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HomeMy WebLinkAboutPOTTER HIGHLANDS PH 2 BLK 2 LT 9Onsite File Potter Highlands Ph 2 Block 2 Lot 9 #020-281-69 (Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211311 PID Number: 020-281-69 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑■ New ❑ Upgrade Name Brandon Schaefer ABSORPTION FIELD El Deep Trench 9Wide Trench El Bed ❑Mound Site Address 6024 Potter Valley Road ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907) 301-5359 4 6.0 GPD/SF 2.8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.2 Ft. Gravel depth beneath pipe 0.6 Ft. Subdivision Block Lot Potter Highlands Phase 2 2 9 Fill added above original grade 1.4 Ft. Gravel length 20 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches 1 Dist. between trenches From Tank Field Tank Line 100 Ft2 Ft. Well >100' >1 00' N/A N/A >25 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding Fm] Other Manufacturer Capacity Advantex / Orenco 1500 Gal. Surface Water >1 >100' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >10' >10' N/A N/A LIFT STATION rer Capacity Gal. Remarks Alarm location Elec stalled by PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Installer Northern Excavation Drainfield D3034 CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 15' 4/15/22 4/15/22 Location and description dates: 2nd Bottom of siding @ point A 3rd 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF A4 Conditional Approval: Date • • qtQIrk ®*: 49 TH •• .�. Septic Syste Benjani3O;Schiller �� �'F�, •, • �� Approved (% Date 1 2 2 CE 12592 ��'srF�• . •7/11/22 • •��G�� `t�® pROFESSION�'4-` Note: this approval oes not include well permit requirements. (Rev 05/02/18) I L 00 00 _-c 0 IL A C < ) _J 0 _j w cc < b (D z Z CN < < W C) z C, F- Lo 0 C� -J o U_ U) 0 w 0 CL LLIJ_ C) cNi Lij Cl) U) U) 0 W w W ui z _C)F-(_) 0-1w 0) (j UW) 0 , ___,_ p IL Z- w P 0 W_ ClfwWil x z F_ m U)- LL w LU :D - �-z o 2 Cwl P ct) x C) D Wap L Z LR "t (D b0 or: U) _1 0 w A �l < w LL (D 0 m < z < C\l n (D U) Jo 0 W L) \1 U) w cr ry 73 UJfi) CrYl W w n I-lof F_ 0 U) co C) V 610 SOV1711A RHJL m O 7 c::! 1-� r__: Lq N 0 cli U'.) 1-d- 00 00 O m m m m 00 oo� m 00 00 0') CD c=. 00 114- r__ C-Ij C"i r-_: L6 C6 CO N co C:6 t- CO r- 0 C\j Cl) C14 C) o o o o PERMIT # OSP211311 PID # 020-281-69 FINISH GRADE SLOPE IS AT LEAST 2:1 & HAS BEGUN TO GERMINATE w/ WILD UNDERGROWTH () o 2i 84.1 FINISH GRADE . 82.7 ORIGINAL GRADE URAINFIELD ROCK 80.5 80.5 MOA FILTER SAND 79.9 79.9 77.9 77.9 ` 20' NO GROUNDWATER 3/22/21 _ 75.2 kt ®: 4� 1H PROFILE AS -BUILT /� �F�'.BenCE 125921'�er• ��D •7/l vzozz.,���V� ENGINEERING NO SCALE �d�`PROFESSIONP .d Development Services Department ; $ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Well Log Permit Number: #OSP211311& Date of Issue: 8/5/2021p Parcel Identification Number: Date Started: 10/25/21 Date Completed: 10/29/21 Is well located at approved permit location? Yes ❑■ No ❑ Legal Description: Potter Highlands PH 2 BLK 2 LT 9 G:3638 Property Owner Name & Address: Trevi Builders Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Casing Stick Up 0 2 Rotten Bedrock & Silt 2 4 Bedrock 4 298 Note: 6" casing grouted 0' 20' 4.5" liner grouted in the borehole with a shale packer & bentonite 20' 40' Coordinates: N 61 ° 2'41 " W 1490 46'12" Water Sample Results: t /11 /2.3 Arsenic: NO ug/L Nitrates: NO mg/L Total Coliform Bacteria:Ncolonies/100mL Method of Drilling ❑■ air rotary ❑ cable tool Casing type: Steel Wall Thickness: •250 inches Diameter: 6 inches Depth: 23 feet Liner Type: PVC Diameter: 4.5 inches Depth: 20-298 feet Casing stickup above ground: 2 feet Static water level (from ground level): 38 feet Pumping level: feet after hours pumping _gpm Recovery Rate: 2 gpm Method of Testing: airlift Well Intake Opening Type: ❑ Open Endx❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: Bentonite Volume: 2Bags Depth: 20 Start 0 feet Stonoed 40 feet Well Disinfected Upon Completion? Yes No Method of Disinfection: Tabs Comments: El ❑ Well Driller: Johnny Kay Company: Hefty Drilling Inc. Mailing Address: P.O. Box 112130 Anch. AK 96 Attention: The well driller shall provide a well log to the On-site Water and Wastewater Section within 30 days of completion. Development Services Department Building Safety Division On -Site Water & Wastewater Program �� e e � 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 s ^ F E T Y Mayor www.muni.