HomeMy WebLinkAboutNOTICE OF OPERATION AND MAINTENANCE OF ON-SITE SEWAGE SYSTEM - OTH Recorded Documents - 9/3/2024 Return To 2215331 MASON CO WA
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24 m E puu 4�c COJ6 .
Shisl4ow. t-JA 99M,
Grantoe(s): (1) ��� NAAAX Pc !i , (2)
Grantee(s): (1) PUBLIC
Legal Description (1) 19, 3 oj� G04 L0 !' 3 '11R 3 OE S4'*1543
(Abbreviated form:i.e. lot, block, plat or section, township, range)
Assessor's Tax Parcel: (1) 2 2 1 3 2 - 4 1 --9 m A 3 3
NOTICE OF OPERATION AND MAINTENANCE OF ON-SITE SEWAGE SYSTEM
I (We)the undersigned grantor, hereby place this notice on record that the described real estate
situated in Mason County, State of Washington; to wit the described real estate is served by an
on-site sewage system that was approved and permitted on the condition that it would receive
on-going operation and maintenance to assure it would continue to function in a manner that
provides adequate treatment and disposal of sewage.
Operation and maintenance of the on-site sewage treatment and disposal system must be done
in accordance with the Mason County On-Site Standards, the Mason County Board of Health
On-Site Sewage Regulations and Washington State Administrative Code: 246.272A On-Site
Sewage Systems.
These covenants shall run with the land and shall be binding to all parties having or acquiring
any right, title, or interest in the land described herein or any part thereof, and shall inure to the
benefits of each owner thereof.
Dated on this 2 0 day of Jun-, , 202t .
Signature of Gra tor(s):
(1) Sn1 31 Page 1 of 2� S�� . (2)��II
SEP 0 3 202=', fpJ11
BY-------------
State of Washington )
County of Mason )
I, the undersigned, a Notary Public in and for the above named County and State, do hereby
certify that on this day of .1uh<, , 20 2+ ,
h"ie and. Htihazl P"nn personally appeared before me, who is known to be
signer of the above instrument, and acknowledged that he (she) (they) signed it.
GIVEN under my hand and official seal the day and year last above written.
,"I,..... Tara k dohe_c
:o o ;"JgYs''t Notary Public in and for the State of Washington,
g NOl' residing at
Aqy 'sit '>i
20rp43�e 3 My commission expires:
P�Btic
w6vyW�MNG•'
Page 2 of 2
21 June 2024 /y ^w ; >,�
To: Darin Paul /•-"^ r -
231 E Duck Cove Rd. � �r✓ ?ArV
Shelton,WA 98584
From: B-Line Construction A
2971 E Phillips Leke Rd. V
Shelton,WA 98584
RE: Replacement of drainfield for Michael &Natalie Penn at 230 E Duck Cove Rd.
Mr. Paul,
As you may know, Michael and Natalie Penn are in the process of remodeling the cabin at 240 E Duck Cove Rd. The
existing drainfield was installed in 2004. At that time, paperwork did not Indicate that the well on that property was a
community well serving 230, 231, and 240 Duck Cove Rd.The system was a repair and was a regular pressure drainfield
system.The drainfield was located 75'downslope from the well toward the lake.
o
With the remodel application, it has come to light that the well on#240 is a community well serving 3 residences(yours
and the Penn's 2lots). Due to the fact that this is a community well,the county has expressed concern that It is not
located 109 from the downslope drainfield per current WA code.The county has asked the Penns to initiate a State
Waiver Process to bring the drainfield as close to current code as possible before proceeding with the remodel.
The drainfield,while remaining in the same area,will be completely replaced and upgraded to include:
• addition of a pretreatment device that meets the highest level the stale recognizes(Treatment Level A)
• a shallower new drainfield Installation which will Increase the amount of soil under the drainfield for treatment(24"
of vertical separation under new drainfield vs. 12" of vertical separation under the old)
• double-encasement of the septic transport line where closer than 100'to the well
• recorded covenant on the title of#240 property ensuring that the system Is regularly Inspected and maintained
per County guidelines
A condition for granting the State Waiver is that you be notified of the proposed development. This package of information
constitutes that notification.
