1122 Williams Road Lot 2Dav
?016
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WARNING: THIS IS NOT A SURVEY .
All data Is pnrAded as Is without wemmy or guarnrtes of any Idnd either expressed or Implied brcluding but not limited to the
Implied mmantes of merchanabllty, or them for a particular use. All users of Davie County's GIS website shall hold harmleu the
County of Davie, North Camllna, is agents, consultants, contmson or employees Rum any and allclalma or causes of action due to
ornddngoutoftheuseorinabiltytousa Me GMdadpmNdedbytdswebste.
77 __ ___:Parcel Information
;
Parcel Number:
170000004313
Township:
Fulton
NCPIN Number:
5778162797
Municipality:
Account Number:
82517540
Census Tract:
37059-804
Listed Owner 1:
WORKMAN WENDY WILLIAMS
Voting Precinct:
FULTON
Mailing Address 1:
701 WILLIAMS ROAD
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class: DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006-7193
Voluntary Ag. District:
No
Legal Description:
LOT 2 CARTERS COURT PHASE I
Fire Response District:
FORK
Assessed Acreage:
0.60
Elementary School Zone:
CORNATZER
Deed Date:
4/2005
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
006020733
Soil Types:
WeC,PcB2
Plat Book:
0007
Flood Zone:
Plat Page:
086
Watershed Overlay:
DAVIE COUNTY
Building Value:
60000.00
Outbu ldi Va uextre
FreaturesLand
130.00
Value:
15450.00
Total Market Value:
75580.00
Total Assessed Value:
75580.00
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Davie County,
NC
All data Is pnrAded as Is without wemmy or guarnrtes of any Idnd either expressed or Implied brcluding but not limited to the
Implied mmantes of merchanabllty, or them for a particular use. All users of Davie County's GIS website shall hold harmleu the
County of Davie, North Camllna, is agents, consultants, contmson or employees Rum any and allclalma or causes of action due to
ornddngoutoftheuseorinabiltytousa Me GMdadpmNdedbytdswebste.
i DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
p Mocksville, NC 27028
�n� ' (336)751-8760
T IMPROVEMENT/OPERATION PERMIT
Account #:
990001216
Tax PIN/EH #:
5778-06-7187.02
Billed To:
Amanda Cline
Subdivision Info:
Carters Court Lot # 2
Reference Name:
Amanda Gine
Location/Address:
Williams Road -27006
Proposed Facility:
Residence
Property Size:
100 x 200
**NO'rE**-ItiiPKprMent/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 TypeA. #People #Bedrooms,_ #Baths /.1/.
Dishwasher: / j Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 13Lot Size 0Q Type Water Supply e Design Wastewater Flow (GPD) Site: New 135/pair ❑
System Specifications: Tank Size 1000 GAL. Pump Tank GAL. Trench Width '( Rock Depth Linear Ft
Other: /"7151Cj—eeCV Or--\,
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the 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 p.m. on the day of installation. Telephone # is (336)751-8760.****
FT
Pit
Environmental
DCHD 05/99 (Revised)
(4) -754 -1DIA-t15
Date: &;) —oa
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
MocksviHe, NC 27028
(336)751-8760
Account #:
990001216
Tax PIN/EH #:
5778-06-7187.02
Billed To:
Amanda Cline
Subdivision Info:
Carter's Court Lot # 2
Reference Name:
Amanda Cline
Location/Address:
Williams Road -27006
rrupuseu racnuy:, mesiaence
ATC Number: 2444
aice: i uu x au
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
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 WASTEWATER—CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Health Specialist's Signature:
CERTIFICATE OF COMPLETION
Date: 6 c� —nc )
The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
has been installed in compliance with Article 11 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.