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: - 6� ;/1311 Date of Issue: 0f /21 Parcel Identification Number: Legal DescriptionpUz Property Owner Name & Address: Z L+9 I T Trey,' (, , 3r-, 3P Pump Installation Date: c _ 114 - Pump Intake Depth Below Top of Well Casing: a q 0 feet Pump Manufacturer's Name: V ,q,w d 9 v 5 Pump Model: 5 S Gki 07— 3 ao Pump Size 1 hp Pitless Adapter Burial Depth: lb feet IPitless Adapter Manufacturer's Name: 9 -10 Pitless Adapter Installer: Re't rjDG Well Disinfected Upon Completion? Z Yes No Method of Disinfection: C � (oma`" -ve, b 4 I Comments: Pump Installer Name: Johnny Kay Hefty Drilling, Inc. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. k cv 0 �o I co I I' - PLAT NO. 2015-10 POTTER HIGHLANDS SUBDIVISION, PHASE 2 LOT • . BLOCK 2 4.867 ACRES N 83°56'091-'E 721.91' q D, -�� �Fzgti -.0- 0) 4 C'C O Z \ \ \ \ DS \ \ CLASS \ A 33' SECTION UNE ESMT. 10' T. & E. ESMT. N 89014'33"E 100.04' N 78°42'43„E 801.12 5' DEVELOPMENT SETBAC 10' T. & E. ESMT: ® SEPTIC SYSTEM EXISTING BULDING O� sss O �k 6 \\ •gyp �Q :L DR. \\ \\ sams w 38f - - 10, X 421' DRAINAGE ESMT AS -BU I LT I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC IT IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 2000 E DOWLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99507 APPS ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR SW3638 11/3/2022 ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JOB NO. I 2022-02 PHS292 NOTE: NO CORNERS SET TH IS DATE. OF q� �P\ °.....,° q • S •49 9 TH . ...... .......... m : Jeffery A. Gastaldi10, o` LS -6091 Ar 11/3/2022 ." tJ� rP0"�p ....... 000 a5J rofessional La\\ TA ass* A. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 - 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www. m u n i, o rg/ons i to On -Site Water & Wastewater System Permit Permit Number: OSP211311 Work Type: WellSeptic Initial Tax Code Number: 02028169000 Site Legal Address: POTTER HIGHLANDS PH 2 BLK 2 LT 9 G:3638 Site Mailing Address: Owner: POTTER CREEK DEVELOPMENT LLC Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: n,.Cp r CAP v Deparrinent Lot Size in Sq Ft: Total Bedrooms: 8/5/2021 815!2022 212021 0 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Category Ill Nitrogen -reducing systems are required in this subdivision. Veronica Pope GE 2021.08.05 Received By: 17:41:35 -08'00' Date: Issued By: A�ADate: O -� "�0 : 2 1 4 11111E 1111111111111111 Jill 111111111111 111111111111111! �J� j _'� ^•4 ��t. 7� 5.-. i illill��lill a � 9 Community Development Department - Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-281-69 Property owner(s) Potter Creek Development LLC Day phone 301-5359 Mailing address 561 E 36th Ave Suite 200 Anchorage, AK 99503 Site address NHN Potter Valley Road Legal description (Sub'd., Block & Lot) Potter Highlands Phase 2, Block 2 Lot 9 Legal description (Township, Range & Section) Lot Size 212,021 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑X Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑ Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑X Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: &?