In a nutshell,the existing system is being upgraded with a superior system, at considerable expense to the Penns.The
new drainfield will be the same distance away from the well, downslope, and Include serious technological upgrades to
ensure sewage has 99%+ contaminants removed before they even enter the drainfield area.This will serve to
dramatically increase protection of the well and your water quality compared to the existing permitted system.
If you have any questions or concerns about this system upgrade, please feel free to reach out to B-Line Construction, the
Penns,or to Mason County Environmental Health.
Thank you outer trim�e\,-\--+
Toby Syrett `
Septic System Designer
B-Line Construction, Inc.
2971 E Phillips Lake Rd.
Shelton,WA 98584
360-427-0255
WO
MASON COUNTY
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
415 N 6"Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 q Belfair: (360)275-4467 ext 400 0 Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid:
Receipt Number:
Instructions
1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed.
2. Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedule.
3. Submit completed application with attachments to Mason County Public Health for review.
PART 1. Applicant/Parcel Identification
Name of Applicant Miaheel&Natalie Penn Telephone 360-426A221
Mailing Address of Applicant 230 E Duck core Rd.
City shellpn State
rI wA Zip 98584
12-digit Tax Parcel No. Z Z 3 Z 3 3
Site Address 240 E Duck Cows Rd.,Shelton,WA 995M
Subdivision Name and Lot TR3Cofrd CRwtW3 Tr3of5Pp2M3
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
❑ Location,WAC 246-272A-0210 ❑ Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines
❑ Mason County Onsite Standards ❑ Departmental Determinations
❑ Other
Description of Waiver/Appeal(Include justification, additional material may be attached.):
Applleant wishes to upgrade an existing nongratreated dralnfleld located within 75'of existing community well.Existing system
system(2004)Is not preheated(TL C)and hoe IT wemeal separation.New system will be preheated to TL A.bete 24'vmibal
separation,Is located In an area of low hydropeologlc evawptibility,will ensure ongoing system O&M with Notice to Title Covenant
aM does not further Impose on existing sanitary oanhol area.Please sea attached materials. LL��
Applicant Signature: r Date: 04 2-
J9EH Forms\Waiver-Appeal Meson ounty Local Revised 1/202017
Page I of 2
PART 3: Public Health Evaluation (Staff Use Only)
1. Type of Determination Required: Type of Onsile Waiver(if applicable)
o Appeal ❑Waiver ❑ None required ❑Class A ❑Class B ❑Class C
2. Identification of Specific Code/Standard/Determination(Include date of determination or latest Code/
Standard revision)
3. Nature of Appeal:
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board ❑ Environmental Health Manager
5. Mitigating Factors:
6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been submitted.
Staff Signature: Date:
PART 4: Determination of the Hearing Official
❑ The hearing official has determined that approval of this request will not adversely affect public health and
is hereby granted.This decision is based on the following findings and conditions:
❑ The hearing official has determined that approval of this request could potentially adversely effect public
j health and is hereby denied.This decision is based on the following findings and conditions:
Hearing Official Signature: Date:
1:\EH Funs WaivervAppeal Mason County Local Revised M012017
Page 2 of 2
On-Site Sewage Systems (Chapter 246-272A WAC)
Request for Waiver from State Regulations ,*� HEALTH
Section I. 1 (Completed by applicant)
Name:(1) Michael & Natalie Penn Local Health Jurisdiction Received (2)
(See instructions)
Address: 230 E Duck Cove Rd.
Shelton, WA 98584
Telephone: (360)426-4221
Signature:
VNNJWT911I,Ap�,�,�o
Property ld :(3) It
22132-41-90033 TR 3 C of Govt Lot 3 TR 3 of SP#2543
Section II. (Completed by applicant)
WAC Number:(4) WAC Requirement(S) Waiver sought:(6)
246-272A 0210 Drainfield &Transport line 100' Replace existing draingeid&transport line 75'from
Subsection: m pU Ic we ubliawell-witAupgraded-dfaingelda d-transport --
Table IV line.
