HomeMy WebLinkAboutMALNARICK LT 1Onsite File
Malnarick
Lot 1
#012-161-07
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201030 PID Number: 012-161-07
Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade
Name
Tal & Lydia Malnarick
ABSORPTION FIELD
01 Deep Trench El Wide Trench 171 Bed El Mound
Site Address
2609 Strawberry Road
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-227-9708
5
1.2 GPD/SF
9.3 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.3 Ft.
Gravel depth beneath pipe
7.0 Ft.
Subdivision Block Lot
Malnarick 1
Fill added above original grade
4..2 Ft.
Gravel length
45 Ft.
Township Range Section
Gravel width
3 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
TolTotal
Septic
Absorption
Holding
Sewer
absorption area
Number of trenches
Dist. between trenches
From Tank
Lift Station
Field
I Tank
Line
630 Ft2
Ft.
Well >100'
> 100, N/A
N/A
' >25'
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
1,530 Gal.
Surface Water >1
> 100' N/A
N/AInfiltrator
Material
Number of compartments
i
Lot Line ! >5'
>10' I N/A
N/A
NA
Plastic
2
f f
Foundation > 10
, , >1 0N/AN/A
LIFT STATION
Manufacturer
Capacity
Remarks 2" insulation over septic tank.
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Wilco Contractors
grainfield D3034 CO/MTD3034
Inspector L. Tidwell / J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspection151 3/6/20 3/9/20
d
Location and description
dates:2
Top of foundation.
aro 4th
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
® OF A,4
Conditional Approval: Date
���P°°°°°° ° S �0
�. th
..49
°.....° .. .®
%,�"" MICHAEL E.�ANDERSON.a 4 ffi
°
�® s° No. CE-4381°• �`"
6/2/20
�����
Septic System
Approved Date 7 Ld20
Fc ...............
�yP�®�
®�NOVI%®®��
Note: this approval does not include well permit requirements.
trcev uoluznu/
// // // // // // // // // // // // // // // // // // // // // // // // // // 105100 95FCO
100500
FEET
1"=50'
4-BDRM HOME
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH#1
PERMIT # OSP201030 PID # 012-161-07
MALNARICK, LOT 1
A B
FCO 3.75
MH1 15.2
SV1 23.6
A B
2CO 28.25
CO1 50.85
MT 50.8
CO2 47.65
27.35
33.4
39.05
42.8
70.4
69.75
45.15
STRAWBERRY ROAD
6/30/20 ARLENE STREET20' UTILITY EASEMENT
BUILDING SETBACK LINES
PT#2EXISTING
ALTERNATE SITE
45' LONG x 3' WIDE x 7'
EFFECTIVE DEPTH
ABSORPTION TRENCH
1,500 GALLON SEPTIC
TANK w/20" MANWAY
MH1
SV1
2CO
CO2
MT
CO1 EXISTING SEPTIC AREA
PUBLIC WATER
SERVICE LINE.
PLAN AS-BUILT
1[9li[:1
LOT 6
30
F
LOT 5
30'
24'
LOT 4
o� 0 r
P 0�
9TH •.7*
�..:........... ..............
�OCD Thomas H. Dr er
Q4s� LS -7625 G
4A�-o fessiono� �GooO
24'
L
0
N
LOT 14812 LOT 15A13
N90°00'00"E 170.00'(R)
Co
ss
LOT 1
38,141 S.F.
8 s
F4. O'�,, L13. o0L
D'
N
Cq
21.0' o
8.0' Existing c� LOT 2
House U-)
o O
0 M 17
N o 18.0'
25.0' 4
r-23.0' 10.0' PO..... r�
N90°00'00"W 94.00'(R) Proposed
Paved O
O
Drive cn
0
0
0
0
6
Ln
w
BK422 PG38
0
0
z
20' UTIL TY ESMT.
