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HomeMy WebLinkAboutCROMWELL HEIGHTS BLK 1 LT 12Onsite File Cromwell Heights Block 1 Lot 12 #015-332-07 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191122 PID Number: 015-332-07 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑® New ❑ Upgrade Name Spinell Homes Inc ABSORPTION FIELD El Deep Trench X Wide Trench El Bed El Mound Site Address 10920 Mountain Lake Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 4.0 GPD/SF 0.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 0.0 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Cromwell Heights 1 12 Fill added above original grade 3.5+ Ft. Gravel length 30 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines n/a Distance between lines n/a Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station ( Tank Line 150 Ftz 1 n/a Ft. Well 100'+ 100'+ 100'+I n/a 25'+ TANK ElSeptic 0 S.T.E.P. El Holding EJ Other Manufacturer Advantex (FAP) Capacity 1500 Gal. Surface Water 100'+ 100'+ 100'+ n/a Material Number of compartments Lot Line 5'+ 10'+ 57+ n/a NA Fiberglass 2 Foundation 10'+ 10'+ 10'+ I n/a LIFT STATION Manufacturer Capacity Remarks Orenco 250 Gal. Alarm location On House Electrical installed by Solid Ground Installer PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Pomraining Construction Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 101.5 fl Inspdection vt 2/2/20 3/4/20 Location and description 2nd 3`d 3/4/20 411 3/9/20 Bottom House Trim @ Point B ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Akgs�>t� Conditional Approval: Date OF 49 TH` X. Steven r�. Pannone ��s CE 8149 �� lF , • ..... �f� Septic System nn , Approved �V7�t'i ��� 3 6 r) pp Date a �k �. Pl?OFESS\V,'T ��'������ Note: this approval does not include well permit requirements. (Rev 05/02/18) 0 CC) c cn � cn D cn M z -<�70rnDp� -:j I r- �x c N .;uI D� Z� �D ��m m kJ 0 �Konoonrn 0 a pOOrx A m n L p= r- m 0 m O -1 m am0 f .. I m�zmz m;u Z 0 U) W > m rc') O ff''�� O Z C Z�E m m> 1+ m O (n rr- X Ci m nr z z n cm Lf)"I 8104 c cn � cn D cn M z -<�70rnDp� -:j I r- �x m N F' D� Z� �D ��m m kJ 0 n ;U O Dz` G-) --IDN =!l�zmrnp(f) f .. m 0) W .p. 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NO DRAWN ACP SPINELL HOMES INC'te " Leii' :'F5o-no. r-4 015-332-07 PERMIT SITE PLAN 10920 ANCHORAGE, ORAGE LAKE AK DRIVE Oa�,� ::�]SHOEP19�1z2 l��\i���' 2 OF 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 TEST HOLE 1 OR ORGANICS SILTY GRAVEL GM/OL AND ORGANIC SILTS GM I SILTY GRAVEL GM/ML SILTY GRAVEL W/ BLUISH SILT BOH DATE PERFORMED: 7/20/18 SOILS LOG - PERCOLATION TEST SLOPE x TH 4BR SITE PLA ! I_ / H OUS E / ILOT 12 P 100' SEPTIC SETBACKI I TH-2 rn o 1 I d- / �TH-1 \ 100' SEPTI SETBACK _ 115TH AVENUE WAS GROUND WATER ENCOUNTERED? Y IF YES, AT WHAT DEPTH? -8.0' DEPTH TO WATER AFTER MONITORING? -7.0' DEPTH TO WATER AFTER MONITORING? -3.0' DATE: 4/10/19 DEPTH TO WATER AFTER MONITORING? -5.0' DATE: 5/8/19 SLOPE TH x READING DATE CLOCK NET TIME WATERTIME LEVEL READING NET DROP 1 7/20/18 11:15 -- 6.31 --- 2 11:45 30 MIN 8.30 1.99 3 12:15 --- 6.31 --- 4 12:45 30 MIN 8.25 1.94 5 12:45 --- 6.31 -- 6 1:15 30 MIN 8.23 1.92 PEROLATION RATE 15.6 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 FT AND 4 FT COMMENTS: Test hole excavated bV POMRAINING CONSTRUCTION PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PANNONE ]EMG SVC LLC ��'�OF A �0� Dote RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 'C� �'9s �i 3/11/2020 PHONE (907) 272-8218 FAX (907) 272-8211 f g�� Scale ..4...-. ....�� P.I.D.TNO CROMWELL HEIGHTS, BLOCK 1, LOT 12 ® 015-332-07 SPINELL HOMES INC. Steven R. Pannone PERMIT No. ��s CE 8149 �m'°� NSN MOUNTAIN LAKE DRIVE � � • OSP191122_ SOILS LOG ANCHORAGE, AK B���'ROFES90'E®- Sheet ���® ®®.s-®� 3 OF 3 DOC CO •ba 13ILL S. COLE WELL!. - c Vis: z's kWATER Af :�%W— P.