Justification(Proposed mitigation measures):(7)
There is already a ermftted re air drainfield 75'from this well TLC with 12"vert se . Applicant wishes to
install a new upgraded drainfield (TLA with 24"ver Sep). in same area due to bld
g. footprint change.
Section III. Com leted by local health officer)
Review Criteria:(8) Additional Mitigation Measures:(9)
Comments/Conditions:(10)
Type of Waiver:(11) Class A Class D I Class C— Request DOH review before granting? Yes 71 Na
Neighbor Notification:(12) Required?Yes❑No❑ If needed,are agreements,easements,etc filed? Yes ❑No❑
Section IV. I (Completed by health officer)
This Request for Waiver from State Regulations has been reviewed according to the provisions of chapter 246-272A WAC On-Site
Sewage Systems.The review criteria applied,and the mitigation measures proposed and/or required,have been evaluated for
their ability to provide public health protection at least equal to that provided by this chapter WAC.
Denied ❑Approved/Granted—Subject to all comments,conditions and requirements noted In Sections II and III.
Local Health Officer(23) Date:
DOH 337-175 February 2024 i
Penn Well Wales lwiMcaflon Notes-page f of 6
PENN JUSTIFICATION NOTES -WELL WAIVER
Existing System
The existing drainfield is a repair system installed in 2004. The existing 3-bedroom system
• is approx 73'from the upslope public well
• has approx 12"vertical separation over restrictive glacial till
• is not pretreated (Treatment Level C)
Proposed System Upgrade
The proposed upgrade to this system is due to the owners wanting to remodel the existing home footprint to
include a garage that would encroach on the 2004 system. The owner's are proposing that in the process of
moving the drainfield to accommodate the garage, their system be upgraded to
• be 75'+from the upslope well
• have approx 24" vertical separation over restrictive glacial till
• meet Treatment Level A
Mitigation measures will include:
• Enhanced Treatment Performance
o NuWater BNR-500 with Jet UV
■ meets Treatment Level B without the add-on UV disinfection
■ will meet Treatment Level A with the add-on UV disinfection
o Shallower trench installation will maintain 24" of vertical separation with time-dosed, pressure
distribution
• Performance Assurance- Notice of Operation & Maintenance of On-Site Sewage System covenant to
be notarized and recorded on property title
• Assurance of Low Hydrogeologic Susceptibility
o This site provides significant aquifer protection due to the shallow restrictive layers (aquatards)
that prevent surface water and effluent from moving downward vertically.Well log attached.
■ restrictive layer 1: 54'thick layer of hardpan (4'to 58')
■ restrictive layer 2: 12'thick layer of blue day(116'to128')
■ restrictive layer 3: 30'thick layer of red clay& gravel (128'to 158')
■ restrictive layer 4: 53'thick layer of blue clay (167'to 220')
■ restrictive layer 5: 18'thick layer of cemented gravel (220' to 238')
Pero Weil Walvw Justification Notes-page 2 of 6
o This shows that combined, there are approximately 167'of restrictively impermeable aquatard
layers between the surface zone where the effluent will be distributed and the well intake
o Additionally, the proposed drainfield is located downslope from the existing well at an elevation
approximately 6 feet lower than the well site which means that effluent encountering the upper
restrictive layer will flow downslope and away from the well location
o Additionally, a bentonite surface seal was placed on the well casing to a depth of 18'to prevent
any surface/subsurface water contamination from migrating downward along the casing
• Extra Protection of Integrity of Pressure Sewer Transport Line
o Pressure transport line to dralnfeld will be located less than 100'from the well. Mitigation will
Include:
■ 2"transport line installed Inside 4"schedule 40 PVC casing where within 100' of existing
well
■ Line installed within casing installed with bentonite grout or casing spacers per AW WA
PVC Pipe Installation Manual M23 and with ASTM D 2774.
