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HomeMy WebLinkAbout0562 SKUNKNET ROAD - Health CA UNKNET IZQAD, CENTERVILLE 9 015.008 llll tpaid- UPC 12543 No.53LOR HASTINGS, LIN 1 S u= Commorweatth of Massachusetts John Grad ExecuWe Office of`EnWorme►Ytal Aft firs _ D.E.P. Title V Septic Inspect©r Department of - P.O. Box 2119 - aticket, MA 02536 Environnient�al Prote�t�o Te n _ _ .. (508) 564-6813 SUBSURFACE SEWAGE_DISPOSAL SYSTEM INSPECTION FORM �,1.. �,�� - _ - e: - PART A - CERTIFICATION SKu�►kNe� .� - S ' ��� ,, � Property Address: 552 SWJ2101eeltRCL Centerville,Ma. Address of Owner: Date of Inspection:8131196 (if different) c 'Name of Inspector.-John Grad Kennealy:Box 749 Centerville,Ma 02632 S �' � &I g ,;- Company Name,Address and Telephone Number: f CERTIFICATION STATEMENT ,._ I'certify that I have personally inspected the sewage disposal system at this address and that the information reported below`is true, accurate and complete as of the time Iof inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes _ Conditionally Passes` Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date:,8131196 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if.applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,.or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system; upon completion of the replacement or repair, passes inspection: Indicate yes, no,or"not determined(Y, N, or ND). Describe basis of determination in all instances. If "riot determined",explain why not.) The septic tank is metal,cracked,structurally unsound;shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by•the Board of Health. (revised 11115195). One Winter Street . • Boston,Massachusetts02108 • FAX(617)556-1049 • Telephone.(617)292-5500 : a SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A -- CERTIFICATION(continued) _ KnhKneck Rd.Centerville,Ma Property Address: 5628 _ OW nef: Kenneary:Box 74g Centerville,Ma.02632 Date of lnspectian:8131196 _ Sewage backup or breakout or high static water level observed in the distribution box is due to.a broken, 1� settled or uneven distribution box.;The system will pass inspection if-(with_approval of the Board of Health) broken pipe(s)are replaced obstruction is removed - distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced . is removed _ strut tion . obstruction - Cl FURTHER EVALUATION IS REQUIRED BY,THE BOARD OF HEALTH: Conditions exist which require further evaluation.by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. SYSTEM NES THAT THE 1) SYSTEM WILL PA S UNLESS BOARD OF HEALTH IN A MANNER WHICH WILL PROTECTTIHE PUBLIC HEALTH AND . NOT FUNCTIONING SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water feet of a bordering vegetated wetland or a salt marsh. Cesspool or privy is within 50 2) SYSTEM WILSUPPLIER,IF APPROPRIATE)L FAIL UNLESS THE BOARD OFAHEALTH (AND PULICNNER THAT P OT ECT THTE ER PUBLIC HEALTH AND SAFETY AND THE DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A M ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a r tribu tary to a surface water supply. ter supply o Y. - surface of water PPY absorption system and is within a Zone 1 of a public water The system has septic tank and soil ly supp .well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. te The system has.a septic tank an ateri analysiso t'on system for col fo mand is less than 100 bacteriia volatile organic compounds indicates that the well is water supply well,unless a well the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. free from pollution for-that facility and . 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis.for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ m component due to an overloaded or clogged SAS or Backup of sewage in facility or syste cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 11115196) . 2 m 'TV SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM - PART A CERTIFICATION(continued) ,: Property Address: 562-Skunkneck Rd.Centerville,Ma Owner: Kennealy:Box 749 Centerville,Ma.02692 Date of Inspection:8f31(98 D] SYSTEM FAILS(continued) - _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _~ Liquid depth in cesspool is less than 6"below invert or available.volume is less than V2 day flow. _ _Required pumping more than 4--times in the last year NOT due to clogged or obstructed pipe(s). Numbers of.times pumped Any.portion of the Soil Absorption System, cesspool orprivy,is below the high groundwater: elevation: Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a lone 1 of a public well ithin 50 feet of a private water supply well. Any portion of a cesspool or privy is w Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform-bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. : E]„LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: The system serves a facility with.a design flow of 10,000 gpd or greater(Large System)and the system is a.significant threat to public health and safety and the environment because one or more of the following