HomeMy WebLinkAboutTALISMAN HEIGHTS LT 1Tali"sman
40
Heights
Lot 1
#017-013-90
Municipality of Anchorage Page of 2
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: S w 9j!�O136i PID Number: 0/ '701390
Name: Phil 1<a14,Lzq
Wastewater System: 12 New ❑ Upgrade
Address; WOW l�acr�o^ SA 4AcAor',:T e 99SV3
ABSORPTION FIELD
Phone:No.
5'd Y _ 9 2ro/
of Bedrooms:
1Y
19 Deep Trench ❑ Shallow Trench ❑ Red ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating: t3
Total Depth from ,original grade:
11'g,
1's
GPD/Sq.Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
I -- allsman #t! r
2.S Ft.
910 Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
if 7
1.0 Ft.
Ft.
WELL- IS New ❑ Upgrade
Gravel width: 2 s
Numbe�of lines:
Distance sre ween lines:
•
Ft.
Ft.
Classification (Private,A.B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material: F• -6t G
Pr1 ✓et%e
Ft.
Ft.
R y G SO. Ft.
I i1 -.70.? /
Driller:
Date Drilled:
Static Water Level:
Installer: , h
- Cart's Exfcrt n
Date installed: e /
7/16/
Ft.
Yield:Pump
Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
® Septic ❑Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
f}nt:.t7o(2Tank
Capacity in gallons:
r2S6
From
Tank
Field
Station
Tank
Sewer Lines
e
Well-
Ito'
1 20'
-
-
Material: V
Skeet
Number of Co partments:
Surface-
Water
�IUO'
�I co
—
—
LIFT STATION N•A..
Lot-
-1S •
,
Size in gallons:
Manufacturer:
Line
SS
-
"Pump on" level at:
"Pump off' level at:
High water alarm at:
Foundation
Curtain
Pump Make&Model
Electrical Inspections performed by:
Drain
—
—
Remarks: km tn.t fa((ec( e.
BENCH MARK
ttA l.oI
v
Location and Description:
Nart In s puce free near welf/'
a ro✓ed erm'1/
2K fro V -a" /V ynO�{,mlxe ufilrz 4/7&^
e.,, O) ><r!^Ch
Assumed Elevation:
of S/Ta l(a w ru t/ S /tuktm. _ 4'".re-
! 00. d
,^
u,) iron no/ in a/ Amne of Se fic In,riul/ck /?on
ENGINEER'S SEAL
a
iafian 1Bc h S -c Dates: 1St 7/1G/96
/5' � �Pt
Ay a �t't y y frt° 9
Inspections performed by:
i•r Hl U•IAMHH!!N•� fit+
2nd 7116 /4
Flo rre
a •w!r' ••. •'*'�••ur.
Department of Healt d Hu7atrvices approval
"..THEODORE ^ �OORH4 t�
ce s�9 „t�
�G-�
°Yt]A/�r.�•e• i� f�6•, '
Reviewed and approved by: Date:
4;k
72-013 (Rev. 9/91) MOA 25
PERMIT NO: SW960136
PID NO:01701390
„A„
i
SWING TIES:
FROM: COR. "A" COR. "B"
TO:
WELL "C"
159'
29'
S.T. C.O. "D"
142'
141'
S.T. C.O. "E"
147'
148'
DBL. C.O. "F"
149'
151'
TR. C.O. "G"
138'
167'
TR. M.T. "H"
138'
167'
TR. C.O. T'
177'
150'
INV
a s�oapee spctpenas
1000 GALLON
SEPTIC TANK INV
T.H.#2 M.T.
BTM ELEV. 78.3
DRY 7/16/96
PROFILE VIEW
NOT TO SCALE
PAGE 2OF2
TALISMAN ROAD
„B1,
LOT 1, TALISMAN HEIGHTS
R 100'
WELL (BEING
DRILLED 8!7196)
FUTURE
4 BDRM
HOUSE
1250 GALLON
SEPTIC TANK
TBM� o „D"
"G „p„o„E” --_----- -
uw
47' LONG SOIL ABSORPTION TRENCH
WITH 9.0' SEWER GVL BELOW DIST. PIPE
PLAN VIEW
SCALE: 1” = 40'- 0"
FINAL GRADE ELEV. 97.
PIPE
BOTTOM EXCAVATION ELEV.
LOT 1, TALISMAN HEIGHTS S/D
SEPTIC SYSTEM INSTALLATION
AS -BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES SCALE: AS NOTED
14530 ECHO STREET DRAWN BY TFM
ANCHORAGE, ALASKA 99516 AUGUST, 1996
RECEIVED
DRILLING LOG SEP 41996
Municipality of Anchorage
^/ Dept. Health & Human Services
Well Owner /y/ i 1 Q �u 7"/Use of well
Location (address, legal description„ etc.) 79po 762 ll s,,; 2 01
Le, m IleA i S vZf l
Size of casing �_ inches Depth of hole 3 feet Cased to z S feet
Static water level 3 % ft. (ab= / below) land surface.