■ Transport line leakage tested consistent with ASTM D 2774 to 150% of design operating
pressure for 1 hour
• Maintenance of Sanitary Control Area
o The well is owned by the applicants and has 3 connections
o The applicants own 2 of the parcels connected to the system
o Notification of the 3rd connection owner to be made in writing and sent certified mail explaining
that the existing system already 75'from the well is being upgraded to meet higher levels of
vertical separation and treatment
Normal Local Waiver Class A Waiver This Site
Horizontal 100, 99'-75' 74' - 50' 75'
Setback private/public private well private well public well
well
Vertical 24" pressure 24" pressure 12" pressure 24" pressure 24" pressure
Separation in Type 3 soil in Type 3 soil in Type 3 soil in Type 3 soil w/time-dosing
in Type 3 soil
Treatment TL E TL E TL C TL B TL A:
Level Wout add on (Nu Water meets
disinfection TL B without
add-on
disinfection.
Adding Jet UV
boosts this to
TL A)
Penn Well WaiverJusaacatlon Notes-page 3 or 6
Prorrrletary 5 ri o �S
Product Name/Model
Multi-Flo FTB-0.5,FTB-0.6, FTB-0.75, FTB-1.0, FTB-1.5 ✓ ✓
Nayadlc M-6A-F/M-6, M-6A-C/M-6AC-F,M-SA-F/M-SA, M-
1050-F/M-1050A,M-1200-F/M-1200A, M-2000-F/M- ✓ ✓
2000A
NuWater 8-500 with Salcor 313 UV
NuWater BNR-500, BNR-600, BNR-750, BNR-850, BNR- ✓ ✓ ✓
1000, BNR-1500
NuWater BNR-500, BNR-600, BNR-750, BNR-850,
1000, BNR-1500with Salcor.3G UV?
246272A. 'Soil dispersal Drove t(L0 got, 1)Enhanced treatment performance
0210(4) component 75 feet from except not in
non-public well or Sail Type)
suction line
2)Performance aceumnce of treatment
system
3)Hydrogeologic susceptibility
4)Iktermimaion of any existing covenants
or easements for maintaining a sanitary
control area
la)Treatment component or sequence listed as meeting Treatment Level B.
Disinfection win not be used to achieve the fecal coliform)imit of the treatment
level The soil dispersal component maintaining at least 3 feet vertical separation,
i.c,sand filter followed by a gravity distribution SSAS with of least 3 feet of vertical
separation or by a pressure distribution SSAS with at least 2 feet of vertical
separation, A mound system with 2 feet of sand media may he allowed,if there ism
(cas(3 feet of available soil depth.
2a)Management program established which assures the on-going proper operation
and maintenance of the system.
3a)Adequate protective site specific conditions existing,such as physical settings
with low hydrogeologic susceptibility from contaminant infiltration;i.e.evidence of
confining layers and or aquitards separating potable water from the OSS treatment
zone,excessive depth to groundwater,down-gradient contaminant source,or outside
the zone of influence.
4s)Notification of proposed encroachment to the well owner if there are no existing
covenants or easements establishing a control area.
Penn Well WaiverJustlacatim Notes-Page 4 0/6
WAC Specific Item Waived Extent or Degree Mn inium Issues/Criteria to Consider
Section Waived
246.272A- Pressure sewer transport line 50 Down to 25 feet 1)Extra protection of integrity of line
0210(1) "feet fioin non-public well or 100 ir`)� within 50 feet of well
Table IV suction life
2)Performance testing of line
3)Determination of any existing
covenants or easements for maintaining a
sanitary control area
WAC Specific Item Waived Extent or Degree Minimmn IssuWCriteria to Consider'
Section Waived
246-272A- Pressure sewer transport lines .Down,to,23 feet,,.. 1)Extra protection of integrity of line
0210(1) feet hom nonpublic.well or 100 within 50 feet of well
Table IV auction line
2)Performance testing of line
3)Detennitation of any existing
covenants or easements for utaittaininc a
sanitary control area
C 0VC Penn Well Waiver Jus011cation Notes-papa 5 of 6
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em orlaaal rm evm coo.,
coo vvan
t � WATER WELL REPORT AP.D..nM Nv. ......Ixoarzmenl of ecoha
aaN cuPr-Donets
mmm c+.>_onrter.c'o> STATE OF WASHINGTON
(1) OWNER: n.m.__ Jeaea Brooke Abe .IM, 4ikQ ..aaeen..Ne,Y._LG ....821a1iDn. Hash ^.