conditions.exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet-of a tributary to a surface drinking water supply the system is located in a nitrogen se area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program MR 5.00 and 6.00. Please consult the local regional office of the Department for further informat requirements of 314 C ion. (revised 1 111 519 5) 3 T .rr. F a � .ihYr"i41 �2 W- 0 F . SUBSURFACE SEWAGE-DISPOSAL• - SYSTEM INSPECTION FORM _ PART 8 . . - Property Address:: 562 Skunkneck Rd.Centerville,Ma: - - Owner: Kennealy:.Box 749 Centerville,Ma:02632 . Date of Inspection:8131196 _ - Check if the following have been done. x Pumping information was requested of the owner,occupant,and Board of Health. _ X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates duringQhat period. Large-volumes of water have not been introduced into the system recently or as part of this -- inspection: n1a As:built plans have been obtained and examined. We if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. x' The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X' All system components,excluding-the Soil Absorption System;have been located on the site. X The septic tank manholes were.uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of..liquid, depth of sludge, depth of scum. X The size'and location.of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner)were provided.with information on the proper maintenance of Sub- : —Surface Disposal System: (revised 11115195) 4 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORMPART C _ SYSTEM INFORMATION Property Address:, 562.Skunkneck.Rd.Centerville,Ma. 4. Owner: Kennealy:.Box 749 Centerville,Ma..02632 Data of Inspection:8131196 — FLOW CONDITIONS: RESIDENTIAL: Design flow: 330 gallons -- Nusimb_ - of bedrooms: 3. — - - - — Number of current residents: t - Garbage grinder(yes or no)`. No — Laundry connected to system(yes or no): Yes Seasonal use(yes or rroy No Water meter-readings, if available: nla _ Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: Na Design flow:0 .. gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No ' Water meter readings, if available: Na Gast date of occupancy: n1a OTHER,:.(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)Yes If yes,.volume pumped: 1250 gallons Reason for pumping: Maintenance. •TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool - Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE.AGE of all components,date installed(if known)and source information: 1981 .- Sewage odors detected when arriving at the site: (yes or no) (revised 11115195) 5' . I Cs - - ♦ s.;,ems;W.S�...,+,a;.��ra?�8 .. r. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ..PART C _ - SYSTEM INFORMATION(:cantlnued)� _ _ - - r Property Address:. 5Q Skunkneck Rd.Centerville,Ma. Owner:. Kenneaty:Box 749,centerville,Ma.02632 Date of Inspection:8131196. -SEPTIC-TANK:X ` - (locate on site plan) - Depth below grade 1 -- - - - - Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L 8'6"H 5'7"W-4'10' Sludge depth:4. _ Distance from top of sludge to bottom of outlet tee or baffle: 23' Scum thickness.:8" _ Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity; evidence of leakage, etc.) ound.Recommend pumping system every two years for maintenance: Septic tank and all components are stucturally s ; I GREASE TRAP: (locate on site plan) Depth below grade: Na Material of construction. _concrete_metal_FRP_other(explain) Dimensions: nla Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:rVa Distance from bottom of scum to bottom of outlet tee or baffle:.nla comments: integrity,,C structural , (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level In relation to outlet Invert, s 9 tY evidence of leakage,etc.) Na (revised 11115195) - 6 SUBSURFACE;SEWAGE:DISPO,SAL SYSTEM,INSPECTION-FORM PART C - SYSTEM INFORMATION.(continued.) -- _ 77 Property.Address: 562 Skunkneck Rd.Centerville,Ma Owner: Kenneaiy:Box 749 Centerville,Ma 02632 Date of inspection:8131196 TIGHT OR HOLDIKG TANK: -(locate on site-plan)- Depth below grade:n1a Material of construction: concrete' .metal_FRP_other(expiain) _. Dimensions: n1a Capacity: n/a gallons - Design flow: n1a gallons/day, Alarm,level: n1a Comments: (condition of inlet tee; condition of alarm and float switches, etc.) rda DISTRIBUTION BOX: X -(locate on site plan) Depth ofaiquid level above outlet invert: Liquid level with bottom of pipe. Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) D-box is structurally sound. PUMP CHAMBER: (locate on site plan) Pumps in working order.