys �enr-��' ugera-�e wa-s or -n+eg3 ger, of the occupant of-the building utilizing the system. Dated this Si day of 19 Signature Title 04.0^e je Corporation Name if corp -- l Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health �s D— . _ ,` • Ing Section Building C.onstructed by. _ Block .. "y: >.. �. ... -s° .. r. .: ♦ . ...- ... y -� ti ..� c. ,.. .. �.�.- rc- i..,:r: -. . — '�k :r, ..—. ,. :y. _ n.. .. n.-.. .. ...•• @ -• �.. ..c. =a - •.:e. ,G:.... � - -a Lo- 16a t 1 1,96 - S reet Lot U Municipality f Building Type Subdv. Lot GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, 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 success- ors, 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.initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services . :..: of-, the - Putnam County - )epart!nent of Hea -nth : as to whether-or not the .;fail- _.. ure of the system.to operate was caused by the willful "or negligent act of the occupant of the building utilizing the system. Dated this day of Z7"_h& 191E Signature Title ©low,C'k Corporation Name if corp.) /A�t> � • �I Jam/ D ... � ���-�C ' �� Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health. -. M Owner or Purchaser of B ding Section Ein l' ding. Co s•tr i'ted =,by. n : >: . rv,. Bloeic Locat on Street Lot ) Municipality Subdivision Name Building Type Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, 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 success- ors, 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 initial use of 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 occu- pant of the building utilizing the system. The undersigned further agrees to - accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services __..-- o#�=the -i°utn�m O un ty Depaxt�rerit `of - Heintin- a s'- ter' ri�3 til; i - or- mo't� °the a- i1-, -- ure of the system to operate was caused by the willful or neglig nt.act of the occupant of the building utilizing the system. Dated this o` ,S- day of ,Ly)& 19� Signature i Title e:wA)IVe, je Corporation Name if corp. ion ,u •�y �v'�P�CS�i 1 Address THREE (3) COPIES ARE REQUIRED WITH THREE (3)'COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health YORKTOWN MEDICAL LABORATORY INC. 9 "321 K Street LOCATIONS: P.O. �oz 9 ear ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 320 ftktown Heights, N.Y. 10599 t-BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737.8777 2,45 3203 ' :::,.: < ,- -....; z •:......<v :a,49`T,_,L�EGi! . Er,K(` _ 5 MAIN ST , MT SCO N Y 10549 666 F F: :'AV EAF.r.gSPi_� L1,. .AR�1E 1n5.1,2 r � (o Zv11.C%w. L ke All �7 -j LABORATORY REPORT m9 /L. ❑ ACIDITY ❑ ALKALINITY ..... ............................... tom' <nACTERIA, TOTAL /mL ....... .................. 10 SOD. 5 DAY ................... ............................... ❑ BROMIDE ................... ............................... ❑ CARBON DIOXIDE, FREE .............................. ❑ CHLORIDE .....:............. ............................... ❑ CHLORINE .................................................. ❑ COD .: ............ ............................... ❑ COLOR ....................................................... ❑ CYANIDE ................... ............................... ❑ DETERGENT, ANIONIC ... ............................... ❑ FLUORIDE ................... ............................... ❑ HARDNESS ................... ..............:.........:...... ❑ h1PN COLIFORM COUNT/ 100 ml .................... ffT COLIFORM COUNT/ 100 ml .................. ❑ CONFIRMATORY TEST ........... .. ....4...... -__.__ -❑ h'1.T90rRN, 4+,.hit,��N!A. _ .. �.....,. ...- . „ ><..<,..< .. ❑ NITROGEN, KJELDAHL ... ............................... ❑ NITROGEN, NITRATE ... ............................... ❑ NITROGEN, ORGANIC .................................. ❑ ODOR ....................... ........................ ;...... ❑ OIL & GREASE ............... ............................... 0 PH .......................................................... ❑ PHENOL ....................... ............................... ❑ PHOSPHATE (ortho) ....... ............................... ❑ PHOSPHATE (condensed) ... ............................... ❑ PHOSPHATE (total) ....... ............................... ❑ SOLIDS, SETTLEABLE; m1 /L .......................... ❑ SOLIDS, SUSPENDED ... ............................... ❑ SOLIDS, DISSOLVED ... ............................... ❑ SOLIDS, TOTAL ........... ............................... ❑ SOLIDS. VOLATILE ....... ............................... ❑ SPECIFIC CONDUCTANCE .............................. ❑ SULFATE ................... ............................... ❑ SULFIDE .................... ............................... ❑ SULFITE .:.................. ............................... ❑ SURFACTANTS ............ ............................... ❑ TUR BIOIT . ................ ............................... THESE RESULTS INDICATE THAT THE WATER THE SAMPLE I4AS COLLECTED. THESE .RESULTS INDICATE THAT THE WATER NEW YORK STATE ADMINISTRATIVE RULES & FOR THE PARAMETERS TESTED. ALBERT It. PADOVANI rI.T (ASCP), DIREC' LAB # DATE TAKEN: b /J-/�f -7 G' DATE RECEIVED: 6 / /y DATE REPORTED: SAMPLE SOU�CE: t Yc REFERRED B�� %���L T COLLECTED BY: 1'�Q- ❑ ALUMINUM ............... }............................................... ❑ ANTIMONY ................................ ............................... ❑ ARSENIC .................................... ............................... ❑ BARIUM ..... ............................... ............................... ❑ BERYLLIUM ................................ ............................... ❑ BISMUTH ................ ............................... ................ ❑ BORON ........................................ ............................... ❑ CADMIUM .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ CHROMIUM Itot.) ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ COBALT .................................... ............................... ❑ COPPER .................................... ............................... ❑ COLD ........................................ ............................... ❑ IRON ................ ............................... ❑ LEAD ........................................ ............................... ❑ LITHIUM .... ... ............... ❑ MANGANESE ........................................................ ..... ❑ MERCURY .................................... ............................... ❑ NICKEL .....................:.................. ............................... ❑ PALLADIUM ................................ ............................... ❑ POTASSIUM ......... .............................:. ❑ RHODIUM ........................... ............................... 6........ ❑ SELENIUM ..................................... .....'......................... ❑ SILICON ........ :..................................... ..................... ❑ SILVER ........................................ ............................... ❑ SODIUM ........................................ ............................... ❑ TIN .............. .......................... ............................... ❑ ZINC ............................................ ............................... ❑ .................................................... ............................... ❑ .................................................... ............................... ❑ REMARKS: ..................................... .......... ............. .. ❑ ................................... ............................... . .............. .................................................... ............................... ❑ .................................................... ............................... ❑ ......... ............ ❑ .................................................... ............................... ..�......... .............. ............................... _.. _._ _ ....... WA OF A SATISFACTORY SANITARY QUALITY WHEN 1 1 A DID MEET Tl SATI CTORY CIIEMICAL LITY OF rD�NS— 4AT,;R STANDAD (PART 72) S.i Yorktown Medical Laboratory, Inc. ALBERT H. PADOVANI M.T. (ASCP) - - �.. ... Ts.r rrs :. vy•f to _t •:.a, -x y a. .v -z...., .... -'.. ,. ... :, .r. :.; ♦ w - a ....mot - . .. .mx .: a.. .. n. .. ,. .... . . Director • �.- - -.