111 Greenfield Road Lot 26Davie County, NC ' a Tax Parcel Report
Monday. December 19.2016
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q�mt8All data Is provided sets vdthottw rmnty or guarantee of any Idnd either expressed or implied Including butnotlimbed to the
Davie County, Implied mmudis, of merchantability or ftems, for a parldcularum All users of Davis Counly's GIS mbsite shall hold harmless the
County of Davis, North Carolina, its agents, consultants, cordmctora or employees from any and all claims or rouses of action due to
MoD 2 NC or arising out orthe use or lnabtittyto use the GIS data provided by thlsnebsbe.
WARNING: THIS IS NOT A SURVEY .
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Parcel Information
Parcel Number.
D3010A0026
Township:
Clarksville
NCPIN Number:
5822148405
Municipality:
Account Number.
8301515
Census Tract:
37059-B01
Listed Owner 1:
NUNN KEVIN R
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
317 VALLEY ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
LOT 26 DUTCHMAN HILLS
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
0.92 Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
10/2012
Middle School Zone:
NORTH DAVIE
Deed Book/Page:
009050883
Soil Types:
MnB2
Plat Book:
0007
Flood Zone:
Plat Page:
190
Watershed Overlay:
DAVIE COUNT
ildin
utbu
Building Value:
FO ea ures Va ue:
Land Value:
Total Market Value:
Total Assessed Value:
q�mt8All data Is provided sets vdthottw rmnty or guarantee of any Idnd either expressed or implied Including butnotlimbed to the
Davie County, Implied mmudis, of merchantability or ftems, for a parldcularum All users of Davis Counly's GIS mbsite shall hold harmless the
County of Davis, North Carolina, its agents, consultants, cordmctora or employees from any and all claims or rouses of action due to
MoD 2 NC or arising out orthe use or lnabtittyto use the GIS data provided by thlsnebsbe.
ermitttee;33 DAVIE COUNTY HEALTH DEPARTMENT
Name Q� lLr/Ge� !J SS •: �'[ ,2 Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Directions to property: /,0///, Mocksville, NC 27028 Subdivision Name: 2k#hA9W!�4Y&
rX- pel r.0// !l• A%>kr it 1"irk Phone #: 336-751-8760 Section: / Lot: zG
�r ' AUTHORIZATION FOR
0, r, ,/r'* (11111,'- 1,'- A full ,I, G(f WASTEWATER Tax Office PIN:# .moi a t _ / c/
SYSTEM CONSTRUCTION ///
AUTHORIZATION NO: 002972 A RoaIvame:6 e,,l//P Zip: Z7n2f�
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
HEALTH SPECIALIST
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
DATE ISSUED -
RESIDENTIAL SPECIFICATION: BUILDING TYPE,_9 # BEDROOMS 3 .. # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY (do I DESIGN WASTEWATER FLOW (GPD) ,,,�,,��.NEW SITE REPAIR SITE /V//01
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP/TANK GAL. TRENCH WIDTH ROCK DEPTH A� LINEAR FT. A��
OTHER "...".f -t-J4" leiwle /a ,„ jlo, �, ow,& -)4 r4 /f il,)d//�7 �/Gw �11�✓/(• �, y/r
13Nw. #/ 'f4^ /7//" NC /rd -A/1 J,Vj EX
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REQUIRED SITE moDIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT z 6O . ('ryi``Ai ilIq ;
ill pfr. �G�
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II FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BEf WEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. II
OPERATION PERMIT p
SYSTEM INSTALLED BY: �"�\�o✓K-�a'2i
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AUTHORIZATION NO. 29'72 OPERATION PERMIT BY:
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DATE: G' 2,7_0 :
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 0110I(P.1ho, AW, 4QkR9nm6 Fr Tvu. 696c—
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Name* I1^'1['/" G> r, Environmental Health Section PROPERTY INFORMATION
.4%`i ... P.O'. Box 848
Directions to property: //' . / L -/i- / . Mocksville, NC 27028 ' Subdivision Name:
Phone #: 336-751-8760
Section: / Lot:
` AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# = � d G - it/
AUTHORIZATIONNO: 002972 A Road Name:(,,•A..i. %f Zip: Z7'�%
**NOTE** This Authorization for Wastewater System Construction MUST BE ISS&Vby the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 1 I of G.S. Chapter 130A• Wastewater Systems, Section .1900,Sewage Treatment and Disposal Systems)
( ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
1��"r' * G•Z� {1% IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIItONMENTAL HEALTH SPECIALIST DATE ISSUED .i
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFT # SEATS _ INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY �do lli( DESIGN WASTEWATER FLOW (GPD) NEW SITE iL,.. REPAIR SITE M/A
SYSTEM SPECIFICATIONS: TANK SIZE /t GAL. PUMP TANK -!!Y/-+—GAL. TRENCH WIDTH /70' ROCK DEPTH /V0- LINEAR FT. 011
OTHER /)lov. m.' EY•3'�` ��i-fyf/ `/1 r)•�li /�,,/✓C [d %(�,rf• /% i..)d,/�y N=l��//w/(• f,/N/♦
,q A•/! o/ Ni•%C i-�/r.// ar I C ii•J . i'/!/ L.iv� X),),47 6; .1u.(lY dr•. ).n[UJ /
REQUIRED SITE MODIFICATIONS/CONDTI70NS:
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT-
SYSTEM INSTALLED BY: La�cv-,..`. ✓C'�
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AUTHORIZATION NO. 2'/72 OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT-
SYSTEM INSTALLED BY: La�cv-,..`. ✓C'�
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AUTHORIZATION NO. 2'/72 OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02102(R"imd) AMJ LV-1C4n I/S k .11 , -1 All) /n9/r'
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 8481210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002147
Billed To: The Ward Group of NC, LLC
Reference Name:
Proposed Facility: Residence
ATC Number: 3172,
Tax PIN/EH #: 5822-14-6855.26 WG
Subdivision Info: Dutchman Hills Lot # 26
Location/Address: Highland Rd -27028
Property Size: 260x 158
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
"Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATERI6i0�CTI AL�PERIOD O/F' FIVE YEARS.