41
N90°00'00"W 75.97'(R)
0 0
O r 7
("I
Strawberry Road
Notes:
1. Steps, and Concrete walk not built at this time
2. Connected to AWWU Water
3. Record Per Plat 68-116 (R)
Ordered by: Tal Malnarick Legend:
Legal Description: ASbu><lt Set Rebar with Cap 0
AL. Monument
Found Rebar Qi
Lot 1, Septic Manhole
Malnarick Subdivision Septic o
Well
Pavement
Survey Certification: I hereby certify that a Mortgagee's
Inspection was performed on the described property.
Overhang
• •• •
Notes: It is the owner's responsibility to determine the
Wood Deck
• • • •'
existence of any easements, covenants, or restriction
• • •
which are not on the recorded subdivision plat. This
Concrete
asbuilt shall not be used for construction or for
•
establishing property lines.
Fence
—x x—
Checked by: THD
Drawn by: TM
Scale 1" = 40'
Grid
SW2127
•
Job 2020-0001
Field Book: 139
Plat 68-116
Date:
7/03/2020
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: OSP201030 Effective Date:
W—W t
Work Type: VkqlSeptic Initial Expiration Date:
Tax Code Number: 01216107000
Site Legal Address: MALNARICK LT 1 G:2127
Site Mailing Address: 2631 STRAWBERRY RD, Anchorage
Owner: MALNARICK TAL 50% &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Q Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy
�0ent
V r
Depai'Cillent
3/2/2020
3/2/2021
Lot Size in Sq Ft: 35250
Total Bedrooms: 5
El 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
C-0 RQA,l se -�o � UJO LL (Y- Y,\,
S/III7.AZo
Received By: In Date: 11
Issued By: %�, I Date: a
S
Epows
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 012-161-07
Property owner(s) Tal & Lydia Malnarick Day phone 227-9708
Mailinq address 2609 Strawberry Road Anchorage, AK 99502
Site address NHN Strawberry Road Anchorage, AK
Legal description (Sub'd., Block & Lot) Malnarick, Lot 1
Legal description (Township, Range & Section)
Lot Size 353250 Sq. Ft. Number of Bedrooms Five (5)
I
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply) f
Absorption Field ❑X Initial R Single Family (SF) ❑X
(w/wo ADU)
Septic Tank Q Upgrade ❑ Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST, FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
s
Permit/Rush Fees: <$Z25 we eec rnkre h
�a �/ Waiver Fees: r
Date of Payment: �'1 �o�o`ZD Date of Payment:
Receipt Number: 3/J Receipt Number:
Permit No. �Sp� (���Q Waiver No. f
Permit App_-'-:- •�. c
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
February 26, 2020
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Subject: Malnarick, Lot 1 – NHN Strawberry Road
Septic System Design
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 4-bedroom home on the property. He has requested
the septic system be design for five-bedrooms. We are submitting this permit application for the
construction of a new well and septic system. The attached site plan identifies the location of the
home and the proposed well, septic location and alternate site. No conflicts exist between this
proposed system and any other well or septic system on this lot or adjacent lots.
The ground surface on the lot has no slopes greater than 25% within 50’ of the absorption trench.
Ground contours are shown on the site plan indicating the grade and direction of flow. Storm water
drainage will not impact this septic system. The new trenches will be constructed parallel to the
slope as much as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank.
Please refer to the attached test hole logs and plan and profile sheets for the septic design. If this
design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Michael E. Anderson, P.E.
2/26/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201030, Rebecca Carroll, 03/02/20
MALNARICK, LOT 1
LOT 16
LOT 141312 —LOT -15A13
ALTERNATE _SITE
BUILDING SETBACK LINES
45' LONG x TWIDE x 7'
MT CO EF_FECTIVEDEPTH
"ABSORPTION TRACH
LJJ PTO I (b
LOT a Lti EXISTING CO TH#1 EXISTING\SEPTICAREA
-260—
01, sv
w
MH
1,500 GALLOEPTIC
Lu FCO SEPTIC
w/20" MANWAY\
41;8q�M ME
k -i
'LOT, 5 -
PUBLIC WATER
T
SERVICE LINE.
