HomeMy WebLinkAboutWOODHAVEN #3 LT 1Onsite File
Woodhaven #3
Lot 1
#015-282-46
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201034 PID Number: 015-282-46
Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: N New ❑ Upgrade
Name
Spinell Homes, Inc
ABSORPTION FIELD
❑ Deep Trench ❑Wide Trench ❑® Bed El Mound
Site Address
4141 Marcelle Circle
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
4
2.0 GPD/SF
JTotal
1 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
0.5 Ft.
Gravel depth beneath pipe
0.5Ft.
Subdivision Block Lot
Woodhaven Addn3 1
Fill added above original grade
2.0 Ft,
Gravel length
30 FL
Township Range Section
Gravel width
15 Ft.
Beds: Number of Lines
3
Distance between lines
5 Ft.
SEPARATION DISTANCES
ToSeptic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
450 Ftz
Ft.
Well
90.5
100'+
n/a
n/a
25'+
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Orenco
Capacity
1500 Gal.
Surface water
100+
100+
n/a
n/a
Material
FAP (FIBERGLAS)
Number of compartments
2
Lot Line
10'+
10'+
n/a
n/a
NA
i
Foundation
10'+
10'+
n/a
n/a
LIFT STATION
Manufacturer
Capacity
Gal.
f
Remarks
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Installer
Pomraning Excavation, LLC
Drainfield 3034 CO/MT3034
Inspector Pannone Engineering
BENCH MARK (Assumed elevation) 409.5 ft
Inspection
15` 4/28/20 2nd 4/29/20
Location and description
3'd 20201103 a«,! -
Bottom house trim at point A
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF AC4k��
Conditional Approval: Date
PP
,.�
`C�
Sven f Pannion.e
CF 8 ` 0J
Septic System%
���� C�Cti�
Approved Datef�v�`°
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
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NOTES: PANNONE ENG SVC LLC C.I. 1088) REVISIONS DATE
RECORD DRAWING
P.O. BOX 1807 PAI -MER, AK 99645 7/22/2020
�''"
PHONE (907) 745-8200 FAX (907) 745-8201 REV: 20201104 �Ct':•'' SCALE
WOODHAVEN ADDN3 L1 "' .......P.I.D. NO
DRAWN MJL SPINELL HOMES, INC ".8,JN�, annpme 015-282-46
CE 8149: PERMIT No.
4141 MARCELLE CIRCLE OSP201034
SITE PLAN ANCHORAGE, AK 99516 SHEET
2 OF 2
OWNER OF LAND: Spinell Homes
ADDRESS: 4141 Marcelle Circle, Anchorage
LEGAL DESCRIPTION Woodhaven #3 Lot 1
DATE: 4-9-20
PERMIT NUMBER: OSP201034 DATE OF ISSUE: 3-16-20
TAX IDENTIFICATION NUMBER 01528246000
Is well located at approved permit location: ®Yes ❑No
Method of Drilling: ®air rotary ❑cable tool
Depth of Well: 164'
Casing Type: Steel Wall thickness .250 inches
Diameter: 6 inches, depth 164 feet
Liner type
Static Water Level: 92 feet
Recovery Rate 30 ® 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: 50lbs
Depth: from 2 feet, to 42 feet
Well Disinfected Upon Completion: ®yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments:
Bore Hole Data
Depth
From To
0 2
2 4
4 21
21 48
48 121
121 130
130 139
139 151
151 164
Casing Stickup
Overburden
Silty Sand & Gravel w/ Clay
Tight Silty Sand & Gravel
Hardpan
Tight Silty Sand & Gravel w/ Clay
Silty Sand & Gravel Water 4 GPM
Tight Silty Sand & Gravel
Sand & Gravel Water
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.
Well Drilling Permit Number: SW OSP201034 Date of Issue 3-16-20
Parcel Identification Number: 01528246000
Legal Description
Woodhaven #3 Lot 1
Pump Installation Date: 8-14-20
Pump Intake Depth Below Top of Well Casing: 150
Pump manufacturer's Name: F&W
Pump Model: 4F11P07301S
Pump Size: 3/4
Pitless Adapter Burial Depth: 10
Pitless Adapter Installer: Pomraning Excavation
Disinfected Upon Completion? ® yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer: Martinson
11 Pump Installers Name: Sullivan Water Wells
Property Owner Name & Address
Spinell Homes
feet
hp
feet
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
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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.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP201034
Work Type: WellSeptic Initial
Tax Code Number: 01528246000
Site Legal Address: WOODHAVEN #3 LT 1 G:2735
Site Mailing Address: 4141 MARCELLE CIR, Anchorage
Owner: SPINELL HOMES INC
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
3/16/2020
3/16/2021
40013
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy 2 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 (24/7).