(.yes or no)- Comments:- (note condition of pump chamber, condition of pumps and appurtenances, etc.) nla (revised 11115195) SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORA . PART C. — SYSTEM INFORMATION(continued)- , Property Address: 562 sicunkneck Rd.centerville,Ma - . Kenneaty:.Box.749 Centerville,Ma.02632 Owner: - Date of Inspection:9131196 - ' I SOICABSORPTION SYSTEM-(SAS):X -,--(locate-on-site plan,if possible;_-excavation not required,but may be approximated by no methods) If not determined to be present, explain:. nla Type: leaching pits, number: 1,a0o.gailon reachptt leaching chambers,number:nra - - leaching galleries, number-: nra leaching trenches,number,length: Na leaching fields,number, dimensions:Na overflow cesspool, number:nla Comments: (note condition of soil,.signs of hydraulic failure, level of ponding,.condition of vegetation, etc.) The leach Ditis structurally sound and functioning roe . CESSPOOLS: (locate on site plan) Number and configuration' Na Depth-top of liquid to inlet invert: nla Depth of solids layer: n!a Depth of scum layer: nla Dimensions of cesspool: nra Materials of construction: nla . Indication of groundwater: nfa inflow(cesspool must be pumped as part of inspection)' Na - Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: nla j Depth of solids: Na Comments: (note condition of soil, signs,of hydraulic failure, level of ponding, condition of vegetation, etc.) PrivyComments L. (revised 11115195) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM NFORMA.TION (continued) - Property Address: 562 Skunkneck Rd.Centerville,Ma.. _ Owner: Kennealy:Box.749.Centerville,Ma.02532 _ Date of lnspectionLA131196 -SKETCH OF SEWAGE DISPOSAL SYSTEM:; _ :-include ties to at least two permanent references landmarks Pr benchmarks - locate all wells within 100' - 33 gc 55, - 8D30 _ DEPTH"TO GROUNDWATER Depth to groundwater: 12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 �1 �n LOCATION SEWAGE PERMIT NO. /.07Tj"-- T 5 ti v•�Ft�.Fr `'.� _ VILLAGE INSTALLER'S NAME i ADDRESS 3 UILDE R OR OWNER DATE PERMIT ISSUED 7 _6 � �( DATE COMPLIANCE ISSUED s� ICI \`• \ Sb/ No4gay- THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH ... \dl�.:'..................OF......... �N..5.�.�?`eJ ApplirFation for Biopos al Works Tonotrnrtiun ramit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal u� System at: ..... .............. Kvr.k r1c ...... ------.. . ................................................................................................. Location-Address r Lot No. - ner A dress .................................... ....._..... e� o......... -----••.... Installer Address Type of Building Size Lot.3\..g ul.......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building a yp g ____________________________'No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----------------------------------------•---•-...-•-.---••-•-•--------- W Design Flow..........._\XJ0.....................gallons per person per day. Total daily flow.........3..................................gallons. WSeptic Tank—Liquid capacity.k®pQgallons Length................ Width................ Diameter.........---.... Depth................ x Disposal Trench—No..................... Width... ................ Total Length............ .......Total leaching area....................sq. ft. Seepage Pit No---------4........ Diameter.... ........... Depth below inlet......6........... Total leaching area...�-tr'?...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by._.. - k. ...__.. ....... ` ............... Date..... . ®`�-' �......... k 4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................... ( (X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to.ground water....................---. a -•-••-•-••--------••-•••-•••--------•-----•-•••-••-•--•-••---•-....-•...................i------------.----------------•-------------------------------------- 0 Description of Soil....... ...........u:Xn........ca............ 5 ' \------------------- .............................................. Ux --------••-.?_-. .............�5.-40va.�---------�c(I� .{�`< ------------------------•--------------------------- �..... i - ----------------------------------------- 4�--•----------cn e_A......��---•-----.-.�.(1�------.-— - -- U Nature of Repairs or Alterations—Answer when applicable............... ............................................................................... ...•••......-----••.---•---•-••-•--•--••-•.................•-------•••------••--••--------•-----•-•---•••----•-----•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL LE4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ' I j Signed..... G1fY��......�....... ln-. ... .' 3_—.......!__. } Date V Application Approved By---�r-' 5/ ------------•------- ---- ';- ....... Date Application Disapproved for the following reasons:................................................................................................................ ----------------------------------•---------•-----.......-----..........----------.....--------...........-•-•-•--------•--------------------•------....--------•---------------....---••--••••---------- Date Permit No......................................................... ------. Issued....................................................... Date .-t No.. i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... . ...............OF............��..�. n ... :. . � a, ...............