(2) LOCATION OF WELL: iftan,XM9.n__,_........,_.."___ —_t.._.,,..._.I'.see)2-r2L—e, nn2M-w.n.
BnnOe aN ONLuce from seedon or .ubuwhwn mNOr __ _ _
(0) PROPOSED USE: Dom«Dc fV Ind.4.1 C xwimv.l CI (10) WELL LOG:
-v 4nl.LLOn Q Tmr WAI Q om.• O FaHnatwn:DeHnb•bV<alar�PM1bNE«ry We b{mbflnbt bna<lr"<W r•.bnb
Ibbw Nleknear Of ob"lf«t and IN.kind bxd wbrar<.1 I..Raft W 4.Dan
{ nraNm pm«rm<a, vruk al Iron ON.•nmo jm .vcn aho
1 (d7 TYPE OF WORK: �i me' numb«at wmt _ •w of laww<-.
3 mm snu.D _ AtATLRNL
I NIw wMl llemod; yVe G BarM�C >ftOtl TO
D<pnW Q 46« Q =Q
a.e.+enwnvb Q n.Yev,� u.NN Q 3he+ rl ay �•n .. -_-�—_0 r 41
(5) DIMENSIONS: DHm««bf w.n 6 -h -FAR_....._... -._.. _ 4 58'
mN«. Red q4X f..�Avel .
Dtmla_.......242 ._n, D.em of<aWmea wu,.,......._242__,p, — - .. ._
Red cla(tl) CONSTRUCTION DETAILS: y & gravel 10_.I u8'
Cuing imulled:...„6...._^Dla.Iron._0_.... n.Y 2�- a. gavel& Nater _
naftil 0 Dta.trba, .._.._..... a.te -___._, A. - RILe play , rL r 1.2,mt
wavw.m Dnel.crow u.ro a "r-�d axval 8I
— t:ravaf A Naker 42'
Pe>Ioradow: YY❑ N.�
T.W W poo"ll a<luq... ..._. .
$IZ$.1 PenanWm ........._ M. b> ..._. ..
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Unin M Is—a. . ..
Ditaft, ..._.__6bl Nq .....,......are. A.W ...«.,....x �..... ___
Grovel packed: Y.D x .— .r er.w:-.„...._._—
Dnv<I PYpa IRm.............................—tL I(I _------1L �
J,lfe No Q To fNl cannot _
e«.I WN 1/n_............$RmtDR1,+9 ........ o Pg
aw nr vH <NYm oao.bY Yn Q I/ r _I 1_.�_.�1r•__._.:_.._. . .
_,
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t;l PUMPI . a walling
_. �.�... -�__-_-____
w: _ aute*eshie ' _. -
OUTNwpei DcS(BN11t
(8) WATER LEVELS:
_....
awns
-
0... w.H,N emnon.b ay.__.._______. 'iF
9 WELL TESTS: arewowa N "maam-.1-1<.el
O taw«. a«v>•an«I.- W
otkna Wn.DaroP YH mN.f Yw 0wnemt... ._._... .....
tewmro w,Y n, ar.waown ear a«. WELL DRILLERS STATEMENT:
This well was d>IUed under my Iuristliction e,M this report 1:
true to the nest of my knowledge aM uhat.
awrov.q .bu tI,- wM.n No «r. wnm lamb w•aW •at twin w++l
ro.mm.e team wU YD ro w.1..w"I I NANEdIPlrfon. , ar ......%p
9e_......
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....,..._.._......_.........,.' -.. —..__....._____„._.___.____.__....__ q8¢ E ekinaon St Shelton, Mesh
........_............__.__......„....,,_... ........_.........._L.........,..'_`...._....... Add>Yo_..i2.C...,.a.. ....__...,.........................._.....,......,...,._.,.,...:..,.
_.............I----'"-..........._._..._.....__.._............. _....__...__..