Finish of well (check one): Open End ( ✓) Screen ( ) Perforated ( ) Liner ( )
Description: 6,1e Ce v f _� $><P� l'a-S; :mss f� 25
Well pumping test at 3 Qallons per (how/ minute) for hours with 3.? -c*) ft. of drawdown
from static level.
Date of completion: Le T /2 — 9 Driller: T o k f' G'r /y4 e� a� _
WELL LOG
ground surface Give details of fannatiions penetrated. size of material, color and hardness
D 'to C.z�i -cy
2
to Clay 6-Lr� �,r� nZ-0d
/ ;,e
e 5— ' to'
'to
y8.6'to 23/
238
to
to 2y
210
to Zic,
�O
to 285
'LS5
'to
�l l�
' to 5 Zo '
520
2
to 32-
to
to
' to
,lie � r�,�� �i�<<c-Ic�..t. � y� ��� yz�1���' i�✓�z,-F��
�YriC•�'u-�•� N /.dYct.L' / G�yst.
lyeJ Yc(.�
Y YYG�wPP ',4 CrP[4YcY:(' Y2 C:>�rr- DiafPr
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW960136
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES
OWNER NAME:KALUZA, PHIL
OWNER ADDRESS:7800 TALISMAN RD
ANCHORAGE, AK 99503
PARCEL ID:01701390
LEGAL DESCRIPTION:
TALISMAN HEIGHTS LT 1
LOT SIZE: 49230 (SQ. FT.)
NUMBER. OF BEDROOMS: -4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF
i 1�YY\
DATE ISSUED: 6/21/96
EXPIRATION DATE: 6/21/97
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
DATE: CQ �oZC�q�O
DATE• 4 Z�
1
CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 May 31, 1996 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for a
permit to construct wastewater disposal facilities on Lot 1, Talisman Heights S/D, located 7800 Talisman
Road. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your
review.
The proposed system will be constructed in the vicinity of test hole # 2. As can be seen from the soil
logs for test holes #1 and #2, the deep native soil in this area is a somewhat silty gravelly sand with a
measured perc rate of 4 minutes per inch. Using a conservative soil application rate of 0.8 gpd/sq. ft.
specified in the wastewater ordinance for soils with a perc rate of 6 - 15 minutes per inch, this 4 bedroom
residence requires a total absorption area of (4 x 150)10.8 = 750 square feet. The proposed 47 foot long
trench design with 8 feet of sewer gravel below the distribution pipe has a total absorption area of 752
square feet. A construction site in the vicinity of T.H. #2 instead of T.H. #1 was chosen because of the
presence of a shallow stratum of clean sandy gravel extending down to 6.5 feet. The presence of this
highly permeable material should greatly enhance the longevity of the proposed trench, while the
underlying sandy material will ensure adequate filtration before effluent can reach any groundwater table.
The topography of the lot in the vicinity of the proposed construction slopes down towards the south at
15%.
The proposed project will have no significant impact on present or future water supply and wastewater
disposal systems serving adjacent properties, nor will it have any significant impact on reserved space -
surface and subsurface, or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
��%32ae•t.
Ted Moore, P.E.
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
JUN 3 1996
RECEIVED
\ LOT 1 STELIOS S/D
I DWELL _ lOT-2,- T-&TS/D
1,
1
` TALISMAN ROAD
1
1
,
----------------
`
4
1
1
,
'
WELL -
PROPOSED
;
WELL SITE --
- -"" ;
LOT 3, BLK. 3
1
,
ASPEN HIGHLANDS
PROPOSED
4BDRM
HOUSE
HOUSE
1
1
'
'
INSTALL 1250 GAL.
_
SEPTIC TANK ------
°
SITE FOR
° REPL.TRENCH
-
'
#2
°
-
'
f-T.H.
SEPTIC
CONSTRUCT 47' LONG #1
SYSTEM
SOIL ABSORPTION TRENCH
1
WITH 8' GRAVEL BELOW PIPE
'
1
LOT 4, BLOCK
'
LOT 1, TALISMAN HEIGHTS
ASPEN HIGHLANDS
------------
LOT 2
1
TALISMAN HTS.
