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Pump Installation Log
Well Drilling Permit Number: OSP 241023 Date of Issue 3/22/24
Parcel Identification Number: 01527515000
Legal Description Property Owner Name & Address
Sky Ridge LT 15 Hultquist Homes
11088 Sky Ridge Dr.
Anchorage, AK 99516
Pump Installation Date:
3/21/2024
Pump Intake Depth Below Top of Well Casing:
212 feet
Pump manufacturer’s Name:
Grundfos
Pump Model:
10SQE07-240
Pump Size:
3/4 hp
Pitless Adapter Burial Depth:
12 feet
Pitless Adapter Installer:
Hultquist Homes
Disinfected Upon Completion?
yes no
Method of Disinfection:
Chlorine 50 PPM
Comments:
Pitless Manufacturer: Martinson
Pump Installers Name:
Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Certified Drilling Log
OWNER OF LAND: Hultquist Homes
ADDRESS: 11088 Sky Ridge Drive. Anchorage, AK 99516
LEGAL DESCRIPTION SKY RIDGE LOT 15
DATE: 3/22/24
PERMIT NUMBER: OSP241023 DATE OF ISSUE: 3/22/24
TAX IDENTIFICATION NUMBER 01527515000
Is well located at approved permit location: Yes No
Method of Drilling: air rotary cable tool
Depth of Well: 224’
Casing Type: Steel Wall thickness .250 inches
Diameter: 6 inches, depth 224 feet
Liner type
Static Water Level: 86 feet
Recovery Rate 15 gpm gph
Method of Testing Air
Well Intake Opening Type: open end open hole
Screened Start feet Stopped
Perforations Start feet Stopped
Grout Type: Bentonite Volume: 100 lbs.
Depth: from 2 feet, to 42 feet
Well Disinfected Upon Completion: yes no
Method of Disinfection: Chlorine 50 PPM
Comments:
Bore Hole Data
Depth
From To
0 2 Casing Stickup
2 4 Overburden
4 15 Gravel
15 18 Sand
18 38 Silt and gravel
38 50 Gravel/Silt
50 55 Silt
55 58 Silt/Clay
58 70 Silt
70 78 Silt some gravel
78 93 Silty sand
93 105 Silt some gravel
105 118 Silt/Gravel
118 138 Silt clay some gravel
138 158 Silt some gravel
158 178 Silty sand some gravel
178 224 Silt/Gravel
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
MatSu Borough: Department of Environmental Conservation.
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: OSP241023
Work Type: Well Initial
Tax Code Number: 01527515000
Site Legal Address: SKY RIDGE LT 15 G:2634
Site Mailing Address: 11088 SKY RIDGE DR, Anchorage
Owner: HULTQUIST HOMES INC
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date:
`S'
V �
l
)�eI)aYtnicnt
Lot Size in Sq Ft:
Total Bedrooms:
3/22/2024
3/22/2025
20120
❑ 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
Received By: S `A�ja t/- tS Date:
Issued By: Date: 5 ZZ-'70 2 `/
4
d
hOUNICIPALITY 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. 015-275-15
Property owner(s) HUltquist Homes, Inc. Day phone _
Mailing address 12570 Old Seward Highway Anchorage, AK 99515
Site address NHN Sky Ridge Drive
Legal description (Sub'd., Block & Lot) Sky Ridge Lot 15
Legal description (Township, Range & Section)
Lot Size 20,120 Sq. Ft. Number of Bedrooms
M
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field ❑ Initial X❑
Single Family (SF) X❑
Septic Tank ❑ Upgrade ❑
(w/wo ADU)
Duplex (D) ❑
Holding Tank El Renewal El
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.
Is �P
(Signature of property owner or authorized agent)
Permit/Rush Fees: Z Z 5-
Date of Payment: 2- Ae _ `1
Receipt Number: 614 1 (5-
Permit No. 050 Z % 42
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Permit App_ - : . _.,:c
r �>
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
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 15
Well Permit Request
Well Design Narrative
Municipality of Anchorage
On -site Water and Wastewater
REVIEWED FOR CODE COMPUANC
OSP241023, Curtis Townsend, 03/26
26 February 2024
This is a design narrative for a permit to install a private well 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,
S F�__P
Steven R. Pannone, PE, F. ASCE
Owner/Civil Engineer
Mailing: P.O. Box 1807 Palmer, AK 99645
Telephone: (907) 745-8200 FAX: (907) 745-8201
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Lot 15,
Sky Ridge Subdivision
As Built
Land Surveying
Land Development Consultants
Subdivision Specialists
Construction Surveying
AEC# 173042
S4
Group
124 E 7th Avenue
Anchorage, Alaska 99501
(907) 306-8104
mail@S4AK.com
08/15/2024
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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:
COSA Checklist_June 2022
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’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/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 Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 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 > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private 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.
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
Phone
Engineer’s Printed Name
Date
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: OSP 241023 Date of Issue 3/22/24
Parcel Identification Number: 01527515000
Legal Description Property Owner Name & Address
Sky Ridge LT 15 Hultquist Homes
11088 Sky Ridge Dr.
Anchorage, AK 99516
Pump Installation Date:
3/21/2024
Pump Intake Depth Below Top of Well Casing:
212 feet
Pump manufacturer’s Name:
Grundfos
Pump Model:
10SQE07-240
Pump Size:
3/4 hp
Pitless Adapter Burial Depth:
12 feet
Pitless Adapter Installer:
Hultquist Homes
Disinfected Upon Completion?
yes no
Method of Disinfection:
Chlorine 50 PPM
Comments:
Pitless Manufacturer: Martinson
Pump Installers Name:
Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Certified Drilling Log
OWNER OF LAND: Hultquist Homes
ADDRESS: 11088 Sky Ridge Drive. Anchorage, AK 99516
LEGAL DESCRIPTION SKY RIDGE LOT 15
DATE: 3/22/24
PERMIT NUMBER: OSP241023 DATE OF ISSUE: 3/22/24
TAX IDENTIFICATION NUMBER 01527515000
Is well located at approved permit location: Yes No
Method of Drilling: air rotary cable tool
Depth of Well: 224’
Casing Type: Steel Wall thickness .250 inches
Diameter: 6 inches, depth 224 feet
Liner type
Static Water Level: 86 feet
Recovery Rate 15 gpm gph
Method of Testing Air
Well Intake Opening Type: open end open hole
Screened Start feet Stopped
Perforations Start feet Stopped
Grout Type: Bentonite Volume: 100 lbs.
Depth: from 2 feet, to 42 feet
Well Disinfected Upon Completion: yes no
Method of Disinfection: Chlorine 50 PPM
Comments:
Bore Hole Data
Depth
From To
0 2 Casing Stickup
2 4 Overburden
4 15 Gravel
15 18 Sand
18 38 Silt and gravel
38 50 Gravel/Silt
50 55 Silt
55 58 Silt/Clay
58 70 Silt
70 78 Silt some gravel
78 93 Silty sand
93 105 Silt some gravel
105 118 Silt/Gravel
118 138 Silt clay some gravel
138 158 Silt some gravel
158 178 Silty sand some gravel
178 224 Silt/Gravel
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
MatSu Borough: Department of Environmental Conservation.
Lot 15,
Sky Ridge Subdivision
As Built
Land Surveying
Land Development Consultants
Subdivision Specialists
Construction Surveying
AEC# 173042
S4
Group
124 E 7th Avenue
Anchorage, Alaska 99501
(907) 306-8104
mail@S4AK.com
08/15/2024