•---•••............-- Appliration for 3li£potal Work.5 Tonotrurtion rrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ................_...:-�............ ��v r:k_n c.�-....�.... ... ......•- -.....-----............... ---------..........-----.........-------- ...... Location-Address `` r Lot No. ............................................. �� ................... Chper 2 Address Wj ...............................c am.C l� .............•--------•-•-------- �4 a f n ct ........::.. .........:. . ........................................... Installer Address U Type of Building Size Lot_ -\-.�. .......Sq. feet Dwelling.—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (ic)) a Other—Type T e of Building yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ................................ _ Design Flow.............\_�.o....._...._._........gallons per person per day. Total daily flow...._.___5_=v._.._........ ......gal W ... Ions. WSeptic Tank—Liquid'capacity_Q jg.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........../-------- Diameter_.__.,#.......... Depth below inlet...... ...... Total leaching area....Z&-y...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..... .S-IJ :k_ .......k..... ............... Date..... ......... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..................... (s. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------•--.......-•----------....--••------......---•-----------•---•---......................................................... O Description of Soil------. ........N--`".P,(-O--------` ....:.............j i. (� ......................................... = Z -•••---•••••----•-----------••----•---••�-A_a:...._.......C'•c-- ......... ............. ......... .n .............................................. U Nature of Repairs or Alterations—Answer when applicable................................_........_.__.........._....__..____............._..._..._...... ------------------------•-------------------•--•-------•---•----------....---------••-•--•-•--•---------...------. ---•---------••-••••••--••••--•••••••--_........•-•••--•-•••............••---•... Agreement: �~ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITil- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig = ned••• u, �1.------\ ------- -----•----------- .................. \. Date Application Approved By E. �..._.;//. .�, ------•--- Application Disapproved for the following reasons:.._ .._;t.................................................................................:.......--- •--------•----------•-----------------------------------------•...--------•--------------...------------.••-•-•••--••-•---•-••--••••----••••---•-•--•-•--•-••••-•••-•-•••-•••••-•••-••-•-••••••••---•--- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........� .r...............OF........ �_'N:�-�ls.................................. Tntifiratp,of ToutpliFatta THIS IS TO CERTIFY,-,That the Individual Sewage Disposal System constructed (✓S or Repaired ( ) by...... (' v s ---....---•--•------------------------------•--------------•-----....------------•--••---•-•-•-------.....-•----......._..---•-••-•----••---. Installer has been installed in accordance with the provisions of T "LY, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit NcOrl, —l_ ................. dated....._.__.._..._..__..._.._._...__......__.__... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... V................................... Inspector--•-- ---......--------...------------........--.....---......-----•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................0F.......... A-.----•----................. ..................... � � ... � .... FEE.. Disposalorko Tonitrur$ion rranit Permission Is hereby granted. .�� . v �'- ��i.a. ......-----.�- ....:.---•--••----....--- to Construct (✓ ) or Repair ( ) an Individual Sewage Disposal System' at No.. J........... `��Kv N K {V_E- C..........&-D---------------- • ............................. Street as shown on the application for Disposal Works Construction Permit No....... __.......... Daped.......................................... --------...-•--....•••......--•-....... e th DATE.. 1� /'P------------------------------- > FORM 1288 HOB6t 9 & WARREN, INC.. PUBLISHERS y� Or--- S 16t.1 nATA _ f �1 t..�-{ FLow _ I I V. 3 • S-t G•PD 8 1FPT�IG f"L�+�1tC SSov (rpo % ■ 4-qCj 6.P0. _t?l5_�oSAL SIT Lise I000 cU"4/AL-L- ArL1=A - 15O S F. SF sc '2.S • 7S G.P.D. 0�� / ?sr r �1 � Q• S=. A 1 .0 = � S-f-D. 97.Zh°)" n E�CP f TOTA L TV ESt6W = 42S G.RD. r•� \o AAIU Age.4 "T-oT-4t- 'p,A1L:..f FLOW 4 330c P.D. Pma r-OL TI01J czA-re . to I-MlW•oiz IF-SS. FuD. OF y� ALPN WGFIARD nAXTER �`9/ /ii T717� ♦A�..,_.�. 4rPPib -,Y pry •� oAA4 e t t d P.P. I000 sup '.A Svt350/L 4 p,P4 Dts-1 IW 6—AL. 9G ,1 :� 2 'aox 9G•G S�nC to �;• i GoAeS� tuv TAUK `t may I000 Bur- GAL. `•►v . FIT f � • of WAS+�ED SToN� Cjp,p f. LbG/ST101-4 CFJ�lu:.s -85 /2 uo 5cn� — I -.fin -"fi'F==• {. 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