1
--------------1
1
1
-
L -I -\
1
1
1
1
IL
1
___________
_
_______________________
_______
LOT 5, NULUKATAK SID
WELL
WELL
LOT 4, NULUKATAK S/D
_ -
LOT 1, TALISMAN HEIGHTS S/D
WELL AND SEPTIC SYSTEM
1
s
SITE PLAN
FLATTOP TECHNICAL SERVICES
I INCH= 50 FEET
�Y 4
14530 ECHO STREET
DRAWN BY TFM
7 si: opo - -. , •, "�
ANCHORAGE, ALASKA 99516
MAY, 1996
LOT 5, BLOCK 3
C
NOTE:
THIS IS NOT A SURVEYED PLAT.
ASPEN HIGHLANDS
v + .,-..-
+ x
ALL LOCATIONS SHOWN ARE APPROXIMATE.
FROM HOUSE
INSTALL 1250 GAL.
SEPTIC TANK
CONSTRUCT 47' LONG
SOIL ABSORPTION TRENCH -
WITH 8' GRAVEL BELOW PIPE
a6 co
2.5
SECTION "A - All
SCALE: 1" = 5'- 0"
„A„
1-000,
47
"A
M.T.
---
PLAN VIEW
SCALE: 1" = 10'- 0"
MONITOR TUBE
BACKFILL 12"
3
I 1
ORIGINAL GROUND
.TER FABRIC
4" DIA. ASTM F-810 PERF. PIPE
/2" - 2 1/2" SEWER GRAVEL
OF EXCAVATION
C.O.
DIA. ASTM D-3034
DIA. ASTM F-810 PERF. PIPE
LOT 1, TALISMAN S/D
PROPOSED SEPTIC SYSTEM
PLAN AND CROSS-SECTION
FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN
14530 ECHO STREET DRAWN BY: TFM
ANCHORAGE, AK, 99516 MAY, 1996
F(attop ?echnica(Services
14530 Echo Street, Anchorage, AK99516
Phone (90 7) 345-1355
Lot 1, Talisman Heights
7800 Talisman Road
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of installing a 1250 gallon septic tank followed by 47 lineal feet
of soil absorption trench containing 8 feet of sewer gravel.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after
the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction.
2.0 Septic Tank:
2.1 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set
level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4"
cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type,
rigid insulation.
2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and the waste
line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A
cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed
within 5 feet downstream of the septic tank.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 47 foot long trench to a depth of
11 feet below original ground level in the vicinity of test hole #2. The axis of the trench shall follow the
natural contour of the land.
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to
allow proper infiltration.
3.3 A total of 8.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 8.0 feet above the
bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing
the #200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum
of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet,
two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in
addition to the filter fabric.
3.6 The top surface of the cover material shall be raised a minimum of 12 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the
site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed
to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and
grading is complete. The septic tank requires one inspection after it is set level and the piping connected,
but prior to backfill. This inspection may be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
TEST HOLE # 1 SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: Lot 1 Talisman Heights s/D
DATE PERFORMED:
PERFORMED FOR:
DEOTu
(tE
110
SM Reddish sandy loam
GM Brown silty gravel
partly frozen
SP/SM Somewhat silty gravelly sand
Lenses of clean gravelly sand
More gravel and cobbles below 10'
GM Silty sandy gravel
Loose, dry
B.H.
SLOPE
Depth to Groundwater
Date
No roundwater
3/29/96
Monitor tube dry
5/10/96
3/29
i
Add water & start
1J a!T 9602paSpp epp'p pp
C;-
SITE
;
SITE PLAN
Date
i
i
Clock
Time
Net Time
(minutes)
Percometer
Reading
Net Dro
(inches
3/29
i
Add water & start
11:19:30
T.H T.H.
#2 #1
11:24:30
5
22
112
33
11:24:45
61
#2
11:29:45
5
22
13/8
Add water
11:30
231/2
#3
11:35
5
/R
13 8
i
113530
i
i
11:40:30
5
2218 i
1516
i
Date
Readin 9
Clock
Time
Net Time
(minutes)
Percometer
Reading
Net Dro
(inches
3/29
12" Presoak
Add water & start
11:19:30
231/2
#1
11:24:30
5
22
112
Add water
11:24:45
23 3:8
#2
11:29:45
5
22
13/8
Add water
11:30
231/2
#3
11:35
5
/R
13 8
Add water
113530
237/16
#4
11:40:30
5
2218 i
1516
u PERCOLATION RATE 4 (minutes/Inch) PERC HOLE DIAMETER 7"
TEST RUN BETWEEN 65 FTAND 7,0 FT
COMMENTS: The measured pert rate is applicable to the stratum between 4 5' and 14' below ground level.