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: Subdivision plat requires CAT III nitrogen -reducing wastewater disposal system.
Received By: Date:
Issued By:h�r'111� Date:
4
W
MUNICIPALITY C A lis AB
US
Q.: -
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
U
Parcel I.D. 015-282-46
Property owner(s) Spinell Homes Inc. Day phone _
Mailing address 1900 W. Northern Lights Blvd, #200, Anchorage AK 99517
Site address NSN Marcelle Circle .
Legal description (Sub'd., Block & Lot) Woodhaven #3, Lot 1
Legal description (Township, Range & Section)
Lot Size 40,0130 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
(® all that apply)
Absorption Field
0
Septic Tank
❑x
Holding Tank
❑
Privy
❑
Private Well
Q
Water Storage
❑
APPLICATION IS AN: TYPE OF DWELLING:
Initial I—XI Single Family (SF) 0
(w/wo ADU)
Upgrade ❑ Duplex (D) ❑
Renewal ❑ Multiple Dwellings ❑
(SF and/or D)
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.
S
f
(Signature of property owner or authorized agent)
Permit/Rush Fees: r 22.6Date of Payment: '31 a//as
Receipt Number: n'5 6 1-13-567C7
5
d
Permit No. P .®1d3q
Permit App__- : .,:c:
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201034, Rebecca Carroll, 03/16/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201034, Rebecca Carroll, 03/16/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201034, Rebecca Carroll, 03/16/20
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: WOODHAVEN SUBDIVISION No. 3
PERFORMED FOR: SPINELL HOMES
DATE: 1124113 PROJECT No.:
PARCEL IDA`: TECHNICIAN: A. HARALA
DEPTH ITEST HOLE No. 1
Iral>
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
OB/OG
SILTY GRAVEL
WITH VARYING SILT
GM/ML
F4
15 BOH @ 15'
16
17
18
19
20
WAS GROUNDWATER ENCOUNTERED? No
IF YES @WHAT DEPTH?
DEPTH TO WATER AFTER MONITORING: 3•
DATE OF MONITORING: 5/15/13
5/15/14 3'
49th /'V
MICHAEL E. ANDERSON jyyppb,,
% No. CE -4381 r'.,
SITE PLAN
SEE SITE PLAN R
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
(INCHES)
INET DROP
(INCHES)
1/24
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
9:13
1.25"
2
9:43
30
1.875"
.625"
3
9:44
1.50"
4
10:14
30
2.125"
.625"
5
10:15
1.50"
6
10:45
30
2.125"
.625"
PERCOLATION RATE: 48 (MIN/INCH) PERC. HOLE DIA.. g (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. 1, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 3/12/13
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
0
1 -
2
3
4
5
6
7
8
9
10
11-
12-
13-
14-
15-
16-
17
18-
19 -
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: WOODHAVEN SUBDIVISION No. 3
PERFORMED FOR: SPwELL HOMES
DATE: 1/25/13 PROJECT No.:
PARCEL ID#: TECHNICIAN: A. HARALA
TEST HOLE No. 2
OB/OG
SILTY SAND
WITH VARYING SILT
SLOPE
4L 49th •'
SITE PLAN
SEE SITE PIAN
E. ANDERSON
WAS GROUND WATER ENCOUNTERED?
NO
IF YES Q WHAT DEPTH?
NET TIME
(MINUTES)
WATERD
(INCHES)
NET DROP
(INCHES)
DEPTH TO WATER AFTER MONITORING:
4
1
DATE OF MONITORING:
5/15/13
.75"
5/15/14
3'
2:45
30
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
WATERD
(INCHES)
NET DROP
(INCHES)
1/25
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
2:15
.75"
2
2:45
30
2.625"
.875"
3
2:46
1.00"
4
3:16
30
1.875"
.875"
5
3:17
1.125"
6
3:47
30
2.00"
.875"
PERCOLATION RATE:34.2 (MIN/INCH) PERC. HOLE DIA. 8" (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 3/12/13
MUNICIPALITY,OF
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. 015-282-46
1. GENERAL INFORMATION
Complete legal description Woodhaven #3 L1
Location (site address) 4141 Marcelle
Current property owner(s) Spinell Homes
Mailing address
Real estate agent
2. TYPE OF DWELLING:
F-1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Expiration Date: FEJ )� ic� O Q 4
Day phone
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
F-71
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
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 Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E.