4
20' UTILITY EASEMENT
-- — — — — — — — — — —
— — — — — — — — — —
STRAWBERRY ROAD
ENGINEERING NOTE.
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 1001 OF THE
OF
................ PROPOSED SEPTIC SYSTEM LEGEND
CO - CLEANOUT
2CO -DOUBLE CLEANOUT
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
• 49th . . I&. * FCO - FOUNDATION CLEANOUT
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
I . ..........................•......... . SYSTEMS. FS - FLOW SPLITTER VALVE
%MICHAEL E. ANDERSON
j,-,vff 0 50 100 MH -MANHOLE
No CE -4381 AV
MT -MONITORING TUBE
00 F 3110/20 FEET o ................ SV - SEPTIC VENT
4%
FESS\ 1"=50'
Itl TZA %a TH -TEST HOLE
MALNARICK, LOT 1
DESIGN FACTORS: SYSTEM REQUIREMENTS:
750 GPD PEAK FLOW
PERK RATE: <1 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
7' DEEP TRENCH SYSTEM
1,500-GAL SEPTIC TANK
TYPICAL TRENCH SECTION
(NO SCALE)
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
3'
6"
6"
3'
7'
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 10.5' BELOW GRADE
FLOW LINE ELEVATION: 3.5' BELOW GRADE
TOP OF TRENCH: .5' ABOVE GRADE
750 GPD / 1.2 GPD/SF / 7' DEEP / 2 SIDES = 44.6 LF TRENCH REQUIRED (45 LF SPECIFIED)
2/24/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201030, Rebecca Carroll, 03/02/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 1
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
Malnarick lot 1
2/13/2020
J. Millette
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
1.02 6
3 4
012-161-07
Tal Malnarick
10:151
2
3
4
5
6
6" / 12"
10:22
10:30
10:37
10:45
10:52
OB
Professional Engineers Stamp:
2/24/20
6m 10s
NO
NONE
2/23/20
SW/SM
6"
6" / 12"6m 08s 6"
6" / 12"6m 11s 6"
6" / 12"6m 10s 6"
6" / 12"6m 10s 6"
6" / 12"6m 08s 6"
Measurements were taken to the 1/16th inch.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201030, Rebecca Carroll, 03/02/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
PERK #2
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
Malnarick lot 1
2/13/2020
J. Millette
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?-
0.76 6
3 4
012-161-07
Tal Malnarick
10:571
2
3
4
5
6
6" / 12"
11:02
11:08
11:13
11:18
11:24
Professional Engineers Stamp:
2/24/20
4m 35s
-
-
6"
6" / 12"4m 25s 6"
6" / 12"4m 30s 6"
6" / 12"4m 31s 6"
6" / 12"4m 30s 6"
6" / 12"4m 32s 6"
-
Sample taken & submitted for gradation 2/13/2020
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201030, Rebecca Carroll, 03/02/20
NORTHERN GEOTECHNICAL ENGINEERING, INC. / TERRA FIRMA TESTING
PROJECT CLIENT:
Forge Engineering
PROJECT NAME:
Malnericic Lot I
PROJECT NO.:
5665-20
SAMPLE LOC.:
Lot 1
NUMBER/ DEPTH:
ASTM D1557 (uncorrected)
DESCRIPTION:
Poorly -graded sand
DATE, RECEIVED:
2/13/2020
TESTED BY:
JA
REVIEWED BY:
RJPC
100
90
80
70
60
50
ami 40
30
w 20
10
0
145
140
120
115
% GRAVEL 0.0
% SAND 97.6
%SILT/CLAY 2.4
%MOIST. CONTENT 5.2
USCS
USACOE FC
%PASS. 0.02 mm
%PASS. 0.002 mm
SP
N/A
N/A
N/A
UNIFORMITY COEFFICIENT (C,,)
2.6
COEFFICIENT OF GRADATION (C°)
1.0
ASTM D1557 (uncorrected)
N/A
ASTM D4718 (corrected)
N/A
OPTIMUM MOIST. CONTENT. (corrected) N/A
3/4"
PARTICLE SIZE ANALYSIS ASTM D422 / C136
II S, SIEVF. ppF.NMCINMCNFS I LLS. SIGVGNU�OERS 1 NYURUUGiEX
100 10 1 0.1 0.01 0.001
GRAIN SIZE (mm)
GRAVEL SAND
CO6nLEs SILT or CLAY
Coarse Fme Coarse Medium Pme
MOISTURE -DENSITY RELATIONSHIP ASTM D1 557
0 2 4 6 8 10 12 14 16
MOISTURE CON'T'ENT (V.)