law
System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
I
Date: 7-( —6D
VIE t° �
D PPLICATION FOR SHE EVAWATION/IMPROVEMENT PERMIT & AT
�r� q Davie County Health Department
MAY
2 8 2000 P:OEBos8�2�0 Hospift tal
ENVIRONMENTAL HEALTH Mocksville, NC 27028
DAVIE COUNTY (336) 751-8760
***1'MPORTAHT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed �(iC�-� �1, �� Q� \ 1(� Contact Person
Nailing Address \�. ) \ l�Q� ` C��nt��t� �`V C.. Home Phona
City/state/ZIP N&ao0oL__@WA Business Phoned n-
2. Name on Permit/ATC if Different than
Mailing Address
City/state/Zip
3. Application For: ❑ Site Evaluation vqmprovement Permit/ATC ❑ Both
a. system to service: ❑ House Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People`5 # Bedrooms -a— # Bathrooms
\y _
KDiahwasher ❑ Garbage Disposal Hashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify •type` # People # sinks
# Commodes # showers # Urinals # Nater Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of Hater supply: County/City ❑ Well ❑ Community
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes VNo
If yes, what type?
***IMPORTANT*** CLIENTS MVSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: `M t 30D V:k
Tax Office PIN: # 5—/v 1 i5 " OLQ�- ri 1 Vy I .DZ
Property Address: Road Nnme Nth \N-,OXYJ& 7)OQCt1
City/Zip f1C'Q
If in a Subdivision` provide information, as follows:
Name: CCl c' s CIiA ).i T
Section: Block: Lol: _e
WRITE DIRECTIONS (from Mocktville) to PROPERTY:
\ •mow_• R-• •n'
L •
): 'L •
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 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 vte County ealth apartment
to enter upon above described property located in Davie County and owned by;\yfLQ�
to conduct all testing procedures as necessary to determine the site suitability.
DATE 3 /a3 Io c, SIGNATURE e L 51i�••�A
TINS 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)
Account No. 1-Z16
Invoice No. __C.7�
R)"4
K)VJ
C2
H. SEAR; -JC,, : SGy�33-54v
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I,WtSL•ItY W•M1LEY CERTIPYT*ftT TME PLAT WqS DRAWN UNDER
MY SuPEitV1SION(DlED DEscmPT16" RECORDIL0 IN BOOK 03 J PAGE
Hos,Etc. ) (oTHiR) ; TNR? -rut Vii+ upiD/t1ES No'r •suRv$YEO ARE
CLEAtu.Y INDICATtG AS WW",006M INFORMRT1614 ROUN01 1N
BOOK 170 , PAGE Y80 ; THAT TINE AR710 OF PAECIS/o1J AS cl!).QULATa'D
IS 1:16,•00+ ; THAT THIS PLAT`WAS PREFPARED M/ ACC*OtDAA#C* w/rH
6•S.4'I.30 AS AMENDED. WtTNES'•S MY ORMINAL. SIGJUATURN,
REGISTAAT/ON 140MONR AND SEAT. THIS 2$ DRY of JNLY, A•O,, 1999.
A l.. S. L,• 3833
1:,WXSLEY W.MILIEY,CERTIFY THAI' THE SURVEYCREATILS A SUPOWISION
OF LAND WIT•Nl►J THE ARVA OF A COUNTY OR MUNICIPAL/?Y 7•flAr HAS
AN ORDINANCE* TNAT REGULATES PARCEL5 OF LAND.
P.L.S. Lr 3833
NORTH CAROLINA, •••• COUNTS(
i, A NO'roRY PUB& -IC. OF Tl1E ' COUNYY AND STATE
RFORIE SAI 01CERT IF`( THAT WESLEY W. . A
pROFESSIONAL LAND SURVAEVOlk,PERSON ALL.Y
APPEARED BEFORE MS THIS DAY A90 ACKN61NA-IED6E
THE EXECUTIOIJ OF FOREGOING INST'RUM"T,
WITNESS MY HAND AND OFFICIAL srAMP OA SEAL.
THIS 23A DAY OF _SU,� 119gA.
.. Ohl
...
S 09 L.
Y HEREBY CRATIFY THAT THE DAVID COUNTY HEALTH
DEPAttTMEN T AFks EVALUATED THE SUSDIV ISION
ENTITLED cAPITBRS CouRT WITH RESPECT' TO CAITERA
AND CONOITIONS ESTA8L1_5MR0 SV STATE LAW OR
PROMULGATED THEAEtJNORR Anlp THE SAME IS FOUND
TO CotAPI~Y WITH SJCH CRITERIA AND CONDITIONS /EXCEPT.