Environmental Health Specialist's Signature: `��{/ Date:
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate a described on Improvement/Operation Permit
has been installed in compliance with Article 11 of G.S. Cha er 3 A, Section .1900 "Sewage Treatment and
Disposal Systems," but shall in NO WAY be taken as a guar t at the system will function satisfactorily for any
given period of time.
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street n Y �A GTL
f Mocksville, NC 27028
(336)751-8760 �� d
IMPROVEMENT/OPERATION PERMIT
Account #: 990002147 Tax PIN/EH #: 5822-14-6855.26 WG
Billed To: The Ward Group of NC, LLC
Reference Name:
Proposed Facility: Residence
Subdivision Info: Dutchman Hills Lot # 26
Location/Address: Highland Rd -27028
Property Size: 260x 158
ATC Number: 3172
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT' IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM
Residential Specification: Building Type
#People #Bedrooms �,? #Baths
Dishwasher:C— Garbage Disposal: ❑ Washing,Machine-9100� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Se 13ats Industrial Waste:
Lot Size Type Water Supply A Design Wastewater Flow (GPD) 36e1) Site: New 0-' Repair ❑
System Specifications: Tank Size /&3& GAL. Pump Tank GAL. Trench Width cT6Rock Depth /�2 Linear Ft. :rZO
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representati pf)he Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 A169fthe day of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature: l Date: —/J 7-2-'�
DCHD 05/99 (Revised)
ti . • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & U
Davie County Health Department
Environments/Health Section
P.O. Box 898/210 Hospital Street JUN
Mocksville, NC 27028 % 2
(3U)751-876.0
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T �� /(
INFORMATION IS PROVIDED. Refer the INFORMATION BULLETIN forL�instr`ucQ q� s. - 11
1. Name to be Billed �'L2. W AAD \&P -o k+ Contact Person YDCL W 4.1Dn p�
Mailing Address -11I W,(�e(�r- ,,�.�} y�1J pt - Home Phone 336 NS ' RZX p
City/State/ZIP W �+�r{<..5�,,,._ V11 C- A� I t) ( Business Phone 336 3It5' OV8 8 a./
2.. Name on Permit/ATC if Different than 1Above (� 1 (_�^..��
Mailing Address Z I I W , Na tLoes' —M Ct,, City/state/zip W'S (V 1✓ 2-2 10 ( ail
3. Application For: ❑ Site Evaluation d7 Improvement Permit/ATC oth
a. System to Service: ZHOuse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. I£Residence: # People 2 # Bedrooms 3 # Bathrooms 2 -
W/
Dishwasher ❑ Garbage Disposal IdWashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify type P) f) �/# People --X— # Sinks _
# Commodes _ X # Showers # Urinals X # Water Coolers
IF FOODSERVICE: # Seats A' Estimated Water Usage (gallons per day) (�
7.- Type of water supply: County/city_ ❑ Well ❑ Community
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ,KNO
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: uGO )C, IS -9 _ WRITE
/ DIRECTIONS (from Mocksville) to PROPERTY::
Tax Office PIN: # S� ss Z6 Y (90/ Noor" Ae-S
Property Address: Road Name
City/Zip
If in a Subdivision provide information, as follows:
Name in C�Mtv`tw. {T�\`S
Section: Block: Lot: Z (D
FZ AA , TAIP_
14,1 0J
Date Property Flagged: & / /0.1 'L
This is to certify that the information provided is correct tothe best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by'
to conduct all testin procedures as necessary to determine the site suitability.