PERFORMED BY FLATTOP TECHNICAL SERVICES. I!:r.�YCWyr,�, CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: s /3/ 196-
TEST HOLE # 2
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: Lot I Talisman Heights S/D
DATE PERFORMED:
PERFORMED FOR:
DEP
(fef
ddish sandy learn
an sandy gravel
anded particles
11 perc @ < Imin/inch
Somewhat silty
gravelly med. sand
Same as mat'l perc'ed
in T.H. #1
Gravelly silt intrusion
between 11.5' and 13'
SLOPE
15%
Depth to Groundwater Date
No roundwater
3/29/96
Monitor tube dry 5/10/96
SITE PLAN
m
M
O
rn
.................................................
0%
Date Reading
Clock
Time
Net Time
(minutes)
Percometer
Reading
Net Drop
(inches)
PERCOLATION RATE (minuteslnch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS: Trench design should be based on 1.2 d s . ft. for material between T and 18'. The sand material below 6.5 feet will provide
a sand filter below the overlying clean gravel. See log for test hole #1 for perc
ntest results applicable to this stratum.
PERFORMED BY FLATTOP TECHNICAL SERVICES. I ' /'WO+�. CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:S I3/ I9�
MUNICIPALITY
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. 017-013-90
1. GENERAL INFORMATION
Complete legal description TALISMAN HEIGHTS
Expiration Date:
Location (site address) 7800 TALISMAN ROAD, ANCHORAGE, AK 99516
Current property owner(s) CONSTANTINE & SHANNON KASHEVAROF Day phone
Mailing address
Real estate agent
7800 TALISMAN ROAD, ANCHORAGE, AK 99516
Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Private Well
Water Storage
Community Well
Public Water System
Waiver request for:
Received by:
2 (41311 SYSTEM 1 TESTED)
- 2d_ZZ
TYPE OF WASTEWATER DISPOSAL:
®
Private Septic
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 55o Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number 1 51 9 5 Receipt Number
COSA # O S C. a a 1 a 9 0 Waiver #
Distance:
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address -13030 -SUES -WAY, ANCHORAGE,—AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/15/2022
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory ��P• .
for current or future occupants or guarantee that no unseen encroachments, deficiencies or g•''.9 �rJ
discrepancies exist can be given by First Water Consulting & FWC5 ' *• 9 Pi •'* {//
.. ........ IJ
6. DSD SIGNATURE �••• "•• '•'",,!
• • Curtis Huffman
CE 128991
System #1 Approved for bedrooms �+ �``�is •-
System #2 Approved for bedrooms ��ilpROF SS NPX�4�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
�W(((((((rr
�G FffON
�r
o w
OG6q FR
=
By: Original Certificate Date: - % — 2 z
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
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
0ther S ep-4e--i e-4e--clvt tc-
Legal Description: TALISMAN HEIGHTS LOT 1 Parcel ID: 017-013-90
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
® Well log is filed with Onsite (or attached) Well production at time of test 3 gpm
Date drilled 8/12/1996 Water storage tank volume NA gallons
Totaldepth-324 ft Well disinfected for coliform test? -❑ Yes No
Cased to 25 ft ® Coliform bacteria is Negative
® Sanitary seal is functioning correctly Nitrate 6.87 mg/L ❑ Nitrate less than MRL (ND)
® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND)
Casing height (above ground) 12+ in.
Date of flow test for COSA 6/13/22y FW��
Collected b
Static water level at beginning of test 20 ft. Date of Sample 6/13/22
Comments
B. TANK DATA
Age of tank(s) 26 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 6/10/22
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/16/1996
® ALL standpipes present per record drawing
Total measured depth from grade 12.8 ft (max)
Measured depth to pipe invert from grade 3.3 ft (min)
❑ N/A - pressurized field
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments: SEE MOA TANK ADVISORY
Adequacy test date 6/13/22
Results 0 Pass For 4 bedrooms
Fluid depth prior to test 5 in
Water added 600 gal
New depth 23 in
® Monitor tubes go to bottom of effective. If not, state Elapsed time 1260 min
depth into effective MOA IR SHOWS 9' ED.
ELEVATIONS SHOW 9.5' ED APPROXIMATELY. Final fluid depth 5 in
® Code -required soil cover over field Absorption rate 600 gpd
❑ System presoaked Any rejuvenation treatment (past 12 months) N
(Required if vacant for greater than 30 days prior to
date of test) If yes, enter date
Gallons introduced gallons ME
Comments/Deficiencies: MT / CO AT GRADE. <41311 HOUSE. BUT A 4BR RATED SEPTIC SYSTEM �-=-°
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
® Yes if No ft
Septic Tank/Lift Station on Lot > 100'
Absorption Field > 5'
® Yes if No ft
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ®Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
® Yes if No ft
Property Line > 5'
® Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes if No ft
Private Wells > 100' ® Yes if No
Water Main > 10'
® Yes if No ft
Community Wells > 200' ® Yes if No _
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'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / 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.
