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MUNICIPALITY OF ANCHORAGE
ment Services Department o
Development t
P p Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Well Log
Permit Number: # 231292 Date of Issue: 9-1-23 Parcel Identification Number:
Date Started: 11-1-23 Date Completed: 11-2-23 Is well located at approved pennit location? Yes 9 No ❑
Legal Description: Sky Ridge Lot 25 G:2634
Property Owner Name & Address: Hultquist Homes, Inc.
Borehole Data: Depth (ft) Method of Drilling 0 air rotary ❑ cable tool
Soil Type, Thickness & Water Strata From To
Casing type: steel
casing stick up
0
2
clay (brown) w/ gravel
2
25
gravel
25
32
moist clay (brown)
32
36
clay (brown) w/ gravel
36
50
silt & gravel
50
56
clay (grey) w/ gravel
56
59
silt & gravel
59
100
moist silt & gravel
100
140
clay (grey) w/ gravel
140
175
silt & gravel w/ H2O
175
185
coarse gravel w/ H2O
185
190
Wall Thickness: .250 inches
Diameter: 6 inches Depth: 190 feet
Liner Type:
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 78 feet
Pumping level: feet after
hours pumping gpm
Recovery Rate: 20 gpm
Method of Testing: airlift
Well Intake Opening Type:
0 Open End ❑ Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: bentonite Volume: 2 bass
Depth: 20 Start 0 feet Stopped 20 feet
Well Disinfected Upon Completion? Yes No
Method of Disinfection: tabs Comments:
Well Driller: ,Johnny Kay El El
Cotnpany: Hefty Drilling, Inc.
Mailing Address: po box 112130 Anch AK 9956
Water Sample Results:
Arsenic: /Vo ug/L
Nitrates: /vQ mg/L
Total Coliform Bacteria: !'SSG colonies/100mL
1
Attention: The well driller shall provide a well to to the t 3 / 2� 3 On -site Water and Wastewater Section within 30 days of
completion.
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________
Pump Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention:The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
OSP231292 9 1 23
Sky Ridge 25 Hultquist Homes, Inc.
11 7 23
132
Grundfos
10SQE07-240
3/4
12
Cambell SS
Hultquist
yes - Chlorine tabs
Dylan Kay
Hefty Drilling, Inc.
po Box 112130
Anch AK 99516
Lot 25, Sky Ridge Subdivision
Land Surveying
Land Development Consultants
Subdivision Specialists
Construction Surveying
124 E 7th Avenue
Anchorage, Alaska 99501
(907) 306-8104
mail@S4AK.com
AKCAN 173042
Group
S4 As Built
11/03/2023
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 System Permit
Permit Number: OSP231292
Work Type: Well Initial
Tax Code Number: 01527525000
Site Legal Address: SKY RIDGE LT 25 G:2634
Site Mailing Address: 11043 SKY RIDGE DR, Anchorage
Owner: HULTQUIST HOMES INC
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date
Expiration Date
cnt
(rte- lw-`a
C
1�rpartment
Lot Size in Sq Ft
Total Bedrooms:
9/1/2023
8/31/2024
20276
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q 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
Issued By: GC/
Date:
Date:
4
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Community Development Department `- 7 Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-275-25
Property owner(s) Hultquist Homes, Inc
Mailing address 12570 Old Seward Hig
Site address 11043Sky Ridge Drive
Day phone _
hway Anchorage, AK 99515
Legal description (Sub'd., Block & Lot) Sky Ridge Lot 25
Legal description (Township, Range & Section)
Lot Size 20,276 Sq. Ft. Number of Bedrooms
0
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑ Initial
X❑ Single Family (SF) X❑
Septic Tank ElUpgrade
1-1(w/wo ADU)
(D) El
Holding Tank ❑ Renewal
ElDuplex
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well X❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /
WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further
certify that this is in accordance with
applicable Municipal Codes.
5';2y
(Signature of property owner or authorized agent)
Permit/Rush Fees: - ) (50
Waiver Fees:
Date of Payment:
Date of Payment:
Receipt Number:
Receipt Number:
Permit No. i2_9 2,
Waiver No.
Permit App_'-'-'.
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E‐mail: steve@panengak.com
Mailing: P.O. Box 1807 Palmer, AK 99645
Telephone: (907) 745‐8200 FAX: (907) 745‐8201
29 August 2023
Municipality of Anchorage
Development Services Department
On‐Site Water & Wastewater Program
4700 Elmore Road
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Sky Ridge Lot 25
Well Permit Request
Well Design Narrative
This is a design narrative for a permit to install a private well to be issued for this property. Currently the lot is
undeveloped. This lot and the surrounding lots are to be served by public sewer. Currently there are no sewer mains
or private septic systems within 100’ of the proposed installation.
1. Initial Well Design.
The well will be located: 100’+ from any sewer main.
100’+ from any on‐site septic system.
25’+ from any private sewer lines.
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions or concerns, please contact me at (907) 745‐8200.