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Spinell Homes ADDRESS: LEGAL DESCRIPTION Cromwell Heights Block 1 Lot 12 DATE: 7-11-19 PERMIT NUMBER: OSP191122 DATE OF ISSUE: 4-29-19 TAX IDENTIFICATION NUMBER 01533207000 Is well located at approved permit location: ®Yes ❑No Method of Drilling: ❑air rotary ❑cable tool Depth of Well: 282 Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 122 feet Liner type Static Water Level: Flowing feet Recovery Rate 3 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ❑ open end ®open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ®yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: WATER QUALITY TESTING 1 Collgorm —N CoU100mL Nitrates '1 b L Arsenic N 3 2020 Bore Hole Data Depth From To 0 2 2 4 4 15 15 42 42 62 62 64 64 112 112 162 162 181 181 282 Casing Stickup Overburden Silt, Gravel & Clay Tight Silty Sand & Gravel Silt w/ Gravel Tight Silt w/ Gravel 2 GPM Clay & Silt Bedrock Gray Bedrock Gray w/ Quartz Bedrock Gray Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. DOC COdba C C a:: WATER WELLS RO. Box 670269, Chugiak, AK 99567 688-2759 www.sullivanwaterwellsxon Pump Installation Log Well D-rilling Permit Number: SW OSP191122 Date of Issue 4-29-19 Parcel Identification Number: 01533207000 Legal Description Cromwell Heights Block 1 Lot 12 Property Owner Name & Address Spinell Homes Pump Installation Date: 1/16/20 Pump Intake Depth Below Top of Well Casing: 270 feet Pump manufacturer's Name: F&W Pump Model: 4F10G10301 Pump Size: 1 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Pomraning Excavation Disinfected Upon Completion? ® yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. w r. i C J��°'} 0 .N- p -�v ci5 a "\' ck: a N�' i •••®��55 ®•••a AV IV • • • • • m V 000. �j s V`C • °� L Q li tC y ®•� ® • � ®1 �$tQ • 1• in— cns • Li i• CL m 0 LLJS w r. i C J��°'} GaN7 N .N- p -�v ci5 a "\' ck: a N�' i •••®��55 ®•••a AV IV • • • • • ID �� • e m • y a a N 000. �j s V`C • °� L Q li tC y ®•� ® • � ®1 �$tQ w r. i C J��°'} GaN7 N .N- p -�v ci5 a "\' ck: a _ t (/}: Li to a a N n� C9 li MUNICIPALITY {]FANCHORAGE On -Site Water & Wastewater Program PO Box 19665*700 Elmore Road Anchorage, masaeyu1y-665n Phone: (e07) 343-7904 pan: (907) 343-7997 PennbNumber OSP181122 Work Type: VVe|SopUo|niba/ Tax Code Number: 01533207000 Site Legal Address: CROK4VVELLHEIGHTS BLR 1 LT 12 G:2630 Site Mailing Address: 10Q2OMountain Lake DR, Anchorage Owner: SPINELL HOMES INC Design Engineer: pANNONEENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms poyo,,mun 4/29/2019 4/28/2020 10 Disposal Field 171 Septic Tank [] Holding Tank [:1 Privy P1 PrivateWell[]Water Storage All construction shall boinaccordance 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) andDrinking Water 3. The wastewater code requires inspections during the installation. The engineer shall notifytheDeve|opment Services Department per AMC 15,55.Provide notification bycalling (807)343-7yO4(246,). 4� From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed on -the same day, or h. Covered, sealed, and heated Loprevent freezing Special Provisions: A groundwater reading shall be taken in May and recorded on the soils log, to confirm minimum separations between the bottom ufsewer rock and seasonal high groundwater. |fresults require a design change, construction shall stop pending Onsite review and approval of a change order. Please submit results with the change order orinspection report. Received By:*j Date: �I'Hlh Date: c2 t� IS MUNICIPALITY OF ANCHORAGE 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. 015-332-07 Property owner(s) Spinell Homes Inc Day phone Mailing address 1900 W. Northern Lights #200, Anchorage, AK 99517 Site address NSN Mountain Lake Drive Legal description (Sub'd., Block & Lot) Cromwell Heights, Block 1, Lot 12 Legal description (Township, Range & Section) Lot Size 28,714 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 Septic Tank ❑X Upgrade ❑ (w/wo ADU) Holding Tank ❑ RenewalDuplex ❑ (D) ❑ Privy ❑ Multiple Dwellings ❑ (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: 016 Date of Payment: LZ312 Receipt Number: (30007— Permit No. US IP 19 [ l 2-;1 Permit App__- : • :'_:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191122, Rebecca Carroll, 04/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191122, Rebecca Carroll, 04/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191122, Rebecca Carroll, 04/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191122, Rebecca Carroll, 04/29/19 MUNICIPALITY OF ANCHORAGE ® Aw Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-332-07 1. GENERAL INFORMATION Expiration Date: (© 1 7 r2®ZO Complete legal description Cromewell Heights B1 L12 Location (site address) 10920 Mountain Lake Drive Current property owners) Spinell Homes Inc Day phone Mailing address Real estate agent 1900 W. Northern Lights Blvd #200 Anchorage, AK 99517 2. TYPE OF DWELLING: E] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic F Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment �3f I&/a6 d-0 Date of Payment Receipt Number 0 2 1),G Receipt Number COSA # Q S C 0_61019D Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. DSD SIGNATURE System #1 Approved for V^ bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date 2®©0 6 T_ OF ALgs A Steven 'R: YGnone CE 8149 111 � Conditional approval for bedrooms, with the following stipulatios: y. - Original Certificate Date: s "- %—/—?—Oo The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Cromwell Heights B1 L12 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA © Well log is filed with Onsite (or attached) Date drilled 7111/19 Total depth 282 ft Cased to 122 ft F0 Sanitary seal is functioning correctly FIC Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 7/11119 Static water level at beginning of test artesian ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material Measured operating fluid level in septic tank n/a Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 314120 FE -1 ALL standpipes present per record drawing Total measured depth from grade 4.0 ft (max) Measured depth to pipe invert from grade ft (min) © N/A — pressurized field © Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-332-07 Structure served by this system 1 Well production at time of test 3.0 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ([NN Coliform bacteria is Negative Nitrate .W1 mg/L ❑ Nitrate less than MRL (ND) Arsenic KT ug/L PR Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 31912020 C. LIFT STATION ❑ Required maintenance completed Age of lift station 0 years Lift station material Steel Comments.- Adequacy omments: Adequacy test date n/a Results Q Pass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) If yes, enter date no E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' [D Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft (/7 Yes if No ft Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' ft Private Wells > 100' Animal Containment > 50' Yes if No ft F/ Yes if No ft if No ft Community Wells > 200' Fv� Yes if No ft Manure/Animal Excreta Storage > 100' ❑✓ Community Sewer Main > 75' �✓ Yes if No ft ✓0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' [D Yes if No ft Surface Water > 100' [21 Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' F,71 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Fv� Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10'�]✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' [Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' F/I Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 20 31 COSA Checklist yellow sheet —'OF AL 4 9' T H *PX\ g-" ceve� R YF,c inose c c'i Lf9 4� MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWA'T'ER TREATMENT SYS'T'EM MAINTENANCE AND REPAID AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this �— Day of mw -g bA of 20_7a , by and between -%+` herein the "OWNER," and the Municipality of 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 Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as . __....__ d r,,-X\Le�e . located at (legal description) 2. Maintenance, Repairs and Alterations. (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 be 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. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing 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 transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided 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. 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 continue 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 Owner 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: ? f 9,%a�a® J« (print name) STATE OF ALASKA } } ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this Ot day of 20,�_q ., by . Ylt'c NM.A Yt UBLIC FOR ALASKA My Commission expires: i-4- i'j- z ; .. OFFICIAL SEAL NIUNICIPALITY: By: LOU (signature) �Q6 CCR t o l (print name) Date: Title: (rev. 05/18.2018) Page 3 of 3