-10 Waiver Fees: Date of Payment: 719-'71 I Date of Payment: Receipt Number: n100010 Receipt Number: Permit No. 05N % 13 f l Waiver No. Permit App__- : .,:c August 5, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 8/5/21 Subject: Potter Highlands Phase 2, B2 L9 – Potter Valley Road Septic system design Dear On-Site Services Engineer: The owner of the above lot intends to build a 4-bedroom home on the subject property, so we are submitting this permit application for the construction of a new well and septic system. The attached site plan identifies the location of the home as well as the proposed well, septic location and alternate site. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot varies in slopes between 25% and 50% toward the west property line. It is in an area between 25-30% that we are proposing a new trench. Due to bedrock, the trench will need to be no deeper than 3.5’ from original grade. The current design meets the steep slope separation exception for a wide trench with a sand liner 36” below the top of the organic layer. Due to the fast-percolating soils, we expect effluent to travel mostly vertical without daylighting. There are no slopes greater than 46% within 100 feet downslope of either the primary or alternate site. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 50’ from all wells and surface water, and more than 5’ away from the septic tank. The alternate site is located more than 6’ away. Please refer to the attached test hole logs, cross section, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211311, Rebecca Carroll, 08/05/21 PRIMARY & ALTERNATE SITE NOTE: NO SLOPES >46% WITHIN 100' OF PROPOSED SEPTIC SYSTEM. NO SURFACE WATER WITHIN 50' OF THE SEPTIC SYSTEM. ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 1" = 100'4-BDRM HOME POTTER HIGHLANDS PHASE 2, BLOCK 2 LOT 9 FEET 0 100 200 August 5, 2021 POTTER VALLEY ROAD10' T&E EASEMENT 33' SECTION LINE EASEMENT 50' STREAM SETBACK 10' T&E EASEMENT 5' DEVELOPMENT SETBACK 10' x 421' DRAINAGE EASEMENT CLASS D WETLANDS STREAM COURSE WELL w/ 50' RADIUS 1,500 GALLON ADVANTEX TANK w/ AX20 FILTER POD PROPOSED WELL w/ 50' RADIUS 100' WELL RADIUS 935925915905 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211311, Rebecca Carroll, 08/05/21 20' LONG x 5' WIDE, 0.5' EFFECTIVE DEPTH ABSORPTION TRENCH NOTE: NO SLOPES >46% WITHIN 100' OF PROPOSED SEPTIC SYSTEM. NO SURFACE WATER WITHIN 50' OF THE SEPTIC SYSTEM. ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TH1 1" = 50'4-BDRM HOMEMT POTTER HIGHLANDS SUB PHASE 2, BLOCK 2 LOT 9 FEET 0 50 100 August 5, 2021 POTTER VALLEY ROAD50' STREAM SETBACK 10' T&E EASEMENT 5' DEVELOPMENT SETBACK 10' x 421' DRAINAGE EASEMENT CLASS D WETLANDS STREAM COURSE 1,500 GALLON ADVANTEX TANK w/ AX20 FILTER POD PROPOSED WELL w/ 50' RADIUS CO CO 2CO FCO ALTERNATE SITE 935925915905895100' SEPARATION FROM >46% SLOPES Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211311, Rebecca Carroll, 08/05/21 POTTER HIGHLANDS SUB PHASE 2, BLOCK 2 LOT 9 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 1'-6" 6" 6" DESIGN FACTORS:SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: <1 MIN/IN APPLICATION RATE: 6.0 GPD/SF SHALLOW TRENCH SYSTEM 1,500-GAL ADVANTEX TANK w/ AX 20 FILTER POD BOTTOM OF TRENCH: 3' BELOW HIGHEST GRADE FLOW LINE ELEVATION: 2' 6" BELOW HIGHEST GRADE TOP OF TRENCH: 1' 6" ABOVE LOWEST GRADE 600 GPD / 6.0 GPD/SF /5' WIDE * 1.0 RED FACTOR = 20 LF TRENCH REQUIRED (20 LF SPECIFIED) August 5, 2021 2' 2' MOA APPROVED FILTER SAND 2:1 2" INSULATION OVER GEOTEXTILE FABRIC 2:1 SLOPE MUST BE SEEDED FOR EROSION PREVENTION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211311, Rebecca Carroll, 08/05/21 1"=15' POTTER HIGHLANDS SUB PHASE 2, BLOCK 2 LOT 9 SLOPE CROSS SECTION 3015 0 FEET 875' 0' 5' 10' 15' 20' 870' 25' 30' 35' 40' 45' 50' 55' 60' 65' 70' 75' 80' 85' 90' 95' 885' 880' 895' 890' 905' 900' 100'15' EXISTING G R O U N D ~20% PROPOSED ABSORPTION TRENCH 46% ANG L E O F EFF L UEN T INF