SIEVE ANALYSIS RESULT
SIEVE
SIZE(mm)
SIEVE
SIZE (JR)
TO'T'AL% SPECIFICATION
PASSING (A PASSING)
N/A
(ASTM D2434)
152.40
6'
76.20
3"
38.10
1.5"
19.00
3/4"
12.70
1/2"
9.50
3/8"
4.75
#4
100
2.00
410
100
0.85
#20
99
0.43
#40
88
0.25
#60
58
0.15
#100
24
0.075
#200
2.4
HYDROMETER RESULT
ELAPSED DIAMETER TOTAL%
TIME noun (Inm) PASSING
0
0.5
2
4
8
15
30
60
250
1440
HYDRAULIC COND.
N/A
(ASTM D2434)
DEGRADATION
N/A
(ATM T-313)
PLASTICITY INDEX
N/A
ASTM 4318
The testing services reported herein have been performed to recognized industry standards, unless otherwise noted. No other warranty is made. Should engineering
interpretation or opinion be required, NGE-TFT will provide upon written request.
11301 Olive Lane - Anchorage, Alaska 99515 Phone: 907-344-5934 Fax: 907-344-5993 Ivwu,.nge-tft.com
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
11)�On-Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC261268
Parcel ID 012-161-07
Legal description MALNARICK LT 1
Site address 2631 STRAWBERRY RD
Expiration Date: f 2 z_C, Z�,fc
Current property owner(s) MALNARICK TAL 50% &
X The On -site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
By: Curtis Townsend
Original Certificate Date
7/24/2026
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
I\'
Development Services Department 1 Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 012-161-07
Complete legal description Malnarick Lot 1
Location (site address) 2631 Strawberry Road, Anchorage, AK 99502
Current property owner(s) Tal Marnarick
2. ON -SITE SYSTEMS SIZED FOR 5 BEDROOMS
Day phone 907-227-9708
3. TYPE OF WATER SUPPLY: ❑ Private Well serving # dwelling units
❑ Other Non-public well as regulated by MOA ❑ Water Storage
❑ Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass
Age 6 - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $ ( O r>
Date of PaymentI
COSA # b S G 6 (�-
Waiver Fee $
Date of Payment
Waiver #
COSA Application_Apr2025.doc
COSA Checklist_May2025.docx
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D.DISPOSAL FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_May2025.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Disposal Field on Lot > 100’ Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10’ Yes if No ft
Field to Foundation > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
G.CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date
In conducting this evaluation, FGES provided an engineering assessment of the well and/or septic system in
accordance with industry practices and regulations established by the Municipality of Anchorage. The
reported findings reflect the condition of the system(s) solely on the date(s) of evaluation. Separation
distances were measured to readily identifiable, visible features; hidden defects, unmarked utilities, or
unknown encroachments may exist that were not identified during this assessment.
The operational lifespan of any well or septic system depends on numerous variable factors beyond the
control of FGES, including but not limited to: localized soil conditions, seasonal groundwater fluctuations,
quality of original construction, and residential water usage habits. Satisfactory test results at the time of
evaluation do not guarantee future performance. Furthermore, FGES makes no representation or guarantee
as to whether a code-compliant alternative well or septic system can be successfully installed on the
property in the event the current system(s) fail in the future.
The content, findings, and conclusions within this report are prepared for the sole and exclusive benefit of
the client who retained FGES for this scope of work. Reliance upon this report by any third party—including
subsequent property buyers-is strictly unauthorized and confers no legal rights or privity whatsoever.