AS FOUND IN SUCH EVALUATION. FOR DETAILS OF THIS
EVALUATION AND FOR LIMITATIONS I SEE rl4X WRITTEN
REPORT Ohl FILE AT TH E ' DE PART IAENT.
IMPORTANT NOT ICE 'YHIS CERTIFICATE DOES Not'
COwsTITUTE R PERMIT OR APPROVRL OF 04DIVIDu90-
LOT'S IN THE SUBDIVISION FOR INSTAL•LA T1 ON OF
SEW AGE FAC II. I TI ES.
0A'rE•• • . COUNTY HEALTH OFFICIAL
jjft JIWOREA WHITTINGION
NOTARY PUBLIC
DAViE CgU TY- Rip"
TAX LaT Af I
N%F Lam, W. IL I V EIJ GOOD JR.
DDS3 PG 329
y SS.7il'
CERTIFICATE OF OwMIERSHIP AND DEDIC AYION
•' I (W6) HERL8Y CERTIFY TNAT I RpA(WE ARE) THTI: OWNER(s) OF
THE PROPERTY DESCRIBED HEREON, WHICH IS LOCATED IMTHE
SUBDIYISIoN JVRISDICT16W OF OAVIE COUNTY ANO THAT Z (wl� +
HERE gY ADOPT T141S SuBDIV1SION PLAN wrrN MY FREE colllsllr"r
ESTABLISHED M►NIMUIV) $UII.DIIJG SETBACK LIMES AMD DEDICATE +JV •
ALL STREETS, ALLEYS, WAs•KS,PARKS, Akio OTHER SITES AND ,IV
IEASEMIEN7S TO PUBLIC OR PRIVATE USE AS NOTED. °' N
r ,.
OWNERS DATE
STATE OF NORTH CAROLINA
COUNTY OF DAVIE
X, •,„ + REVIEW OFFICER OF ORVIE COUNTY, CERTIFY THAT
THE MAP OR PLAT TO WHICH rj4IS crATIFICATIoM 1S APPIXNO MEETS RLL.
STRTu7ORY REO►ulRlEpAEN`YS FOR RECORDING.
REVIEW OFFICER
RAW
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- --
'`1 /P LaNN/E E. JONES
O
Tl E NOTES -
Dg 170 PG 780
HOW OR FaItMALLY
A SUBDIV ISIorJ NRMED `CAR7-ERS COvR'r" FOR MCAR1.Son/
D 8 /85 PG S-/7
BL
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E.
SURVEY NOTES
TN/S /5 >pNpSE ZL
FORK- aIxaY RogD • N 7o'-IS'.13"E /928.09 b P.K.
IJOTE: BUILDIMG SETBACKS
1.)RIGHT OF WAY ow WILLIAMS ROAD IS
LEGEQD
PG
ADDRESS vFaWNERS '
yo'(FT)FROAJ'Y
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R/v,l
RIGHT CtF WAY R.C.P.
RRIUFORCED
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ls,(FT) SIDES
2.)LOTS WILL HAVE PRIVA-•E- PUBLIC WA rER
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EXSISTIK16 2Re)&J Roo
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EXSISTI"G =Roy PIPE LF Q.
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3.) w1L
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5.) RL1" EASEMENTS Ale? Syou�N APE NOT tlAl/MPLIED,
G
CURVE DAT19
loo O Ieo tan
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L
LIIJE DATE
GRAPHIC SCALE
PLAQ AS PER FEMA MAP.
- --
N6l•1-SURVEYED LIWES
O
Tl E NOTES -
N/17
HOW OR FaItMALLY
A SUBDIV ISIorJ NRMED `CAR7-ERS COvR'r" FOR MCAR1.Son/
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No.Z To £CREEK 14vo"RCP AND WI,LL/gM5 RoRDfL.
PG
PAGE
BEIWG PART of TAX to -r A43, 7-I9x MAP T-7, D.4v/FCovAW,
S 88' -47' -53 -vi 95N,9�1'
n10,
NUMBER
STg7'E' OF IJOR7N CR>•Toaln/ A. J=UL•To t.1 -r WS P.