- P.O. Box 99 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -3.203 201 Buttonwood Avenue (Comer of 202, across from Hospital) Peekskill, N.Y. 10566 (914) 737 -8777 495 Main Street (Across from Lloyds) Mount Kisco, N.Y. 10549 (914) 666 -3335 THE MEANING OF THE WATER ANALYSIS REPORT Stoneleigh Avenue (Corner of Drewville Road) Carmel, N.Y. 10512 (914) 278.9330 This statement has been prepared to help you interpret the WATER ANALYSIS REPORT you.have received. The purpose of this examination is twofold: the determination of the total number of bacteria present and the specific determination of the presence of members of the COLIFORM group. The item BACTERIA per ml is a measure of the total bacteria present. One quart of water contains 940 ml. One ml of water is added to a nutritive medium which acts as a source of food for the bacteria. This portion of water sample plus medium is then incubated for 24 hours at 37 °C. At the end of that time, the organisms which have grown and multi- plied are counted. There, is no limiting value for this determination but it is of interest in judging the sanitary quality of the water sample. The second determination, the COLIFORM GROUP is of more importance. This group includes several species of bacteria which are,.more or less, normal inhabitants of the intestinal tract of man and many other animals. Conse- quentIy,..th.ey, are.,found,in tremendous numbers.in fecal matter.and sewage. The - organisms of this group are usually -not d igeriiusl'i5 fhemse7Q but �wvWdfi -found 'ihby do indicate potentially d`an`gerous contamination since sewage'at any time might carry pathogenic or disease producing organisms.' The source of this contamination might be a sewage system which is located close to a well or spring. It might also result from failure to protect the water supply from' surface drainage or contamination or the entrance of small animals. Any time a water system is repaired or opened up it should be sterilized by the addition of chlorine in some form before being returned to use in order to eliminate any contamination which might have been introduced. Our test is done by "MEMBRANE FILTER TECHNIQUE" or MFT. A negative test is indicated by a value of LESS THAN 1. Any number greater than 1 indicates the presence of COLIFORM organisms and is reason for stating the source of the sample is not satisfactory. The test requires a minimum of 24 to 48 hours and very often 72 -96 hours. It must be understood that the results of this test apply to the water source only at the time of sampling. Unusual conditions, such as heavy rainfall or drought, flooding, changes or additions to the water system, installation of septic tanks or cesspools to the nearby area might all have an effect on the sanitary quality of the water. Consequently, analyses should be made as often as circumstances warrant. .- a WEI L COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of analysis of •water sample indicating water. Is of satisfactory bacterial quality before certificate,of construction compliance Is Issued. - REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAMEo ADDRESS LOCATION OF WELL (N Street) (Town) r (Lot Number) 27- / O X7 PROPOSED USE OF WELL BUSINESS OMESTIC ❑ ESTABLISHMENT ❑ FARM TEST WELL ❑ OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DRILLING EQUIPMENT COMPRESSED CABLE OTHER ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION LJ (specify) CASING DETAILS ' LENGTH (feet) / DIAMETER(inches) Cy A IWEIGHT PER FOOT THREADED. ❑ WEIDED DRIVE SHOE YES ❑NO — tiT D°) YES NO s... YIELD TEST �:; - r:.:.- .: HOURS G P.M. BAILED ❑ PUMPED COMPRESSED AIR YIELD (0 P M.J WATER LEVEL MEASURE FROM LAND SURFACE— STATIC(Specify, feet) - DURING `YIELD TEST 1 feet) Depth of Completed.Well' in feet below Land surface. (y SCREEN MAKE LENGTH OPEN TO AQUIFER'(feet) DETAILS: SLOT SIZE DIAMETER (inches) =IFF VEL Di ameter of well including: gravel pack (inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least ' two permanent landmarks. FEET to FEET If yield was tested at different depths during drilling, list below' FEET GALLONS PER MINUTE DATE WELL OMPLE ED DATE OF- REPORT WELL DRILLER (Si a(turej - •' a, - P�- 'PUTNA COUNTY4 DEPARTMENT_ OF HEA {Pe:m it'r � I _Division of. Enviionmenta7 Health `S&vices, C* M"06 N. Y. 10512 CJ CONSTRUCTION PERMIT, FOR SEWAGE _DISPOSAL SYSTEM'= !' 