L UE N C E BEDROC K ~5 0 % August 5, 2021 910' 10' 5' 915'PROPOSED ALTERNATE SITE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211311, Rebecca Carroll, 08/05/21 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 1 SLOPE SLOPE SITE PLAN DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) J. Millette DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH? 0.72 6 2 3 2/4/21 1 2 3 4 5 6 GP (POORLY GRADED 6" MINUS GRAVEL) Professional Engineers Stamp: NO NONE 3/22/21 POTTER HIGHLANDS PH2, B2 L9 02/04/2021 020-281-69 Trevi Builders 13:051 2 3 4 5 6 1 - 6 1' OB 4:20 July 19, 2021 BED ROCK 6" 13:11 1 - 64:25 6" 13:17 1 - 64:18 6" 13:23 1 - 64:21 6" 13:29 1 - 64:25 6" 13:36 1 - 64:20 6" Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211311, Rebecca Carroll, 08/05/21 MUNICIP ALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT,herein the "AGREEMENT"made and enteredintoasofthis_2 Dayof y Bandoa ,herein tłe"OWNER,"andtheMunicipalityof Anchorage.herein the "MUNICIPALITY";,in accordance with Anchorage Municipal Code (AMC)15.65.365.In consideration of the mutual covenants contained herein,the parties to this Agrecmcnt agrec as follows: of 20/-byandbetween 1.Advanced Wastewater Treatment Systems.The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex Waste Water Treatment System located at (legal description) Potter Highlands Phase 2,Block 2 Lot 9 2.Maintenance,RepairsandAlterations. (Owner is required to read,understand and initial each section) Throughout the term of this Agreement.the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative.The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall bc the responsibility of the Owner during the term of this Agreement to pay for all repair(s),maintenance,adjustment(s),replacement costs,and inspection costs.This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system,which could include sewage backup and costly repairs or drainfield replacement. BS BS BS BS (rev.05/18/2018)Page 1 of3 BS BS BS BS BS Owncr agrces that the AWWTS installation and maintenance requirements as provided Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance providcr. Owner acknowledges that the fine for lailing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS.The Municipality will give at least 24-hour notice. Owner agrees that any sale or transler of title of the property will not occur without a new Certificate of On-Site Systems Approval. by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction,maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. BS 3.Term.The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system,or upon transfer of title,and shall continuc while the AWWTS is operational or until title is transferred. 4.Nonwaiver.The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions,nor in any way affect the validity of the Agreement or any part hereof,or the right of the Municipality thereafter to enforce every provision hereof. 5.Amendment.This Agreement shall only be amended by authorized representatives of the Owncr and Municipality.Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6.Jurisdiction:Choice of Law.Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage.The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7.Severability.Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev.05/18/2018)Page 2 of 3 OWNER: By: _ (signature) Date: '7103 a/ 'PrO,Ytd0yl � t�(print name) STATE OF A —7 -YO -5v ) ) ss. THIRD .RMICTAL DISTRICT ) The foregoing instrument was acknowledged before me this 23 day of JU , 2021 , byrrAr�an Schl�r F T ANTHONY ZURITA NOR PUB FOR AL-� A '�('-c.xasNotary Public. State of Texas My C Mills,riexpires: Comm. Expires 09-18-2024 �f °• ai;�` Notary ID 132684674 MUNICIPALITY: By: W(Lj(signature) JQebeOCA 6�t-0�1 (print name) Date: 8-151,7-10.2 t Title: (rev. 05/18/2018) Page 3 of 3