�4 OF
•• TH
• Curtis Huffman •.'
��� �'F�j•.� CE 128991 •,•n``�i
ft
ft
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 221290
Subdivision: Talisman Heights Lot 1
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this COSA / property is 26 years old. A leaking septic tank may be a source of contamination to
the aquifer. Typical replacement costs range from $10,000 to $15,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of a 16 -year-old septic tank in failure and should be replaced.
Mailing Address P O Box 19665D *Anchorage, Alaska 99519 6650 *www muni org
7 8 3 70
•
•
•rL(`( Municipality of Anchor •e
On-Site Water and Wastewater Prog a MAY I a 2017 • ®u ti, 2
(907) 343-7904 SAFETY
ti
Certificate of On-Site Systems App Aa g L g c:ti
Parcel I.D. 017-013-90 Expiration Date: - `
1. GENERAL INFORMATION:
Complete legal description TALISMAN HEIGHTS; LOT 1
Location (site address) 7800 Talisman Dr. *Anchorage 99516
*
Current Property owner(s) Kevin Robins Day phone 297-9296
Mailing address
Real Estate Agent Barbra Michelson Day phone 230-5577
2. TYPE OF DWELLING:
Z Single Family (wfwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for. Distance:
Received by: Date: c/I Co /1 q•
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ — Waiver Fee $
Date of Payment JC/t E 111 Date of Payment
Receipt Number 01`5LI,G Receipt Number
COSA# 05CA.11 y 1 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified bymyse I�affik d hereto and as of the validation date shown below, I verifythat myinvestigation,
>� �.., ' 9
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.
Name of Firm:• Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 ff ff
Engineer's Printed Name: Jeffrey A. Garness Date: -
, •
Q�000�44�
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system oOF
in accordance with the guidelines and regulations established by the Municipality of Anchorage and Kc. .
industry practices. The reported results describe the condition of the system/s on the date/s of the 00,( .•• On
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or � `�
encroachments may exist that were not identified during the evaluation. The operational life of all wells *:• J'i ' • '* vO
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, d I O
groundwater levels (that may fluctuate during the year), quality of construction (materials and /Q VA
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary, and p- .-f("ir
V
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Vn J y G•mess.:system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of vh c �
the well or septic system. GEG makes no representation whether an alternative well or septic system 0 s ` a• �c�4
can be installed on the property in the event either of the current systems fail to perform adequately in oo
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4t\0 p,o fess `o�
perform the evaluation. Reliance upon the information provided in this report by any other person or 444O�o�a4
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
s ON-SITE
Conditional approval for bedrooms, with the followingU�it�ti�r(
WASTEVVATER
PROURAM ,
• Wim. Original Certificate Date: 6-21s -17
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10.10.12.dac
If more than 1 septic system is on the lot:
COSA Checklist#_of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description. TALISMAN HEIGHTS. LOT 1 Parcel ID: 017-013-90
A. WELL DATA
Well type PRIVATE If A. B. or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 8/12/1996 Sanitary seal (YIN) YES Wires properly protected (YIN) YES
Total depth 324 ft. Cased to 25 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 8/12/1996 4/11/2017
Static water level 37 ft. 39.2 ft
Well production 3 0 g p m. 2.3+ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 8.63 mg./L. Collected by: GEG, Ltd.
Arsenic: ND ug/L. Date of sample: 4/11/2017
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 7/16/1996
Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES
YES Depression over tank (YIN) NO High water alarm (Y/N) N/A
Foundation cleanout (YIN) p 9
Date of pumping 8/30/2016 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA I'BELOW EXISTING GRADE J
Date installed 7/16/1996 Soil rating (Cp.d./ft r fe/bdrm) 0.8 System type DEEP TRENCH
Length 47 ft. Width 2.5 ft Gravel below pipe 9.0 ft.
Total depth '12.4+ ft. Eff. absorption area 846 ft Monitoring tube YES Depression over field NO
Date of adequacy test 4/11/2017 Results (Pass/Fail) PASS For 2 bedrooms
Fluid depth in absorption field before test DRY in. Water added 554 gal. New depth—DRY in.
Elapsed Time: 0 min Final fluid depth DRY in. Absorption rate >= 300+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date -
"PER GEG FIELD MEASUREMENTS.THE MONITORING TUBE EXTENDS 9.25'BELOW THE INVERT OF THE CLEANOUT
–*THE MAXIMUM LIQUID LEVEL THROUGHOUT THE TEST WAS 6 INCHES. HOWEVER,THE FLOW WAS SLOWED DOWN
TOWARDS THE END OF THE TEST AND THE LIQUID LEVEL IN THE TRENCH DROPPED TO ZERO
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off"level at wa er alarm level at in.
- Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 1004 On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout "100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'4-
Curtain
0'+Curtain drain NONE KNOWN Wells on adjacent lots 1004
F. COMMENTS
.'• OF `, 4 a.
G. ENGINEER'S CERTIFICATION : \t--.... .•• � �//
I certifythat t have determined through field inspections and 1 9°• v��1 �.* //
9 P /
review of Municipal records that the above systems are in '• I- • ••• i
conformance with MOA COSA guidelines in effect on this ^r•• •
^-.date. s c •-y • Garn ss 'is
JEFFREY A. GARNESS /1-• C�.:79
Engineer's Printed Name •
Date ci C// +t '�OFESSI ..
•
LICENSE R111%i%„ot.'
*AECC884
(Rev 10/12/12)
•
Municipality of Anchorage•
o.i s;Irs9a;I jieiii h o
!sr_
Development Services Department
= I�;ii
;'1$11
ie:Ixil �,,1P;
Building Safety Division s,, ,
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisor
Certificate of On-Site Systems Approval # OSC 171171
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
1 of Talisman Heights subdivision. This inspection revealed a nitrate
concentration of 8.63 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
.
. 8389M
.
TALISMAN ROAD
,-
— � —— — - - - 7' —
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—S89°17'55"W 164.83
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10' UTILITY EASEMENT
— — — —
N89°26'45"E 164.83 I
I LOT 5 I LOT 4
le. /I NULAKATAK SUBD. I ff/'
�
REVISED 5,10-17,ACCED SEPTIC VENT(//
/ RECERTIFIED 4-20-17 !!��
.....
+`,
\`''
AS-BUILT NO CORNERS SET THIS DATE
At li t I ha y amity Nat I have pedormed a Mortgagees inspection
•t� "'!.,d,, of the folonong described property:Lp 1.
�P. U• �1. of
TALISMAN HEIGHTS SUBDMSION
* lag th * *0I Anchorage Recording[Petrel.Noses.and Mal dee
•
mprwm
eentf sauated Therar
eon e wtnin Ne property linea
..1. and do nal overlap or encroach on the property anapp
Fred Wala tka adjecent thereto.treat no provementa on d,property tyre
adjacent therelo encroach on the n
premises Oudot,and
•$fly•• 3255-5 = that then are no roadways.Iransmaaoon lines or otter
*4'.,• natio easements on sac properly except as encased
."••••••
hereon
SCALE: 1"-=-34 ;O +�( s\, ` Dated 22na�as,Alaska
or otinier .2ota.
EASEMENTS OF RECORD,OTHER THAN
THOSE SHOWN ON THE RECORDED FRED WALATKA 4 ASSOCIATES
cF a
• Municipality of Anchorage
Z
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-013-90
1. GENERAL INFORMATION
Complete legal description TALISMAN HEIGHTS LOT 1
Expiration Date: a- % -/4b
Location (site address) 7800 TALISMAN ROAD, ANCHORAGE, AK 99516
Current Property owner(s) Mark Mitchell & Virginia Kuebelbeck Revoc. Trust Day phone
Mailing address
Real Estate Agent
7800 TALISMAN ROAD, ANCHORAGE, AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2 (Tested for 4)
4. TYPE OF WATER SUPPLY:
Individual Well
19
Individual Water Storage
❑
Community Class_ Well
❑
Public Water System
❑
WaiverNariance request for:
Received by: l
COSA to be released
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
unless otherwise requested by the engineer.
COSA Fee $
Date of Payment 3
Receipt Number) a
COSA# 0SC1,6 1451 a
Date: 11-7-11
Waiver Fee $
Date of Payment
Receipt Number
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.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577
Engineer's Printed Name KENNETH M. DUFFUS - Date 10/3/13
Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future ' OF, <�
occupants or can ArcTerra guarantee that no unseen i L
encroachments, deficiencies or discrepancies exist. '?c� 1 1
r
C) TH
6. DSD SIGNATURE
9 KENNETH V. DUFF' r /
System #1 Approved for bedrooms.to
, �, `
System #2 Approved for bedrooms. , rho E SON' •
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
0
The
Original Certificate
DevelopmentServicesDivision (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 engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory_
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA bl asheet 10-10-12A.
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: TALISMAN HEIGHTS LOT 1 Parcel ID: 017.013.90
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID #
Date completed 81121996 Sanitary seal (Y/N) Y
Total depth 324 ft. Cased to 25 ft.
FROM WELL LOG
Date of test 8112196
Static water level 37 ft.
Well production 3 9 -
p.m -
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 6.55 mg/L
Arsenic: ND ug/L Date of sample: 912712013
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24+ in.
AT INSPECTION
912512013
ft.