1 gown or age LOCated..at * !if r Ly l Subdivision ubd:'.Lot•q Renewal Q Iteyision + Owner /Address O �� i 60 = �' °� Date OP Previous Approval - -' - - (- Building,-Type ,% G S Lot Area' eill on, only 0 Z r , (Number of Bedrooms.; Design',Plow c /e /d c D,. Notification Required �O P R y .. s h Separate Sewerage. System to consist of % ,Z'' �YGar Septic Tank -' and,--* r4' /rJ�! To be constructed by Address vp 4 _ 5 Water. Supply Public Supply From I Prwate Supply to be tlF;lled by F.w Address: Other .Requirements 7_ f fr h �/�T/1 r j� .a r7 /� G� /Cf "r, /• -i 1` d represent that'1.tam wholly ind',eompletely responsible for the design 'ind l location of the proposed system(s); 1) that the separate; sewage dis orals stem :'above described will be constructed as shown on ttie approved amendrnentth'ere to and'in accordance with the standards, rules an regulations o r u nam + 'Count `De artment of Health, and that on completion thereof a Certificate of Construction Compliance" 'satisiactory to the Commiffioner,pf Health will 1 Y P - x nbe -submitted' to" the Department and a written �g'uaranteeTWIll betfurnished the'owner his'successors ,,heirs' 1°b a he builder, that',said,builder will place .in good operating,i onditionr any part of said,:sewage disposal sy;terli during. the period ofawo'.(2 s m j�e Ilowiry the date of the isw- once of the appioval of,,ttie' Certificate, of Construction. Compliance of_the original, system or any re ��CCQhe�fto ! ti(pt„ filled •well'descrlbed above` ,will be located.as'shoavn on the approved plan and that sa�� well will be Installed in accordance ,with the aifdplr%(��al�doo ons of the ' Putnam., County Department of Health 0 j Date' r Address LlcenQe�N APPROVED FOR CONSTRUCTION This,approvsl expues one year from the date issued unless tor° • iod5 f Duiltlin� y eon undertaken and 1s 4 ;revocable for-cause-or . may De amended or- moditiedwhen considered necessary by the Comma; er;C�.InAtlx nt�e +� s�jiteratkin of construction .. rf, requi►es'a ne p` mat ?. proveif f r disposal of: "domestic sa ry age; and/ private star`s e� 0,► .sou p® t 0 _ Date r 9 =81 t v1 2 vaAm�o D1:1'ART� --,M :T OP 1f1'Aulf h Date -- =fZ ,-5 " -/ � Rea Property of �� � ✓�i-7 � � !�'Gr � fir' - Located at J 12 -1—r" . Section z Block j' 'Lo ©�_! Gentlemen: This letter is to authorize 7015 a •duly licensed professional engineer y or registered architect. (Indicate) to. apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as pro,atulagated by the Commissioner of the Putnam County - -Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction-of said` system or systems in conformity with the provisions .o.f.Ar_ticl.e 145. or 1747, 'Educai:ion' Law, the Public Health Law, and the Putnam County Sani- tary Code._ � t Countersigned: P.E:; R.A.,! Add2'CSS Telephone Very truly yours, Signed agner of OF HNElp*N, $ o° NCI operto� ° A• e�io v 0 f� " f�• � � .,.�• 1, Telephone v R. (, I MAP W* e . C)F f ° oT PUTNAM COUNTY DEPARTMENT OF HEALTH .DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING,.CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner / �i i'�ryQj„„ ti �3�.,a��iiess ! y C/ C' 1 JJ" , 're Located -at ( Street %3P r'__ Sec. Block % Lot Indicate— nearest cross street) Municipality. y In h7 0- / e Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse, Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate Start. -Stop Min. Start Stop Drop in Min. /in drop . Inches Inches Inches 2 ... ,: 7_l. f 3,)3 4 W_ __4 Notes: 1) Teys�ts to be repeated at same depth. until apppproximately equal. soil _ .. rates are .oh ne�L t..,e &;ch_ >pe co] nti':an hest, hole::.,- All- ,data- to:-be"._slibmit�t;ed-�.. • __ for review. 2) Depth measurements to be. mad'& from top of hole. DEPTH G.L. 6" 12" 18 2411' 30" 36 it 42" 48" 5411 -- I '. b TEST PIT DATA RD &IRED TO BE SUBMITTED.. WITH. APPLICATION DESGRIPTI-ON`OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0._ HOLE .NO.a 22'. HOLE NO. --� 60'► 66" 72" _ 7. 84" INDICATE . LEVEL. AT, WHICH GROUND..WATER. -IS. -ENCOUNTERED INDICATE LEVEL TO WATER .LEVEL; RISES AFTER BEING ENCOUNTERED TESTS MADE .BY., Ylile� . Date .1j g / DESIGN. ,Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided 5'p 0, a No of BedroomsSeptic Tank Capacity % Gals. Type a.�c�oor Absorption Area Provided By,!rV v L.F.x24" width trench. ' ' Address 2 t>'�! �� �EAL�� ° r THIS SP CE FOR USE BY HEALTH DEPARTMENT ONLY: ?Q0 °° ° e 00 Soil Rate Approved Sq. Ft /Gala Checked by R) ECENED PUTNAM COUN IN DEPT. OF HEAL T6. .qP�1 v -.. wi•i r.�• yy ♦•. �• .�.y0 .eztr• v'•I aw t._w._.• a.r•..��t l' ��.��a� �www�r�'� .f..• .. aI P. .i .•.• r w .. -a...• .....• a�rrt... J ••y •i •, E � � t �' ' i � (` .. � � � '� -.s mot• .u. ;+�, •,�,• ' tv �; � ' �.' '*<.� :�� � Cry,, . tat j �C+� �,,�`•. '�. �Q 'gip � C? 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