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Interpret the paired $A,B,C$ disks as the three one-handles of a genus-three handlebody. Attach two-handles on the two displayed $\beta$ curves. Orient the three disk-crossing generators as $a,b,c$. Reading the signed crossings, starting at the upper-left portion of each attaching curve and changing the start point when needed, givesThe first says $abc=bca$ and the second $abc=cab$. Thus the fundamental group presentation isHere $[u,v]=uv{u}^{-1}{v}^{-1}$. Cyclically changing the starting point, reversing an attaching curve, or changing generator orientations gives equivalent presentations. With $h=abc$, these relations make $h$ central; eliminating $c=b^{-1}{a}^{-1}h$ givesFor the topological identification, thicken the diagram's two nested bands and identify the three paired disk mouths. The complement of those bands is the product region of a pair of pants with a circle; its two compressing curves are exactly $[a,bc]$ and $[ab,c]$. Equivalently, the standard cell decomposition of this product has three one-handles and the two commuting two-handle attachments shown. Thus this is a generalized Heegaard diagram of $P\times S^1$.

The Hopf fibration of $S^3$ has three disjoint regular fibers whose removal leaves $P\times S^1$. Its three fibers are the components of the torus link $T_{3,3}$, as is also apparent from the full three-strand twist in the later link diagram. This identifies $Y$ with that link exterior, using the diagram and product structure rather than just its fundamental group. In particular it is a link exterior in the three-sphere.

Give the three Hopf fibration components coherent orientations, so their pairwise linking numbers are one. In the link exterior, their longitudes satisfy $[{\lambda }_i]={\sum }_{j\ne i}{\mu }_j$. Filling along $p_i{\mu }_i+q_i{\lambda }_i$ imposes that relation on first homology. For the three rational coefficients the presentation matrix isIts determinant is $30$, and the greatest common divisor of its two-by-two minors is one (for example, $-5$ and $-3$ occur). Its Smith normal form is $\mathrm{diag}(1,1,30)$, soA nonzero rational coefficient with numerator one does not by itself make a multi-component surgery an integral homology sphere: the nonzero linking numbers must be included.

For the integer filling, use the Seifert fibered space structure $P\times S^1$. Its central regular fiber is $h=abc$, and each preferred longitude is $h{\mu }_i^{-1}$. The three filling relations are consequentlySubstituting $b=h$ into $abc=h$ gives $c=a^{-1}$. The remaining equations say $a^2=a^4$, hence $a^2=1$ and $h=1$. Thus its fundamental group is cyclic of order two.

Geometrically, a filling coefficient $r$ attaches a Seifert fibered space solid torus with multiplicity $|r-1|$, the distance of $r\mu +\lambda$ from the regular fiber $\mu +\lambda$. The multiplicities are $2,1,4$; the middle filling creates no exceptional fiber. The result is a Seifert fibered space over the sphere with at most two exceptional fibers, hence a union of two solid tori, or a lens space. A lens space with fundamental group of order two is $L(2,1)$. ThereforeAs a separate arithmetic check, the integer surgery linking matrix has determinant $-2$, in agreement with its first homology of order two.