No.3 To NORTH Eu0 of 18"R.C.P. UNDER WILLIAMS
Wn6DED AREA -t
SCALE: /"=/o o' WESLEY W. MILE`( PLS L-3833 oA4vu/J:W�n M
+M ROAD. "_TIG -S9'- 44"E 208.03'
____
SrRERN1
1'•11 OR V M LN .
+
POIWT
DA7E: 7 -ZZ -1959 ; O�KSVI39SS' C 270Za REVISEDT-27-99
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APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
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Davie County Health Department
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Environmental Health Section rI JUN
2 3 1999
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P.O. Box 848/210 Hospital Street
111
Mocksville, NC 27028
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(336) 751-8760 bi
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***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS
PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
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1.
Nemo to be Billed
/��, //d-rContuet Person �•�L-
Mailing Address
rt Homs Phone
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City/state/ZIP
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_ ry�y- -yt�� /? [ 7 `� d U 6 Business Phone �-
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2.
Name on Permit/ATC
if Different than Above
Mailing Addreee
City/state/zip
3.
Application For:
❑ Site Evaluation ❑ Improvement Permit/ATC
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4.
system to service:
House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5.
If Residence:
A People ♦ Bedrooms -3 i Bathrooms
Z
II Dishwasher 11
Garbage Disposal 11 Washing Machine 11 Basement/Plumbing II Basement/No Plumbing
6. I£ Business/Industry/Other: Specify type
♦ People i Sinks
♦ Commodes t• Showers R Urinals 4 Neter Coolers
IF FOODSERVICE: # Seats 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 ❑ No
If yes, what type?
***rAIPORTAVT*
** CLIENTS MUST COMPLETE TO E REQUIRED PROPERTY INFORMA'T'ION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION.
Properly Dimensions:i �- ��G l of WRITE DIRECTIONS (from Mocksville) to PROPERTY:
'Tax Office PIN: 4 S 7 7 5i' - o 7.o Z-
Property Address: Road Name lt/ J�� �po.6l
City/Zip I�rt, 71 C . 2706yG�,t/
If in a Subdivision provide information, as follows:
Name: CRetz'-es roue l
Section: ihL Block: Lot: Z
Date Property Flagged: 7 - 402 - !
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 use change, or If the Information
suLmitted :a �::is 3ppHcatiaa s .-....:'ed or crr :bed I, also, u.rdermand thae I cr. inrarred from
this application. I, hereby, give consent to the Autborized 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 asnecessaryto determine the site suit biil/ityy.
DATE,1Z .3 - �/ �� SIGNATURE ^A,/ Z
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:
LU691
Revised DCHD (07/99)
Account No.
Invoice No. r1_2 U
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900562 Tax PIN/EH #: 5778-06-7187.02
Billed To: Gray Carter Subdivision Info: Carters Court Lot # 2
Reference Name: Gray Carter Location/Address: Williams Road -27006
Proposed Facility: Residence Property Size:., 100 X 300 , Date Evaluated:
Water Supply: On -Site Well Community ;Public
Evaluation_
' By Auger Boring Pit Cut
FACTORS, 1 .2 3 q .... 5 6 7_
-77
Landscape position L
. Slo % _
HORIZON I DEPTH
Texture group
Consistence .
Structure
Mineralogy
HORIZON II DEPTH s G ti
Texture group
Consistence
Structure ., 7
Mineralogy
HORIZON HI DEPTH
Texture group
Consistence
Structure,
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence -
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE r
SITE CLASSIFICATION: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE:' � � �-OTHER(S) PRESENT:' „ _ •
REMARKS:.,
LEGEND
Landscaa Positi
R - Ridge S Shoulder L - Linear slope FS - Foot slope N - Nose slope
CC - FP -
Concave slope r CV - Convex slope T - Terrace Flood plain j H'.- Head slope
S - Sand LS - Loamy sand SL- Sandy loam L - Loam SI - Silt
SICL- Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam
Ity cay C - Clay
SC -Sandy clay ;. 5C -Sil
.. _ lCONSISTENCE
VFR - Very friable, FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm '
Wet
NS - Non sticky SS - Slightly sticky :' S - Sticky VS - Very Sticky
NTP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
Structure
SC - Single grain M - Massive CR - Crumb GR -Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineraloev
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)
MEMO
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