H'
Collected by: ARCTERRA
Tank Type/Material SEPTIC 1 STEEL Date installed 711611996
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 9125113 Pumper Around The Clock Pumping
C. ABSORPTION FIELD DATA
Date installed 711611996 Soil rating (g.p.d./ftZ or ftZ/bdrm) 0.8 System type DEEP TRENCH
Length 47 ft. Width 2.5 ft. Gravel below pipe 9 ft.
Total depth 12.4 ft. (Measured 9125/13) Eff. absorption area 846 W Monitoring tube Y Depression over field N
Date of adequacy test 912512013 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 13 in. Water added 660 gal. New depth 17 in.
Elapsed Time: 10 min. Final fluid depth 14 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at_ in.
Datum
Size in gallons
"Pump off"level at _ in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer /septic service line 254
Animal containment areas 504
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 54
Manhole/Access (YIN)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 1001+
Public sewer manhole/cleanout 100'+
Holding tank 1004
Manure/animal excrete storage areas 100'+
Absorption field 5'+
Water main 10'+ Water service line 104 Surface water 100'+
Wells on adjacent lots 1004
ABSORPTION FIELD ON LOT TO:
Property line 104 Building foundation 1104 Water main 10'+
Water Service line 104 Surface water. 1004 Driveway, parking/vehicle storage 10'+
Curtain drain 504 (NONE KNOWN) Wells on adjacent lots 1004
F. COMMENTS
4 -bedroom system serving a 2 -bedroom residence.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review of
determined through field inspections and review of Municipal records that
inspections and review of Municipal records that the above systems are in
Municipal records that the above systems are in conformance with -MOA
above systems are in conformance with MOA COSA guidelines in effect on
conformance with MOA COSA guidelines in effect on this date.
COSA guidelines in effect on this date.
on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date
COSA brown sheet 10-10-12.doc
OF�AL� A
���,'
IA
KENNETT1�16D .y 00
17 $E
/
Y�Fk;SS 1D"��
Municipality of Anchorage
Community Development Department
Development Services Division s A E'.
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 131572
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
1 of Talisman Heights subdivision. This inspection revealed a nitrate
concentration of 6.55 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage1W
• -- Development Services Department
Building Safety Division 4
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FORA SINGLE FAMILY DWELLING ,�t�,np�
Parcel I.D. O 17 - 013 - 90 COSA # f IfW�S
h Z
1. GENERAL INFORMATION Expiration Date: 7- /0 _
Complete legal description L.ot 1� Talyw+on /f t�
Location (site address) _ 745Go Twlui»wn Rii
Current Property owner(s) _Phil 61ca l o z ek Day phone 3 V 6 - 6l'9.t-
Mailing address
Lending agency
Mailing address
7E1G0 Tilunrwn RpfA•^r--��" W' iFtc 9
I 9Sr<
Day phone
Real Estate Agent _F S ata Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup. pleoJe call Phil IT41147-Q67TY49-6693`
2. NUMBER OF BEDROOMS: wtie,) Cef.4 I,r ready p r ek -&V
3. TYPE OF WATER SUPPLY:
Individual Well 191
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
FRI
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
4. 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 Onsite 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.
Name of Firm F/aff�a %cAA;ea f Svcs Phone 3 y5'- r3sS'
Address '1115'30 EcAe 6wnMA lial� ctio'_o /5'k 995'i�
Engineer's Printed Name T1 todez' F. r-r&ore Date 3 / 7
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By:
(nw 11N5)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: !' —10-07
r ............... ..os.:.�
SIGNATURE
5. DSD
Ss.... ........:...�
Approved for L4'
.........
7HECDORE F. 140CRE
bedrooms.,i'�'•..� CE -3589
n�ti;"2
Disapproved.
0./0
Conditional approval for
bedrooms, with the following stipulatio is`: -=•.y'''
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By:
(nw 11N5)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: !' —10-07
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Ac - 1 7-o H 17 Parcel ID: of 7 -ora -90
A. WELL DATA
Well type PvIf A. B, or C provide PWSID #
Date completed 61 12/96 Sanitary seal (Y/N) Y
Total depth 3 Zy ft. Cased to 2S ft.
FROM WELL LOG
Dale of test _&//2/99'
Static water level 3 7 ft.
Well production 3 g.p.m.
WATER SAMPLE RESULTS:
Coliform _0_colonies/100 mL Nitrate 2„fo mg/L
Arsenic: ppb date of sample: I/ Sl 07
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 2 1Y in.
AT INSPECTION
3/28/iev-r
z 6 ft.
2.3 h g.p.m.