6. DSD
SIGNATURE
J System #1 Approved for __y_ bedrooms
System #2 Approved for bedrooms
Disapproved
Date
0.
.:•4....
• Steven R� 'lP'criiore•
CE 0149
Conditional approval for bedrooms, with the following stipulations:
_ Or
�n/rte .
f:g WATER AND
By: Original Certificate Date:
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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
X Nitrate Advisory
Arsenic Advisory
Other
Legal Description: Woodhaven #3 L1
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 '3 s V1712O .O
Total depth 164 ft
Cased to 164 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA new
Static water level at beginning of test 92 ft.
Comments new well
B. TANK DATA
Age of tank(s) new years
Tank type/material sep °m'
Measured operating fluid level in septic tank NA
❑ Standpipes/foundation cleanout per record drawing
Date of pumping NEW
D. ABSORPTION FIELD DATA BED
Which system tested (date installed) 4/2912020
❑ ALL standpipes present per record drawing
Total measured depth from grade 3 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: NEwvsTEM
COSA Checklist yellow sheet
Parcel ID: 015-282-46
Structure served by this system 1
Well production at time of test 30 gpm
Water storage tank volume gallons
Well disinfected for coliform test? Q Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 3.61 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L 11 Arsenic less than MRL (ND)
Collected by PES
Date of Sample 11/5/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date NEW
Results O✓ 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 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
Septic Tank/Lift Station on Lot > 00'°
'Yes
015
Community Sewer Manhole/Cleanout > 100'
Property Line > 5'
if No` ft
Q Yes
if No ft
Neighboring Tank > 100' r_71 Yes
if No ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No ft
Holding Tank > 100' R Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No ft
Animal Containment > 50' R Yes
if No ft
0 Yes
if No ft
ft
Community Wells > 200'
0 Yes if No ft
Water Service Line > 10'
Manure/Animal Excreta Storage > 100'
Yes
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'
0
Yes
if No
ft
Surface Water > 100'
[-,(] Yes if No ft
Property Line > 5'
E]
Yes
if No
ft
Wells on Adjacent Lots:
p
Absorption Field > 5'
®✓
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
ft
Yes
if No
ft
Community Wells > 200'
0 Yes if No ft
Water Service Line > 10'
F71
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'
El
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
p
Yes
if No
ft
Private Wells > 100' U Yes if No ft
Water Service Line > 10'
F
Yes
if No
ft
Community Wells > 200' Q✓ Yes if No ft
Surface Water > 100'
✓Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
,,` OF ,AL���
that / have
P
certify determined through field inspections and review
TH
of Municipal records that the above systems are in conformance with
MOA COSA in this date.
. �.
guidelines effect on
/l` q
Steven R. Pennon
CE 814
v AO'GPY i�lqu\&-
COSA Checklist yellow sheet
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of lsl1L`' %'l l of 20 Z-40, by and between
l,/ . herein the "OVTNER," and the Municipality of
Anchorage. herein the "MUNICIPALITZY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to tlus
Agreement agree as follows:
1. Advanced Wastewatez• T a•eatment SvsteYns. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as �cuvcLrrk c w1AVO-0 Qvr,.n
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, adiustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $100 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, «,hick could include sewage backup and costly repairs or drain -field
replacement.
(rev. 05/18/2018) Page I of 3
F
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
ON-vner 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
ty
AWWTS approval.
3. T•m. 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 AMTS is operational or until title is t7•ansferred.
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 Ag-eernent 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. 'Jul-isdiction: Choice of Lase. Any civil action arising frorn 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- '
B %! r signature Date:
ff
(Print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
rt, r
The foregoing instrument was aQknowledged before me thisl;, day of
20 ji, c 1.y lli'�i,:j yi (Z !ille ! J
NOTARY PUBLIC FOR ALASKgP�''G g
My Commission expires:
NOTARY
4 PUBLIC �
���llllllllllll\1\\,�
MUNICIPALITY.
By: / (signatuue) Date:
f�2CCGZ t�/d lC (In•int name) Title:
(rev. 05/18/22018) Page 3 of 3