DATE % 2 SIGNATURE r -CK
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Client Notification Date:
EHS•
Revised DCHD (07/99) v`L- —fo
Account No. / c/ 7 -
Invoice No. 0 (S c/
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC yD BE�.a •w e '
Davie County Health Department
/ Environmental Health Sectlon
4 -se G'��I��- P.O. Bo: 869/210 Hospital street Z'� 7
MAckeville, NC 27028
(336)751-8760
>,
***nWDRTANT*** THIS APPLICATION CANNOT BID PROCESSED UNLE88 ALL HE REQUIRED
INFORMATION I8 PROVIDED. Refer to the INYORMATIOH BULLETIN for instructions.
1. Naas to be Killed contact Parson 6r AU4
Nailing Address nn �tC/ SS el some mono
city/atate/azP 1� U61Nee_ Ale, ,27e06 Business mens
a. Nese on Permit/arc if Different than Above
Nailing Address City/state/Kip
3. Application for: 19 'Hite Evaluation ❑ Improvement Permit/ATC ❑ Both
s. eystem to service, P"RHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
S. If Residence: 11 People 1 Bedrooms i Bathrooms
D Dishwasher D Garbage Disposal O Hashing machine D sasament/Plumbing D Bassmu,t/no Plumbing
6. It susiness/industry/other, "airy hype I People 6 sinks
I Comdex a showers 1 urinals a Nater coolera
iP TOODSERVICE: II seats Estimated Nater Usage (gallons per day)
7. Type of water supply: E County/City ❑ Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑Yea ❑ No
If yes, what type?
***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the rlteni wdih TN1c ADp1.1r AT1nN
Property Dlmensie5 l /.3
Tax Office PDN:s�.�j
Property Address: Road Name _(d / cf%ifly dh Pol
city/zip I>1ac,(sv,_ — qe,,t;7we
If In a Subdivision provide Information, as follows:
Name: ��G �C it I -ha /L —
Section: Block: Lot: lZa
WRITE DIRECTIONS (from MockrAlle) to PROPERTY:
/O/ /''V//yAlt 72
yhrOe
Date Property Flagged: �U /n�'t t�c�tfarte�i`C
This Is to certify that the Information provided Is correct to the best of my knowledge. I understand that any permit(s)
Issued hereafter are subject to suspension or revocation, If the site plans or Intended as change, or If the Information
submitted In this application Is falsified or changed I, also, understand Ihsl lam responsible for aB charges incurred from
rhls opplicallom 1, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitsWity.
DATE �- I%,O — 60t)
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Incl sill of the following: Existing and proposed
a
property lines and dimensions, structures, setbacks, and septic lotio ;
Revised DCHD (07/99)
Date(s):
EHS•
Site Revisit Charge
Notification Date:
Account No. 411
Invoice No.
' - DAVIE COUNTY HEALTH DEPARTMENT 4 all
Environmental Health Section
'Soil/Site Evaluation
TION
APPLICANT INFORMA PROPERTY INFORMATION
Account #: ,9899
00111 ,Tax PIN/EH#5K2-,14-6855.26
6
Billed To: GrayPotts SubdivisionInfo: DutchmanHills
Reference Name: Gray Potts Location/Address: Eatons Church Ro
ad�-2�70'2�8
Proposed Facility: Residence Property Size: Acres Date Evaluated:
Water Supply: - On-Site Well Community Public
n By: , Auger Bonng Pit j/ • Cut
ut �
FACTORS 1: 2. g 4 ... 5 6
Landscape position
Slope %
HORIZON I DEPTH
Texture group LC
Consistence .
Structure
Mineralogy
HORIZON H DEPTH i / . it
Texture group
Consistence..
Structure
Mineralogy
HORIZON III DEPTH
Texture group
..Consistence
i' Structure -
Mineralogy
HORIZON IV DEPTH .
Texture group
Consistence
Structure,
Mineralogy,
'TOIL—WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION.
:.-'LONG-TERM ACCEPTANCE RATE I Io'
SITE CLASSIFICATION: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE:
OTHER(S) PRESENT:
J.
REMARKS:
LEGEND
Landscape Position
R -Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope
CC - Concave slope CV - Convex slope < T - Terrace . FP -Flood plain ., H - Head slope
Texture
S - Sand LS = Loamy sand ..SL- Sandy loam.. L - Loam . SI-Silt. .. .
SICL - Silry clay loam SIL - Silty loam - CL - Clay`loam . SCL - Sandy clay loam
SC - Sandy claySIC Silty clay C - Clay
CONSISTENCE..
Mois
VFR - Very friable I FR -Friable FI - Firm VFI Very firm EFI - Extremely firm
Wet
NS - Non sticky . SS = Slightly sticky S - Sticky VS - Very Sticky
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
ructure
SC - Single grain M - Massive CR - Crumb OR - Granular ABK - Angular blocky
SBK-Subangular blocky PL - Platy PR - Prismatic
Mineralogy ..
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
: Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD 05/99 (Revised)
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