Other bacteria 0 colonies/100 mL
Collected by: F /.t!-h!o 7'ecA Cmc
Tank Type/Material Sys Date Installed 7/ / 6 / 9e
Tank size I Z5'0 gal. Number of Compartments _v Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) IV High water alarm (Y/N) Al. A,
Date of pumping 3 /3 0 / 67 Pumper
C. ABSORPTION FIELD DATA
Date installed 7//6/96 Soil rating (g.p.d./W or ft2/bdrm) 0_ 89�Odi System type Trr^c 4
Length H7 ft. Width !2-r ft. T+ Gravel below pipe 9-t� ft.
Total depth LL.L ft. Eft. absorption area Evil ft2 Monitoring tube Y Depression over field N
-7
Date of adequacy test/ 28/07 Results (Pass/Fail) Puu For 'r bedrooms
Fluid depth in absorption field before test _.a_ in. Water added gal. New depth G in.
Elapsed Time: = min. Final fluid depth _C.� in. Absorption rate >= 600' g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date M_ A.
D. LIFT STATION N• k•
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' level at _in. 'Pump off" level at _in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot I t G ' On adjacent lots > /oo
Absorption field on lot 120' On adjacent lots > 16V
Public sewer main P. A: Public sewer manhole/cleanout N• A.
Sewer /septic service line > 2S' Holding tank
Animal containment areas N. A. Manure/animal excrete storage areas N. A_
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 2t' Property line 71-" Absorption field 7
Water main N• 4. Water service line > t0' Surface water > roc '
Wells on adjacent lots > (CIO r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Ss' Building foundation H6" Water main W. .�.
Water Service line > 10' Surface water > t d v' Driveway. parkinglvehicle storage tS'
Curtain drain J1gnc neon Wells on adjacent lots
F. COMMENTS e`os,
M.r.
G. ENGINEER'S CERTIFICATION `�: �,���` d ••= L`
,•......................:... c
1 certify that I have determined through field inspections and .,
review of Municipal records that the above systems are in f•••;• """"•••'
TFK9PORE r. u�oaE : F
conformance with MOA COSA guidelines in effect on this date.�`ra '•,. 'Ct - 3509 r ;�% ,
Engineer's Printed Name Tiii�✓lo �L F. Noo rC , •?� • 1 .. r,
_
Date Mgrfet. 29 2007
COSA Fee $ Ji -no �' Waiver Fee $
Date of Paymentpp W 6
Receipt Number qe - 7 �w
(Rev. 11105)
Date of Payment
Receipt Number
SCS Ref.M
1071067001
Client Name
flattop Technical Srv.
Project Name/x
Water Samples
Client Sample ID
Lot 1, Talisman Fits
Matrix
Drinking Water
P%1 SID
0
Sample Remarks:
Parameter
Results
PQL
Metals by ICP/M3
Received Date/time
03/15/2007 14:55
Arsenic
ND
5.00
Waters Department
Total Nivatc/Nitrite-N
2.50
0.100
Microbiology Laboratory
Total Coliform
0
All Dates/fimes are Alaska Standard Time
Printed Date/Time
03/27/2007 10:14
CollectedDate/rime
03/15/2007 12:25
Received Date/time
03/15/2007 14:55
Technical Director
Stephen C. Ede
Allo%abl: Prep Amlysis
Units Method Container ID Limits Date Due Init
ug(L EP200.8
mg/L EPA 353.2
C (<10) 0321/07 0322/07 TK
D (<to)
coV100mL SM2092220 A (<I)
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PLOT PLAN _ AS BUILT _ SCALE 1"' 4& GRID 2642 Project No. ')(j -5O
�v 1731 George Bell Circle
�@I�lIDl@�1 (�o �a11�1�9 �oeyo Anchorage, Alaska 99515 (907)345-6476
1 Hereby certify that I have surveyed the following described property: -%+ 0F v �>,�
Lot I Block _� Tp.L 1SMAt t FiGICykF f` f PLUT -12 situ ` �,Sr �
A�c*oteW *u- Recording District. Alaska. and that the improvements situated �,`Q',•'•��•-,4 • * -.,-
thereon are within tLe property lines and do not encroach onto the property *.y ,•q 9T11 ls� �9
adjacent thereto, that no improvements on the property lying adjacent thereto 00% ,, .••.i * A
encroach on the surveyed premises and that There are no roadways, transmission Vit• 0
lines or other visible easements on said property except as indicated hereon. �.. .�...Q
� ?y � aan.wtn 1� Tm � A• �
Dated This the 104 Day of Ma 19 11L. at Anchorage. Alaska a
/ ' ^ '• LS - 520 (Ss►
1 .4 •.• .,: a.�l
It is the responsibility of the owner to determine the existence of any easements, �a'•• Otb,�iu,ill �.'! +y
covenants. or restrictions which do not appear on the recorded subdivision plat. ttrasa�.. ass.