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5hellot.,t t.JA°18'SfS4i I��vt.�
Grantor(s): (1) ��M- Nt�►d`FN, (2)
Grantee(s): (1) PUBLIC 11 1 _ .tp y/�
Legal Description (1) 79, 3 O� eoyT �.0'I' 3 1 �3 4 SP#2543
(Abbreviated form:i.e. lot, block,plat or section, township, range)
Assessor's Tax Parcel: (1) 2 2 1 3 2 - y 1 -9 0 0 3 3
NOTICE OF OPERATION AND MAINTENANCE OF ON-SITE SEWAGE SYSTEM
I (We)the undersigned grantor, hereby place this notice on record that the described real estate
situated in Mason County, State of Washington; to wit the described real estate Is served by an
on-site sewage system that was approved and permitted on the condition that it would receive
on-going operation and maintenance to assure it would continue to function in a manner that
provides adequate treatment and disposal of sewage.
Operation and maintenance of the on-site sewage treatment and disposal system must be done
in accordance with the Mason County On-Site Standards, the Mason County Board of Health
On-Site Sewage Regulations and Washington State Administrative Code: 246.272A On-Site
Sewage Systems.
These covenants shall run with the land and shall be binding to all parties having or acquiring
any right, title, or interest in the land described herein or any part thereof, and shall inure to the
benefits of each owner thereof.
Dated on this day of , 20_
Signature of Grantor(s):
(1) (2)
Page 1 of 2
State of Washington )
County of Mason )
I, the undersigned, a Notary Public in and for the above named County and State, do hereby
certify that on this_day of , 20_
personally appeared before me, who is known to be
signer of the above Instrument, and acknowledged that he (she) (they) signed it.
GIVEN under my hand and official seal the day and year last above written.
Notary Public in and for the State of Washington,
residing at
My commission expires:
Page 2 of 2
U.S. Postal Service'"
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Return To
1
I�1:GhgEl NAW:6— PENN
214 0 E" 61)Gk GONE Pi
Shel+ot,, WA
Grantor(s): (1) �C.�ngt, "IkT �fN, (2)
Grantee(s): (1) PUBLIC 1 _ 1 _ .p r
Legal Description (1) "1'�G 3 0� Croy} r.AT 3 1 n3 GT SP#Z,S
(Abbreviated form:i.e. lot, block,plat or section, township, range)
Assessor's Tax Parcel: (1) 2 2 1 3 2 - L( I --9 (b o 3 3
NOTICE OF OPERATION AND MAINTENANCE OF ON-SITE SEWAGE SYSTEM
I (We)the undersigned grantor, hereby place this notice on record that the described real estate
situated in Mason County, State of Washington; to wit the described real estate is served by an
on-site sewage system that was approved and permitted on the condition that it would receive
on-going operation and maintenance to assure it would continue to function in a manner that
provides adequate treatment and disposal of sewage.
Operation and maintenance of the on-site sewage treatment and disposal system must be done
in accordance with the Mason County On-Site Standards, the Mason County Board of Health
On-Site Sewage Regulations and Washington State Administrative Code: 246.272A On-Site
Sewage Systems.
These covenants shall run with the land and shall be binding to all parties having or acquiring
any right, title, or interest in the land described herein or any part thereof, and shall inure to the
benefits of each owner thereof.
Dated on this',(L day of Ju n-e , 20')C4 .
Signature of Gra tor(s):
(1) o (2)
Page 1 of 2
State of Washington )
County of Mason )
I, the undersigned, a Notary Public in and for the above named County and State, do hereby
certify that on this day of 3411C , 20_94� ,
gpowic and. NILHn[GI penis personally appeared before me, who is known to be
signer of the above instrument, and acknowledged that he (she) (they) signed it.
GIVEN under my hand and official seal the day and year last above written.
„.... nn� 1 OA-, A- &N\e
- PWAA.J' •"`
Notary Public in and for the State of Washington,
p ; NOigRY m 5_ residing at A
ZOrpg3je My commission expires:
• y:, Pf/aUC a
•6 an pl't'ASH1N�'•d•
Page 2 of 2