Sincerely,
SRP
Steven R. Pannone, PE, F. ASCE
Owner/Civil Engineer
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231292, Deb Wockenfuss, 09/01/23
FOR CONSTRUCTION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231292, Deb Wockenfuss, 09/01/23
FOR CONSTRUCTION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231292, Deb Wockenfuss, 09/01/23
Certificate of On -Site Systems Approval
Parcel I.D. 015-275-25
Legal description SKY RIDGE LT 25
Site address 11043 SKY RIDGE DR Anchorage AK
Current property owner(s) ELKIN & BYRAM
Expiration Date: 11 /3/2024
X The On -site system(s) is/are approved for 5 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 6/20/2024
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 Services 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 work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval June 2022
Development Services Department 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. 015-275-25
Complete legal description SKY RIDGE LOT 25
Location (site address) 11043 SKY RIDGE DRIVE, ANCHORAGE, AK 99507
Current property owner(s) JOSHUA ELKIN & ESTHER BYRAM — Day phone
2. ON -SITE SYSTEMS SIZED FOR 5 BEDROOMS
3. TYPE OF WATER SUPPLY: Z Private Well F Private Well serving 2 dwelling units
R Private Well serving 3+ dwelling units F] Community Well or Public
F-1 Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic E] Private Septic serving 2 dwelling units
F-1 Holding Tank Z Community Septic or Public Sewer
5. SEPTIC TANK: F-1 Steel F-1 Plastic E] Concrete M Fiberglass
Age - See advisory if steel older than 20 years
6. ABSORPTION FIELD: 0 AWWTS 0 Bed n Deep Trench n Wide Trench n Seepage Pit
Waiver request for:
Expedited review requested: El
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 $145.00 — PAID Waiver Fee $
Date of Payment 6/13/2024
COSA # OSC241195
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist
Legal Description: SKY RIDGE LOT 25 Parcel ID: 015-275-25
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) Well production at time of test 20 gpm
Date drilled 11/2/2023 Total depth 190 ft Water storage tank volume NONE gallons
Cased to 190 ft Well disinfected for coliform test? ® Yes ❑ No
® Sanitary seal is functioning correctly ® Coliform bacteria is Negative
® Wires are properly protected Nitrate mg/L ® Nitrate less than MRL (ND)
Casing height (above ground) 18+ in. Arsenic ug/L ® Arsenic less than MRL (ND)
Date of flow test for COSA NEW WELL Collected by HEFTY DRILLING Date 11/3/2023
Static water level at beginning of test 78 ft.
Comments: PER WELL LOG THIS WELL IS CAPABLE OF PRODUCING 20 GPM. SITE VISIT CONDUCTED ON 6/25/24.
TANK DATA — PUBLIC SEWER
operating fluid level in septic tank
Date of purr
❑ Required
Comments:
nance completed, if AWWTS
D. ABSORPTION FIELD DATE►,.- PUBLIC SEWER
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
Comments/Deficienci
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date
Results ❑ Pass
Fluid depth prior to test _ in
Water added _ gal
New fluid depth _ in
Elapsed time _ min
Finai'fl~uid depth _ in
FIELD STATU
Effective depth
_ gpd
POST RECOVERY
Effective depth used
Effective depth remaining
drawings) in
COSA Checklist WELL ONLY.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑ Yes if No NA ft ® Yes if No ft
Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No
Neighboring Absorption Fields > 100' 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
❑ N/A — Served by Community Well (not on lot) or Public Water
From-Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building FoundaYes if No ft Surface Water > 100' ❑ Yes if No
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
F. ENGINEER'S COMMENTS
IJ`Yes
if No ft
Wells on Adjacent Lots:
❑ Yes
if No " — eft
Private Wells > 100'
❑ Yes
if No ft
-,-Community Wells > 200'
❑ Yes
if No ft
If tank or field is under_drive
❑ Yes if No
❑ Yes if No
comment below
ft
ft
ft
ft
ft
ft
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 FIRST WATER CONSULTING Phone 907-350-9566
Engineer's Printed Name CURTIS HUFFMAN PE Date 6/25/2024
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 or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & f4i S
......... ......
�j Curtis Huffman /
f�jj�°c�•,e CE128991 �.•c4'�
! spF�•. 6/25/24•,•���
� 1rtF°
COSA Checklist WELL ONLY.docx
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-275-25
Legal description SKY RIDGE LT 25
Site address 11043 SKY RIDGE DR Anchorage AK
Current property owner(s) HULTQUIST HOMES
Expiration Date: 2 / 2 o Z 17
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 11 /17/2023
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 Services 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 work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval June 2022
;�-
Development Services Department
On -Site Water &Wastewater Section
ANCHORAGE PU5"
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 01527525
Complete legal description Sky Ridge L25
Location (site address) 11043 Sky Ridge Dr
Current property owner(s) HultquiSt Homes
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank [F] Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: 0
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 $_ / ',?0
Date of Payment [ i 1 'p z j
COSA # (:) S 3 I y Lt
Waiver Fee $
Date of Payment
Waiver #
COSA Application_ June 2022
COSA Checklist_June 2022
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. ABSORPTION 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:
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
■o Yes
if No
ft
no Yes if No ft
Neighboring Tank > 100' 0■ Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' ❑■ Yes if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' Q■ Yes if No ft
Qi Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
Q Yes if No ft
❑ N/A — Served
by Community
Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot
to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes
if No
ft
Surface Water > 100' [:]Yes if No ft
Tank to Property Line > 5' ❑ Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10' ❑ Yes
if No
ft
Private Wells > 100' _ [--]Yes if No ft
Water Main > 10' ❑ Yes
if No
ft
Community Wells > 200' ❑ Yes if No ft
Water Service Line > 10' ❑ Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
Well only COSA
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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with ADEC & MOA guidelines and regulations. The reported results describe the performance of the system
under the conditions encountered at the time of the test, and separation distances measured to readily identifiable
features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that
may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside
the control of the evaluator of this system. All systems eventually fail, and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we
cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this
report is for the sole benefit of the owner listed above.
Name of Firm Pannone Engineering Services
Engineer's Printed Name Steven R Pannone P.E., F. ASCE
COSA Checklist June 2022
Phone 907-745-8200
Date 1111412023